Drop in low income uninsured is partly due to drop in low income population

In 2015, I noted that Democrats had paid in political blood for devising a health reform scheme that primarily benefited people in the lower third of the national income distribution  (those with incomes below 200% of the Federal Poverty level), where more than half of the country's uninsured were concentrated pre-ACA.

Chance led me this morning to take a bird's eye view of how the income distribution of the uninsured changed from 2013 (pre-ACA) to 2017. This snapshot is based on the Census Bureau's annual September report, Health Insurance Coverage in the United States, for 2014 and 2017.

The percentage of the uninsured in the lowest income brackets has shrunk considerably. But that's in part because the percentage of the total population in those brackets has also shrunk.  In 2013, 39% of the population and 59% of the nation's uninsured were in households with incomes below $50k. In 2017, 49% of the uninsured and 34% of the total population were in households with incomes below that threshold.

Here is the breakout by income group.

Census: ACA cut uninsured rate in half in Medicaid expansion states by 2016

The Census Bureau released its report on health insurance coverage in the U.S. for 2016 today. One striking trend was flagged by Matt Broaddus at the Center for Budget and Policy Priorities: the gap between states that expanded Medicaid and those that refused continues to widen:



To this let me add a sidelight: in expansion states, the uninsured rate has been cut in half since the main ACA programs were implemented in 2014 -- from 12.9% in 2013 to 6.5% in 2016.

As more Americans move out of poverty, will some move into ACA marketplace?

Data from the Census Bureau's just-released Current Population Reports for 2015 records a trifecta for the U.S. economy: incomes soaring (after years of stagnation and shrinkage), poverty reduced, health insurance rates rising.

A thought occurred to me while reading this part of economist Jared Bernstein's overview:

The official poverty rate fell from 14.8 percent in 2014 to 13.5 percent last year, a decline of 3.5 million people in households whose incomes put them below the poverty threshold for their family type (the poverty threshold for a single parent with two children was around $19,000 in 2015). 

The thought: Families rising out of poverty could be pushing ACA marketplace enrollment from the bottom up, particularly in states that refused the ACA Medicaid expansion.

Kaiser: ACA marketplace at 70% capacity among subsidy-eligible

The Kaiser Family Foundation has published an updated assessment of ACA marketplace enrollment to date and what full capacity would look like.  At present, total signups for private plans in the marketplace nationwide stands at 12.7 million, a total that's likely to drift down to somewhere between 10 and 11 million by year's end.  Kaiser estimates that if the national marketplace matched the performance of the 10 best-performing states to date, 16.3 million would be signed up by the end of open enrollment, drifting down to about 14.7 million by year's end.

There's a lot to unpack here. At the outset, I want to highlight a couple of noteworthy findings, discussed in more detail below. The first one is not actually spelled out in this report.

• According to Kaiser's estimates, nationwide, at present about 70% of the subsidy-eligible potential marketplace customer base have signed up for marketplace plans. That will probably drift down to somewhere around 60% by year's end. Of 12.7 million total enrollees, 82%, or 10.4 million, were subsidized. According to Kaiser's Sept. 30, 2015 estimate, 14.8 million Americans were potentially eligible for premium subsidies at that time.


• Kaiser's findings as to which income groups are cutting their uninsurance rates most dramatically* raise questions about the prevailing understanding of who finds the marketplace most attractive, at least by implication. Both Avalere Health and the Urban Institute have found that eligible marketplace shoppers with the lowest incomes have high takeup rates, which drop sharply and steadily with income. Kaiser finds that people in the lowest income bracket, below 150% FPL, have the second-lowest reduction in their uninsured rate among the income groups -- just an 18% reduction, compared to 33% reduction at 150-200% FPL, 23% at 200-300%, and 22% for those above 400% FPL (and so subsidy ineligible).

The Census on health insurance gains: who got what and how?

This week the Census reported on changes in Americans' health insurance rates from 2013 to 2014, based on results of its two yearly surveys, the Current Population Survey and the American Community Survey. The two together show what is probably the most dramatic drop in the percentage of people without insurance since Medicare and Medicaid were implemented. The drop in the ranks of uninsured was steepest among the roughly one third of the population living in households with incomes under 200% of the Federal Poverty Level (FPL) -- where lack of insurance is most concentrated.

In my grand personal tradition of burying the lead, I discuss an apparent oddity in the data under the second subhead below. Feel free to skip! If you're well-versed in these matters, it may be no mystery to you.

The near-poor gain most

The ranks of the uninsured dropped more steeply for the near-poor than for those below the poverty line, and for the part-time employed than for the nonworking population,  The pattern does not hold for educational level: the uninsured rate dropped most for those without a high school diploma and next most for high school grads, with smaller drops at each level of educational attainment.