1. Changes in Health Insurance Coverage 2000-2009 John Holahan Alliance for Health Reform December 6, 2010

2. Changes in Unemployment Rates The 2000-2009 period began with a recession that was followed by declining unemployment and a modest recovery. The “great” recession began in 2007. 2

3. Changes in Real Personal Incomes, 2000-2009 Real incomes fell between 2000 and 2004, then grew slightly between 2004 and 2007. With the recession, real incomes again declined. 3

4. 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, 2010. Based on data from the 2001-2010 ASEC Supplement to the Current Population Surveys.

5. Change in Coverage, 2000-2009 Coverage Rates Employer Sponsored Insurance Medicaid - StateUninsured Millions of Uninsured 200069.5%5.3%17.2%29.0 200465.2%6.4%19.5%34.6 200764.5%6.8%19.7%36.1 200960.4%8.1%22.5%41.7 5 Among adults, employer sponsored insurance declined and the number of uninsured grew, even in the period of economic growth.

6. Change in Coverage Among Children, 2000-2009 Coverage Rates Employer Sponsored Insurance Medicaid - StateUninsured Millions of Uninsured 200065.7%16.7%12.0%9.1 200461.4%21.9%10.9%8.4 200759.4%23.5%11.3%8.9 200955.6%28.3%10.4%8.3 6 The number of uninsured children actually fell over the decade; while employer coverage fell, public coverage expanded.

7. Percentage Point Changes in Health Insurance Coverage of Adults and Children, All Incomes, 2007-2009 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

8. 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, 2007-2009 *percentage point changes are significant at the.05 level

9. Percentage Point Changes in Health Insurance Coverage, by Family Work Status, 2007-2009 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

10. 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, 2007-2009 MidwestNortheastSouth West *percentage point changes are significant at the.05 level

11. Other Findings (2007-2009) 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 55-64 year olds 11

12. 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