Health Coverage for Working-Age Adults Rose in Every State Since 2013

Health Coverage for Working-Age Adults Rose in Every State Since 2013

Most Declines in Uninsured Rates for All Age Groups Occurred Between 2013 and 2019

Many states continued to see improvements in health insurance coverage rates for all age groups between 2019 and 2023, according to American Community Survey (ACS) data.

Uninsured rates dropped in 17 states for children, 42 states for working-age adults, and in one state (Florida) for adults age 65 and older from 2019 to 2023.

Because many public health insurance programs are aimed specifically at coverage for children, older adults, and those in need, the uninsured rate among working-age adults ages 19 to 64 is higher.

But fewer states saw drops in uninsured rates than from 2013 to 2019, when rates declined in 37 states for children, in all 50 states and the District of Columbia for working-age adults, and in 14 states for older adults.

The report, State Health Insurance Coverage: 2013, 2019, and 2023, highlights changes in the health insurance landscape across the states in the past decade, from the implementation of key provisions of the Patient Protection and Affordable Care Act (ACA) through the COVID-19 pandemic and resulting economic and policy changes.

An interactive dashboard also released recently focuses on the 2022 to 2023 changes as well as the 2019 to 2023 changes across the states. A companion working paper further examines the working-age adult population by smaller age groups across states.

Health Policies and Health Coverage

Health insurance policies at the federal and state level affect the availability and affordability of health coverage.

The ACA was signed into law in 2010 and major provisions of ACA that went into effect before 2019 may have impacted uninsured rates between 2013 and 2019.

They included offering states additional funds to expand Medicaid for those under age 65 with incomes up to 133% of the federal poverty level and establishing health insurance marketplaces for those seeking to purchase coverage.

While the ACA included an individual mandate requiring every person to have health insurance, the tax penalty for uninsured individuals was removed in 2019.

The COVID-19 pandemic in 2020 spurred the passing of the Families First Coronavirus Response Act, which mandated that states provide continuous eligibility for individuals enrolled in Medicaid on or after March 8, 2020. Most of these pandemic-related provisions expired in mid-2023.

Health Coverage for Children Under Age 19

Age is an important factor in eligibility for health insurance coverage. Children may have access to a variety of public health insurance coverage types, such as Medicaid or Children’s Health Insurance Program (CHIP) or dependent coverage under a parent’s employer or direct purchase plan.

Between 2013 and 2019:

• The uninsured rate for children decreased in 37 states.
• Private coverage rates for children increased in 20 states.

• Public coverage rates for children increased in 22 states.
   

  Between 2019 and 2023:

• The uninsured rate for children decreased in 17 states.
• Private coverage rates for children increased in 9 states.
• Public coverage rates for children increased in 24 states.
   

How Uninsured Rates Changed for Working-Age Adults
 

Because many public health insurance programs are aimed specifically at coverage for children, older adults, and those in need, the uninsured rate among working-age adults ages 19 to 64 is higher.

Provisions of the ACA expanded coverage options for younger adults via the healthcare marketplace and through their parent’s health insurance coverage if they were under age 26.

The uninsured rate for the total working-age adult population fell in every state plus the District of Columbia between 2013 and 2019:

For adults ages 19 to 25, it decreased between 2.4 and 18.2 percentage points across 48 states.
For adults ages 26 to 34, it decreased between 1.3 and 17.4 percentage points across 49 states and the District of Columbia.
For adults ages 35 to 44, it decreased in 48 states and the District of Columbia, with declines ranging from 0.8 to 14.2 percentage points.
For adults ages 45 to 54, it decreased between 0.8 and 9.9 percentage points in 48 states and the District of Columbia.
For working-age adults ages 55 to 64, it decreased between 1.8 to 9.5 percentage points across 46 states and the District of Columbia.
The uninsured rate for the total working-age population decreased in 42 states between 2019 and 2023.

For adults ages 19 to 25, it decreased between 1.4 and 5.6 percentage points across 24 states and the District of Columbia and increased in one (Montana).
For adults ages 26 to 34, it decreased between 1.1 and 8.2 percentage points across 35 states.
For adults ages 35 to 44, it decreased in 35 states, with declines ranging from 0.7 and 4.2 percentage points.
For adults ages 45 to 54, it decreased between 0.9 and 5.1 percentage points across 31 states and increased in one (Maryland).
For the oldest working-age adults ages 55 to 64, it decreased between 0.4 and 3.6 percentage points across 28 states and increased in one (Rhode Island).