2coverage among young adults was not enough to offset the decline in private coverage among adultsaged 25 to 64 while Medicaid and CHIP enrollment remained steady.
Uninsured Rate Fell in 20 States, Due to Health Reform and Public Programs
The ACS data are consistent with the earlier Census data from the CPS. (Under the ACS data, thenumber of uninsured Americans decreased by roughly 830,000 and the percentage without healthinsurance coverage fell from 15.5 percent in 2010 to 15.1 percent in 2011.) The ACS data also show that the reduction in 2011 in the share of people without insurance coverage occurred across adiverse set of states. The uninsured rate declined significantly in 20 states and remained flat in 30states. (Tables 1 and 2 show the changes in the percentage and number, respectively, of uninsuredindividuals and children under 18 in each state.) The state-level ACS data confirm that a key contributor to these coverage gains was a substantialrise in health coverage among young adults, which largely reflected a health reform provisionenabling adult children to get coverage through their parents’ health insurance plans until their 26
birthday. This provision marked a significant shift from prior rules, under which young adultstypically were no longer eligible for their parents’ health plans once they turned 19 or graduatedfrom college. The young adult provision took effect in September 2010, so 2011 represented the first full yearthat it affected health insurance coverage rates. In 34 states, the rate of private coverage among young adults aged 18 to 24 increased; at the same time, the rate of private coverage among adultsaged 25 to 64
in most states.In 21 states, the increase in private coverage among young adults entirely offset the continuing erosion in private coverage among other non-elderly adults. Table 3 shows the change between2010 and 2011 in private coverage rates in each state for young adults, adults aged 25 to 64, and allnon-elderly adults (aged 18 to 64). The ACS data also show that enrollment increases in public programs, particularly Medicaid andCHIP, contributed to the coverage gains across the states. Federal policies, including a temporary increase in Medicaid funding for states through June 2011 (which policymakers included in the 2009Recovery Act and later extended) and health reform’s requirement that states maintain theirMedicaid and CHIP eligibility levels and enrollment procedures, likely enabled these programs tocover more low-income people during the slow economic recovery. Medicaid and CHIP enrollmenttends to continue rising for a few years after the end of a recession. Table 4 shows the change in theMedicaid coverage rate in each state for all individuals and children under 18.States will have an opportunity to make substantially greater progress in covering uninsured low-income adults starting in 2014, when the health reform provisions enabling them to extend Medicaidto nearly all individuals up to 133 percent of the poverty line take effect. The recent Supreme Courtdecision gives states the choice of whether or not to institute that expansion. Some 30 millionpeople who would otherwise be uninsured will gain coverage under health reform by 2022, theCongressional Budget Office estimates, with 11 million people gaining Medicaid coverage. The