U.S. Health Insurance Coverage Rates Reached Record Level in 2015

The percentage of people under age 65 with health insurance increased to nearly 89 percent in 2015 -- the highest level in more than 40 years of record-keeping, according to a new fact sheet, Long-Term Trends in Health Insurance Coverage, from CDC's National Center for Health Statistics. The fact sheet, which draws on data from the National Health Interview Survey, summarizes both health insurance rates (expressed in percent covered) and the total number of persons insured over the period from 1968 through 2015.

However, data on the percentage and total number of people insured and uninsured have only been available since 1972. Although coverage rates and numbers among persons under age 65 have varied from year to year, the percentage of persons with health coverage declined from an early maximum of about 88 percent in 1978 to a low of 82 percent by 2010. During that 30-year period, the number of uninsured persons rose from 23.0 million to over 48.3 million -- a reflection of both lower coverage rates and population growth.

However, this trend began to reverse in 2011, with increasing coverage and declining percentages and numbers of people uninsured -- particularly after the implementation of the Affordable Care Act (ACA). By 2015, the percentage of persons uninsured had declined from the high of 18.2 percent in 2010 to 10.6 percent. During that same period, the total number of uninsured persons decreased by nearly 20 million, to 28.7 million -- the lowest level since the early 1980s. The fact sheet provides breakdowns of health coverage in the following categories: employer-based private coverage, other private coverage, Medicaid, Medicare, other public coverage, and uninsured.

The data indicate that most of the change in health coverage occurred in two groups: persons with Medicaid coverage and those with non-employer-based private coverage. The number of people insured through Medicaid increased from 44.8 million in 2010 to 55.4 million in 2015, and from 12.7 million to 20.8 million for those with non-employer-based coverage. Concerns about maintaining the insurance coverage gains achieved since the implementation of the ACA are at the forefront of current Congressional debate over the proposed repeal and replacement of the ACA.

Health Coverage and Viral Suppression Have Improved for HIV+ Persons in States with Medicaid Expansion

The ACA, which was fully implemented in 2014, expanded the healthcare options for many people living with HIV in the U.S. To determine whether the rollout of ACA led to changes in insurance coverage and HIV viral suppression, researchers from the CDC, HRSA, and Kaiser Family Foundation examined data from CDC's Medical Monitoring Project (MMP) for the period 2012 (pre-ACA implementation) through 2014 (post-ACA implementation). MMP gathers data on a nationally representative sample of people who have been or are currently being treated for HIV infection.

The researchers calculated the proportion of adults living with HIV who were uninsured or had private, Medicaid, or Medicare coverage in 2012 and 2014. They also computed the percentage of adults who received Ryan White HIV/AIDS Program (Ryan White) services for low-income, uninsured, and underinsured persons, as well as the percentage of persons virally suppressed at their last test (viral load less than 200 copies/mL).

In addition, the researchers stratified the data by the type of state where each person resided -- distinguishing between Medicaid-expansion (ME) states and nonMedicaid-expansion (NME) states. For the purposes of the study, the researchers included all states that had expanded Medicaid coverage anytime in 2014 as ME states.

The researchers found that, in 2012, 26 percent of persons in HIV medical care were uninsured in NME states compared with 13 percent in ME states. During the following 2 years, there was no change in healthcare coverage rates of persons receiving HIV care in NME states. However, in ME states, the percentage of persons in HIV care and uninsured declined from 13 percent to 7 percent, while Medicaid coverage increased from 39 percent to 51 percent. In 2012, the percentage of patients receiving Ryan White services was 42 percent in both NME and ME states.

By 2014, the proportion receiving such services rose to 55 percent in NME states, but did not change significantly in ME states. The prevalence of viral suppression among persons in HIV care was 77 percent in both NME and ME states during 2012. The viral suppression rate rose significantly to 83 percent among patients in ME states during 2014, with a smaller, but not statistically significant, increase seen among patients in NME states.

In a poster at the 2017 CROI summarizing their work, the researchers noted that Ryan White assistance increased over time in nearly every coverage group, particularly among persons in NME states, and that the Ryan White program "is likely to remain an important source of support for quality HIV care, treatment, and supportive services." They also said that they plan to do additional work to examine whether the observed increase in viral suppression rates in ME states can be directly attributed to changes in healthcare coverage following ACA implementation.

Eric Brus writes about HIV policy. His HIV/AIDS Disparities Report is produced by the New England AIDS Education and Training Center Minority AIDS Initiative Project. The full version is available online.