Changes in Health Insurance Coverage John Holahan Alliance for Health Reform December 6, 2010

Changes in Unemployment Rates The period began with a recession that was followed by declining unemployment and a modest recovery. The “great” recession began in

Changes in Real Personal Incomes, Real incomes fell between 2000 and 2004, then grew slightly between 2004 and With the recession, real incomes again declined. 3

4 Growth in Population Virtually all the net change in population between 2000 and 2009 was among those with incomes below 200% FPL. Source: Urban Institute, Based on data from the ASEC Supplement to the Current Population Surveys.

Change in Coverage, Coverage Rates Employer Sponsored Insurance Medicaid - StateUninsured Millions of Uninsured %5.3%17.2% %6.4%19.5% %6.8%19.7% %8.1%22.5% Among adults, employer sponsored insurance declined and the number of uninsured grew, even in the period of economic growth.

Change in Coverage Among Children, Coverage Rates Employer Sponsored Insurance Medicaid - StateUninsured Millions of Uninsured %16.7%12.0% %21.9%10.9% %23.5%11.3% %28.3%10.4%8.3 6 The number of uninsured children actually fell over the decade; while employer coverage fell, public coverage expanded.

Percentage Point Changes in Health Insurance Coverage of Adults and Children, All Incomes, AdultsChildren Change in Population Change in Uninsured 2.6 Million 5.6 Million 0.7 Million -0.6 Million 7 *percentage point changes are significant at the.05 level

AdultsChildren Change in Population Change in Uninsured 7.8 Million 5.1 Million 3.1 Million -0.3 Million 8 Percentage Point Changes in Health Insurance Coverage, Low Income Adults and Children, *percentage point changes are significant at the.05 level

Percentage Point Changes in Health Insurance Coverage, by Family Work Status, Change in Population Change in Uninsured -4.7 Million -0.2 Million 5.5 Million 2.6 Million 6.8 Million 2.9 Million 9 *percentage point changes are significant at the.05 level -4.3 Million -0.2Million One Full Time Worker Two Full Time Workers Part Time Workers No Workers

Change in Population Change in Uninsured 0.4 Million 0.6 Million 0.1 Million 1.3 Million 2.0 Million 1.9 Million 0.8 Million 1.2 Million 10 Percentage Point Changes in Health Insurance Coverage, by Region, MidwestNortheastSouth West *percentage point changes are significant at the.05 level

Other Findings ( ) About 60% of the increase in the number of uninsured was among whites, in line with their share of the population About 80% of the increase in the number of uninsured was among native citizens; non citizens were only a very small share of the growth Almost half of the increase in uninsured adults was among young adults, but for the first time in this decade there was an increase in the number of uninsured among year olds 11

Long standing secular decline in ESI, exacerbated by economic downturns Slow increases of public coverage among adults, greater expansions for children Increases in number of uninsured concentrated among adults Growing uninsured places great strain on families and on health care institutions, especially in poor economic times Health reform will end link between ESI and uninsured by expanding Medicaid and providing tax credits in exchanges 12 Conclusions