Thursday, August 30, 2018

NHIS puts individual market angst in perspective

The Kaiser Family Foundation reports that individual market enrollment dropped by about 2 million from the first quarter of 2017 to the first quarter of 2018. Medicaid/CHIP enrollment is down by about 1 million in the same period, to 73.8 million in April of this year (preliminary count*).

Together those reported drops, if accurate, would account for about 1% of the U.S. population under age 65.  Yet according to the preliminary results of the National Health Interview Survey (NHIS) for the first quarter of 2018, released this week, the uninsured population has not changed significantly since 2017.  In fact, the percentage of the total population that is uninsured has downticked from 9.1% to 8.8%, and among the under-65 population from 10.7% to 10.3%, though those changes are not deemed statistically significant.

These facts should serve to remind us that only about 5% of the population is insured through the individual market, though any of us may need to fall back on it at any given time, and the availability of affordable, comprehensive insurance in the market is an important component of lifetime financial security, until/unless the individual market is replaced by a public program. Further, the net increase in Medicaid enrollment since 2013 triggered by the ACA Medicaid expansion -- 16 million -- is bigger than the entire individual market.

Still, with Medicaid and individual market enrollment down, it's worth at least tentatively speculating why the total insured population would seem to be flat-to-up. With the unemployment rate down to 4%, perhaps employer-sponsored insurance is taking up the slack.  In the under-65 population,  private insurance, which is mostly employer-sponsored, is reported up .4%, matching the drop in the uninsured percentage.  That's not statistically significant, but it's directionally plausible. Similarly, for the population of all ages, public health coverage is up .4%, whereas for the 18-64 population it's marginally down. Perhaps that reflects that a higher percentage of the population is over age 65.**

Update, 9/12/18: The Census Bureau released new health insurance stats from the Current Population Survey and American Community Survey today. In 2017, the percentage of the population insured through Medicare rose 0.6%. Aging of the population into Medicare could largely offset apparent individual market and Medicaid enrollment losses.

* on, I cannot get an updated tally for recent months.  The April 2018 count is about 1.2 million below the updated count for April 2017 and about 760,000 below the preliminary count for that month.

** The NHIS also shows public insurance up .6% among children -- whereas reports the number of children enrolled in Medicaid/CHIP as essentially flat from April 2017 to April 2018.

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