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2011 Census Data Reaffirm Need to Implement the Affordable Care Act

Dr. Michael Lenoir, right, examines Dante Jones, 2, being held by his mother Daaiyah Shabazz in Lenoir's offices in Oakland, California.

Today’s 2011 data on the numbers of Americans living in poverty and without health insurance demonstrate yet again why our country needs to move forward with implementation of the Affordable Care Act. Last year the number of uninsured Americans dropped for the first time in four years as the reforms in the Affordable Care Act continued to expand access to health insurance. This drop in the uninsured was driven in part by the gains in health coverage among young adults who were able to stay on their parents’ health insurance plans.

Another hopeful trend in the data on health care coverage is that for the first time in 10 years, the rate of private insurance coverage did not decrease. Contrary to the doomsday predictions by critics of the Affordable Care Act, employers have not dropped coverage in anticipation of the law’s reforms going into effect in 2014. Private insurance for some groups has actually increased, even as our economy is still recovering from the recession.

How did access to health coverage change in 2011? Here are the key indicators:

  • The number of people with health insurance increased for the first time in four years, to 260.2 million in 2011 from 256.6 million in 2010, as did the percentage of people with health insurance (84.3 percent in 2011, 83.7 percent in 2010).
  • The percentage of people covered by private health insurance in 2011 was not statistically different from 2010, at 63.9 percent. This was the first time in the last 10 years that the rate of private health insurance coverage has not decreased. The percentage covered by employment-based health insurance in 2011 was not statistically different from 2010, at 55.1 percent.
  • The percentage of people covered by government health insurance increased from 31.2 percent in 2010 to 32.2 percent in 2011. The percentage covered by Medicaid increased from 15.8 percent to 16.5 percent. The percentage covered by Medicare also rose over the period, from 14.6 percent to 15.2 percent. The percentage covered by Medicaid in 2011 was higher than the percentage covered by Medicare.
  • In 2011, 9.7 percent of children, or 7.6 million, under 19 years of age were without health insurance. Neither estimate is significantly different from the corresponding 2010 estimate. The uninsured rate also remained statistically unchanged for those ages 26 to 34 and adults ages 45 to 64. It declined, however, for people ages 19 to 25, ages 35 to 44, and those 65 years of age and older.

Move forward with Affordable Care Act implementation and protect Medicare and Medicaid

The 2011 census numbers show that the Affordable Care Act is already helping lower the number of uninsured Americans. And these numbers are just the start. In just over a year, millions more Americans will have access to affordable health care because the law’s premium tax credits and cost-sharing subsidies will help pay for health insurance. And millions of lower-income Americans will also gain access to Medicaid.

But there is significant work still to be done to assist Americans living in poverty and to prevent many more Americans from falling out of the middle class. Today’s data also serve as a stark reminder of continuing disparities in health insurance access:

  • The uninsured rate for children in poverty (13.8 percent) was higher than the rate for all children (9.4 percent).
  • The number of uninsured Hispanics decreased in 2011 by 0.6 percent. Hispanics remained the least likely group to hold insurance coverage among major ethnic and racial groups, though percentages of uninsured decreased to 30.1 percent in 2011 from 30.7 percent in 2010.
  • In 2011 the uninsured rates decreased as household income increased, from 25.4 percent uninsured for those in households with annual income less than $25,000 to 7.8 percent uninsured in households with income of $75,000 or more.

The data also confirm that Medicaid continues to be a critical safety net for Americans living in poverty, with more Americans relying on the Medicaid program.

For the millions of Americans living at or below the poverty line—$11,170 for an individual and $19,090 for a family of three—the Affordable Care Act’s Medicaid expansion provision could not be more important. And unfortunately, it is this group that faces the most uncertainty about whether they will benefit from the Affordable Care Act. If fully implemented, the Affordable Care Act’s Medicaid expansion would allow an additional 17 million poor and uninsured Americans to gain access to Medicaid. But the decision by a number of governors to refuse the new Medicaid money—even though the federal government will pay almost all of these new costs—threatens their access to care.

And this is not the only threat. Efforts to further cut Medicaid, such as the block-grant proposal in the latest House Republican budget, would have a devastating effect on the most vulnerable Americans, including the elderly, disabled, and poor. This proposal would cut Medicaid spending by $810 billion without accounting for its proposed repeal of the Affordable Care Act. That cut would amount to 22 percent of the program over the next 10 years. These proposals would result in more than 19 million low-income Americans losing coverage over 10 years.

What today’s data again remind us is that programs that protect health care coverage—especially the Medicaid and Medicare programs that protect health care for our most vulnerable citizens—must be safeguarded as we address our nation’s fiscal challenges.

Maura Calsyn is Associate Director of Health Policy at the Center for American Progress, and Lindsay Rosenthal is Special Assistant for Health Policy, Women’s Health and Rights at the Center for American Progress.