Uninsurance Rate Drops to Record Low of 8%, Pointing to ACA Enrollment Boom

The national uninsurance rate has dropped to eight percent, a record-breaking low for the US, according to data from the Assistant Secretary for Planning and Evaluation’s Office of Health Policy (ASPE).

The report used National Health Interview Survey data from the first quarter of 2022 and combined it with data from the American Community Survey (ACS) data on state-level uninsurance rates, particularly in states that have adopted Medicaid expansion.

In the first quarter of 2022 the uninsurance rate was eight percent, which is a full percentage point lower than the last lowest full-year uninsurance rate and over half a percentage point lower than the previous lowest quarterly estimate. 

Prior to the first quarter of 2022, the lowest insurance rate occurred in 2016. That year, the full-year uninsurance rate hit nine percent. The same year held the record for the lowest quarterly uninsurance rate when the uninsurance rate dropped to 8.6 percent in the first quarter of 2016.

The results indicate that around at least 5.2 million Americans have gained healthcare coverage since 2020. However, the actual number of individuals who gained coverage could be as high as 7.2 million.

Adults under the age of 65 and children each experienced a 2.7 percentage point decrease in uninsurance in the first quarter of 2022 compared to the fourth quarter of 2020. The full-year declines were a bit lower, with adults seeing a 2.1 percentage point decrease in uninsurance in 2022 versus 2020 and children seeing a 1.4 percentage point decrease.

Uninsurance dropped regardless of income. However, individuals making less than 200 percent of the federal poverty level saw the highest decreases in uninsurance. 

The share of individuals making less than 100 percent of the federal poverty level dropped from 10 percent to 15.5 percent between the first quarter of 2021 and the first quarter of 2022. The share of those making between 100 and 200 percent of the federal poverty level fluctuated but ultimately fell from 16.6 percent to 16.0 percent during the same time period.

ASPE attributed this drop in part to a growth in Affordable Care Act marketplace enrollment. The report found that 5.4 percent of adults under the age of 65 had Marketplace coverage in the first months of 2022, a full percentage point higher than in 2019.

“These health coverage gains build on the large reductions in the uninsured rate that occurred after the implementation of the Affordable Care Act (ACA) in 2014. Medicaid enrollment has grown under the continuous enrollment provision passed by Congress as part of the COVID-19 pandemic response, as well as several states’ recent Medicaid expansions,” the report stated.

“States that expanded Medicaid since 2019 have experienced a decrease in the uninsured rates among low-income adults.”

The Affordable Care Act marketplace saw record-breaking enrollment during the 2022 open enrollment season, gaining 5.8 million new enrollees.

Additionally, the Biden Administration extended the federal special enrollment period in 2021 in response to the economic impacts of the coronavirus pandemic, expanding Americans’ opportunities to gain coverage.

In contrast, employer-sponsored health plan coverage was slow to recover from the coronavirus pandemic’s economic influence in the first year of the pandemic.