Uninsured Rate for Adults Falls in Most U.S. Counties

Census Bureau releases annual health insurance estimates

The rate of uninsured Americans under the age of 65 fell in three out of four counties from 2013 to 2014 and rose in just a single county, the U.S. Census Bureau says.

For the total population under age 65, the estimated uninsured rate decreased in 2,325 counties (74.1%) and showed no statistically significant changes in 25.9% of counties, the bureau reported. Among working-age adults (ages 18 to 64), the estimated uninsured rate fell in 2,262 counties (72.1%).

 In 2014, a provision of the Patient Protection and Affordable Care Act went into effect giving states the option to expand Medicaid eligibility to most working-age adults living at or below 138% of the poverty level. In states that expanded Medicaid eligibility, 96% of counties had a decrease in uninsured rates for working-age adults. In comparison, among states that did not expand their Medicaid eligibility, 37% of counties had a decrease in uninsured rates for their working-age adults.

These findings come from the 2014 Small Area Health Insurance Estimates, which are the only source for single-year estimates of the number of people with health insurance for each of the nation’s roughly 3,140 counties. The statistics are provided by age and sex groups, and at income levels that reflect thresholds for state and federal assistance programs. Statewide estimates also break out the data by race and Hispanic origin.

“One way communities use these health insurance statistics is to guide access to screening services for breast and cervical cancer among low-income women.” said Lauren Bowers, a statistician in the Social, Economic, and Housing Statistics Division. “For example, our estimates indicate that working-age females had a lower uninsured rate than males in about 40% of counties.”

Here are highlights for the working-age population:

  • Between 2013 and 2014, working-age adults living at or below 138% of the poverty threshold saw a decrease in the uninsured in 1,860 counties (59.3%).
  • Working-age men had a higher uninsured rate than females in 1,259 counties (40.1%); there were no statistically significant differences in the remaining counties.
  • Between 2013 and 2014, the uninsured rate decreased in 2,089 counties (66.6%) for working-age adults living between 138% to 400% of the poverty level (which is the range of eligibility for subsidies to purchase health insurance coverage through the exchanges).

Here are highlights for the general population:

  • In 2014, for the population under 65 years of age, non-Hispanic whites had a lower uninsured rate than both Hispanics and non-Hispanic blacks in every state and Washington, D.C.
  • For the population under the age of 65 living at or below 138% of poverty, non-Hispanic blacks had a lower uninsured rate than non-Hispanic whites in 28 states.
  • Between 2013 and 2014, the uninsured rate decreased for children under age 19 in 650 counties (20.7%).

The Small Area Health Insurance Estimates program models coverage by combining survey data with population estimates and administrative records. Specifically, it uses the American Community Survey, demographic population estimates, aggregated federal tax returns, participation records from the Supplemental Nutrition Assistance Program, County Business Patterns, Medicaid, Children’s Health Insurance Program participation records, and the 2010 Census.

Small Area Health Insurance Estimates data are an important consideration when planning and evaluating public policy on health insurance programs, the impact of common illnesses, or serious health conditions for states and counties.

Source: U.S. Census Bureau; May 12, 2016.