HHS: December 2023 uninsured rate actually *lower* than a year earlier even w/Medicaid unwinding!

Via the U.S. Health & Human Services Dept (HHS):

Today, U.S. Health and Human Services Secretary Xavier Becerra released the following statement after the Centers for Disease Control and Prevention (CDC) released new data - PDF showing the uninsurance rate holding steady at 7.7 percent:

“Under President Biden’s leadership more people have health coverage than under any previous president. Even more encouraging, the data released today does not reflect the record-breaking open enrollment period that saw over 21 million people sign up for insurance. The Biden-Harris Administration will redouble our efforts to make sure tax breaks for working families stay in place so that every single person in America can go to the doctor and afford the care that will keep them and their families healthy.”

The data CDC released today captures the fourth quarter of 2023 and represents a drop from 8.3 percent during the same period in 2022.

At first glance, this may sound incredibly surprising, given that more than 22 million Americans have had their Medicaid or CHIP healthcare coverage terminated over the past twelve months. On the surface, that makes it sound like the uninsured rate should have jumped by a good 6-7 percentage points since spring 2023.

HOWEVER, there's some important factors which slice that 22 million down to consider:

  • Second, as I've been writing about every month since last summer, a good number of those folks shifted over to heavily subsidized ACA exchange heatlhcare policies or ACA Basic Health Plan coverage instead...around 3.7 million as of the end of December.
  • Another 430,000 had been determined to be eligible for Medicaid or CHIP thru December after all, and presumably (hopefully?) were re-enrolled in the program.
  • I've estimated that perhaps 250,000 or so of the Unwinding population were 64 at the time they lost coverage, and have since turned 65 and moved to Medicare.

Even so, that still leaves around 9.4 million more Americans theoretically uninsured...except for the big unknown: How many of them enrolled in Employer Sponsored Insurance after losing Medicaid/CHIP coverage, and beyond that, how many of them ALREADY had Employer Sponsored Insurance all along and may never have even realized they had Medicaid in the first place?

In addition, it's important to remember that there's other people who were never on Medicaid/CHIP to begin with who may have gained coverage last year as well which have nothing to do with the Unwinding process.

With all of this in mind, let's take a look at the National Health Interview Survey Early Release of Quarterly Estimates, Oct. 2022 - Dec. 2023:

Since 2001, the National Center for Health Statistics (NCHS) National Health Interview Survey (NHIS) Early Release Program has released selected estimates of health and health care for the civilian noninstitutionalized U.S. population.

Table 1 presents quarterly estimates of health insurance coverage disaggregated by age group and family income as a percentage of the federal poverty level (FPL) for the civilian noninstitutionalized U.S. population based on data from the July–September 2023 NHIS.

Table 2 presents quarterly population estimates of health insurance coverage disaggregated by age group.

Table 3 presents quarterly estimates of health insurance coverage for adults aged 18–64 disaggregated by race and ethnicity.

Table 4 presents quarterly estimates of health insurance coverage for adults aged 18–64 disaggregated by region.

Quarterly estimates for October– December 2022 through July–September 2023 are also presented for comparison. These estimates are being published prior to final data editing and final weighting to provide access to the most recent information from the NHIS.

Again, these are early release data, so there may be some tweaks made prior to the final official report being released.

I'm not going to repost the entire report; it would be too unwieldy (the link goes to a PDF) and there's too much data there, but here's a very simplified summary which shows the year over year change broken out by age and household income level.

The total U.S. population was estimated to be around 332 million in 2022 vs. around 336 million at the end of 2023. If you take the estimates from the NHIS literally, that would put the uninsured rate at roughly 25.9 million in December 2023 vs 27.5 million in December 2022, give or take.

Of course there's a ton of caveats here--these surveys cover the full 3-month periods, and they're based on surveys of the population, not actual enrollment data...and of course a lot of people are confused about what type of healthcare coverage they have (see the links about Medicaid coverage above) or whether they have it at all.

Even so, this is still a whole lot better than if the report had shown a dramatic increase in the uninsured rate: