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Census Bureau finds share of people without health insurance fell in most counties during pandemic

The share of Americans under 65 without health insurance fell in 280 counties and rose in 80 counties from 2020 to 2021 as Medicaid expanded coverage during the COVID-19 pandemic, the Census Bureau reported Thursday.

The figures are the latest from the Small Area Health Insurance Estimates program, the only federal source that estimates health insurance rates within all 3,142 U.S. counties. It also breaks down coverage by ethnicity, region and age.

The bureau found the percentage of uninsured Americans under 65 decreased in 2,906 U.S. counties and rose in 10 counties from 2013 — the year before many Obamacare provisions took effect — to 2021.



In 2021, 1,231 or 39% of U.S. counties had less than 10% of residents uninsured, up from 34% of counties in 2020 and 4% in 2013.

“The county-level health insurance coverage estimates…reflect an overall decrease in uninsured rates since 2019,” James Mouser, a Census Bureau survey statistician, told The Washington Times. “This period coincides with various economic and policy changes, including mandated continuous coverage for those with Medicaid for the duration of the COVID-19 pandemic.”

The figures arrived hours after the Centers for Disease Control and Prevention reported early Thursday that the number of uninsured Americans dropped to a record low of 25.3 million people, 7.7% of the population, in the first three months of 2023.


SEE ALSO: Number of Americans without health insurance falls to record low, says CDC


The surge in coverage is a “positive indicator” that could unravel in upcoming months, said Brendan Saloner, an associate professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health.

“The improvements were almost certainly buoyed by the overall strong labor market and low unemployment rate in the U.S.,” Mr. Saloner told The Washington Times. “However, the Medicaid unwinding caused by the end of the pandemic-era flexibility will pose a major disruption to the insurance market this year.”

The CDC report stopped one month short of April, when Medicaid ended a continuous enrollment policy implemented during COVID that had kept states from performing annual eligibility reviews to disenroll patients.

Before COVID, many beneficiaries periodically cycled in and out of the rolls due to income fluctuations and a failure to submit complete or accurate paperwork.

Congressional expansion of continuous Medicaid enrollment during the pandemic is the main reason the number of uninsured Americans has fallen to an all-time low, health experts say.

Health policy advocacy group KFF, which tracks disclosures, reported that 41 states had booted nearly 3.8 million Americans out of Medicaid as of Tuesday. Disenrollment rates ranged from 82% of beneficiaries in Texas to 8% in Wyoming.

The group estimates that up to 24 million people could lose Medicaid coverage by the time states finish disenrolling people.

“Policymakers must act quickly to help people undergo the re-enrollment process,” said Mr. Saloner, the Johns Hopkins professor. “People losing Medicaid coverage will also need help to secure new insurance on the federal and state exchanges.”

According to the Census Bureau report, estimated county uninsured rates ranged from 2.4% to 46.3% of people under 65 in 2021, with a median rate of 10.4% of county residents uninsured.

Other key findings included:

The number of counties with fewer than 10% of residents lacking insurance was lowest in the Northeast and Midwest, while the South had the largest share of counties with uninsurance rates over 15%.

Uninsured rates of working-age adults aged 18 to 64 living at or below 138% of the federal poverty level ranged from 4.9% to 64.1% across all counties, with a median rate of 20.3%. (In 2021, a person who earned $12,880 annually was living at the poverty level.)

In states that expanded Medicaid eligibility, 346 out of 2,006 counties, or 17.2%, reported a lack of insurance among at least 20% of working-age adults living at or below 138% of the poverty level.

In states that did not expand Medicaid, 942 out of 1,136 counties, or 82.9%, had an uninsurance rate above 20% among working adults at the same income level.

The Census Bureau found White, Black, Asian, and non-Hispanic multiracial Americans under 65 had lower estimated uninsured rates than their Latino peers in every state in 2021.

“Uninsured rates vary due to many factors, including state Medicaid eligibility expansion status,” Mr. Mouser said. “In particular, high county uninsured rates tend to be less prevalent among low-income, working-age adults in states that expanded Medicaid eligibility by the end of 2021.”

For more information, visit The Washington Times COVID-19 resource page.

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