Uninsured rate remains stable even as incomes drop

Washington -- The percentage of uninsured Americans stabilized in 2010, despite a continued decline in employer-based insurance coverage, a decrease in median income and an increase in the poverty rate.

The number of uninsured Americans grew by nearly 1 million between 2009 and 2010 to reach 49.9 million. But the percentage of uninsured people increased by only 0.2 percentage points to reach 16.3% -- not a statistically significant hike, according to the report, released Sept. 13 by the U.S. Census Bureau.

The lack of a significant increase in the uninsured rate surprised some experts at first, given sluggish economic growth in 2010. But upon further reflection, the estimate makes sense, because the unemployment rate did not change much between 2009 and 2010, according to Peter Cunningham, PhD. He's director of quantitative research at the Center for Studying Health System Change, a research group in Washington.

"While things didn't get any better, they didn't get any worse," Cunningham said. Still, many people -- especially in low-income families -- lost private health coverage since the economic recession that occurred between December 2007 and June 2009. "It's important not to get too caught up in just the one-year change."

The long-term move away from work-based coverage continued, according to the report. The number of people with employer-based health insurance decreased by 1.5 million to reach 169.3 million. The drop was offset by a gain in public health coverage of 1.8 million to reach 95 million.

The bureau's report also highlighted a coverage trend possibly driven by the health system reform law. A net of 500,000 adults between ages 18 and 26 gained health coverage between 2009 and 2010, bucking the overall trend in most other age brackets. That could be due partly to a provision in the health reform law allowing dependent young adults to remain on their parents' health coverage.

"I could imagine [the provision] had some impact," Cunningham said. But a more detailed examination is needed before this conclusion can be confirmed, he said.

More certain, Cunningham said, was the safety net provided by Medicaid and the Children's Health Insurance Program for people who lost other health insurance since the recession began. Provisions in the 2009 stimulus package and the health system reform law prevented states from rolling back Medicaid and CHIP eligibility.

The uninsured rate held steady despite a decline in median household income of more than $1,100 in 2010 to reach $49,445. In addition, 2.6 million more people fell under the federal poverty level, for a total of 46.2 million. The overall poverty rate in 2010 increased to 15.1%, a 0.8 percentage point hike.

The report also found more elderly uninsured. The population of uninsured people over 65 increased by 150,000 in 2010 to reach about 800,000. About 7% of the elderly population is not enrolled in Medicare, said John Holahan, PhD, director of the Urban Institute's Health Policy Research Center. "They tend to be people who have never had the work history to be eligible," he said. Others could be immigrant parents who also are ineligible for Medicare.

The Census Bureau adopted a more conservative formula for estimating the number of uninsured in 2010. Some people do not answer the survey insurance status questions, so the bureau estimates their likely answers. Formula adjustments this year produced a lower uninsured population estimate for 2010 and revisions for previous years. For example, the bureau last year initially reported 50.7 million uninsured in 2009, but it since has revised that estimate downward to 49 million.

"The Census has been worried for a number of years that they're missing people who do have coverage," Holahan said.