The Center's work on 'Health Policy' Issues

The Center works to ensure that federal and state health insurance programs provide coverage that meets the health care needs of low-income children and families, as well as seniors and people with disabilities. The Center also works to remove barriers preventing eligible families from gaining access to health coverage.

Census Data Show Continued Wide Disparities in Health Coverage

September 17, 2014 at 11:46 am

Certain groups of Americans continue to be uninsured at particularly high rates, the new Census Bureau data show.  African Americans and Hispanics, residents of the South and West, adults under age 35, and households with incomes under $50,000 had uninsured rates in 2013 well above the national average of 13.8 percent (see chart).  Hispanics’ 24.3 percent uninsured rate, for example, was nearly twice the national average.

These estimates, from the Current Population Survey (CPS), are the best source for comparing coverage rates among population groups in a single year but can’t be compared to CPS estimates from previous years because of changes to the CPS questions for 2013.  For health coverage trends over time, one should look instead to Census’ American Community Survey data, which we discussed yesterday.

Health reform’s major coverage expansions — the Medicaid expansion in many states to cover more low-income adults and the availability of subsidies for private marketplace coverage — will help reduce the disparities in health coverage among population groups.  But the expansions didn’t begin until 2014, so the new Census figures for 2013 don’t capture those coverage gains.  The Centers for Disease Control and Prevention released data yesterday covering the first quarter of 2014, and they show that the coverage gains in 2014 were greatest among some of the groups with the highest uninsured rates, including young adults, Latinos, and low-income households.

Census Report Shows Rise in Full-Time Work, Undercutting Claims by Health Reform Opponents

September 17, 2014 at 9:55 am

Yesterday’s Census Bureau report shows that the share of workers with full-time, full-year work rose in 2013, while the share with part-time, part-year work fell.  This finding further undercuts assertions that health reform is causing a large increase in part-time employment — as proponents of a House measure to change health reform’s rules on covering full-time workers claim.

Health reform requires employers with at least 50 full-time-equivalent workers to offer coverage to full-time employees — defined as those who work at least 30 hours a week — or pay a penalty.  Critics claim that employers are shifting some employees to part-time work to avoid offering them health insurance.  But the data provide scant evidence of such a shift.

To the contrary, part-time work became less frequent last year.  “An estimated 72.7 percent of working men with earnings and 60.5 percent of working women with earnings worked full time, year round in 2013, both percentages higher than the 2012 estimates of 71.1 percent and 59.4 percent respectively,” according to the new Census report.  These data are consistent with a recent Urban Institute analysis that found little evidence that health reform has increased part-time work.

The share of involuntary part-timers — workers who’d rather have full-time jobs but can’t find them — tells a similar story.  If health reform were distorting hiring practices, as critics assert, we’d expect the share of involuntary part-timers to be growing.  Instead, as the chart (based on Labor Department data) shows, it’s down by 1½ percentage points from its post-recession peak.  My colleague Jared Bernstein finds that this pattern is typical for this stage of a recovery.

Later this week, the House will consider a proposal (part of a so-called “jobs bill”) to raise health reform’s threshold for full-time work from 30 to 40 hours.  But this step would make a shift toward part-time employment much more likely — not less so.

Only about 7 percent of employees work 30 to 34 hours (that is, at or modestly above health reform’s 30-hour threshold), but 44 percent of employees work 40 hours a week and thus would be vulnerable to cuts in their hours if the threshold rose to 40 hours.  Employers could easily cut back large numbers of employees from 40 to 39 hours so they wouldn’t have to offer them health coverage.

If you exclude workers at firms that already offer health insurance and thus won’t be tempted to cut workers’ hours, more than twice as many workers would face a high risk of reduced hours under a 40-hour threshold than under the current 30-hour threshold, according to New York University economist Sherry Glied.

There’s little evidence to date that health reform has caused a shift to part-time work.  There’s every reason to expect the impact to be small as a share of total employment, as we have explained.  And raising the cutoff for the employer mandate from 30 to 40 hours a week would be a step in the wrong direction.

New CDC Figures Show Health Coverage Gains in the First Quarter of 2014

September 16, 2014 at 3:14 pm

Separate from the Census Bureau’s release today of official health coverage figures for 2013, the Centers for Disease Control and Prevention (CDC) issued preliminary data this morning showing that the ranks of the uninsured fell in the first quarter of 2014 by 3.8 million people.  The CDC data provide the first government survey data showing the early impacts of health reform’s major coverage expansions, which took effect in January 2014, in reducing the ranks of the uninsured.

The CDC figures are consistent with four independent surveys that also show significant gains in health coverage in 2014, particularly among states that have adopted health reform’s Medicaid expansion.

Some 13.1 percent of Americans were uninsured in the first quarter of 2014, the CDC data show, a 1.3 percentage-point decline from 2013 and the lowest uninsured rate since the CDC first collected these data in 1997.

Coverage gains were greatest among population groups historically least likely to have coverage.  The uninsured rate for adults under 26 plummeted from 26.5 percent in 2013 to 20.9 percent in the first quarter of 2014.  People in families under 200 percent of the poverty line, Latinos, African Americans, and people with less than a high school education also experienced disproportionately high coverage gains over this period.

The coverage gains among non-elderly adults were more than twice as large in states that have adopted the Medicaid expansion as in non-expansion states, widening the gap between the uninsured rates in the two groups of states from 4.3 percentage points to 5.8 percentage points.  (Expansion states have a non-elderly adult uninsured rate of 15.7 percent, compared to 21.5 percent for non-expansion states; see graph.)

The CDC data were collected in January-March and do not fully capture the significant enrollment growth in states’ Medicaid programs and health reform marketplaces that took place towards the end of this period, as the March 31 deadline for enrolling in marketplace coverage approached.  Data that include the second quarter of 2014 — as several of the independent surveys cited above did — will likely show even larger coverage gains.  For example, the Urban Institute’s Health Reform Monitoring Survey found that the uninsured rate among adults aged 18-64 fell from 17.9 percent to 13.9 percent between the third quarter of 2013 and the second quarter of 2014.

Later today, the Census Bureau may also release similar preliminary estimates for early 2014, but these estimates — unlike the CDC estimates discussed here — are the first in a new series and thus can’t be compared to estimates from earlier years.

Greenstein on Today’s Census Figures

September 16, 2014 at 1:44 pm

CBPP President Robert Greenstein just issued a statement on the Census Bureau’s 2013 data on poverty, income inequality, and health insurance:

Today’s Census data provide fresh evidence that the economy strengthened in 2013, but too slowly to improve the living standards of many middle- and low-income Americans.  Median household income did not rise significantly and remained 8.0 percent (or $4,497) below its level in 2007, before the Great Recession — and 8.6 percent below its level in 2000, before the 2001 recession.  The poverty rate fell from 15 percent in 2012 to 14.5 percent, the first statistically significant decline since 2006 (and only the second since 2000).  But the rate remained well above its 12.5 percent level in 2007 and even further above its 2000 level of 11.3 percent.  At last year’s rate of improvement, we would need to wait until 2018 for it to fall to or below the 2007 pre-recession level, and until 2020 to fall below the 2000 level.

Today’s report, however, does include a substantial and welcome decline in poverty among children, from 21.8 percent in 2012 to 19.9 percent in 2013 (although the child poverty rate remains well above its 2000 and 2007 levels).  The Census data indicate that the drop in 2013 was driven largely by a rise in employment and earnings among parents.  Indeed, median income among families with children rose between 2012 and 2013 even as overall median income was statistically unchanged.

In contrast with the 1960s, 1970s, and 1980s — when the benefits of economic recoveries were more broadly shared and poverty and median income improved more quickly when recoveries started — the recoveries of the past two decades have been much slower to generate income gains for middle- and low-income Americans.  Part of the problem is the rising inequality of recent decades, which has meant that economic growth has not been widely shared.  By various Census measures, inequality remained at or near record levels in 2013, with inequality essentially unchanged between 2012 and 2013.

Another factor that held down improvements in middle- and low-income living standards in 2013 was premature federal austerity policies, such as the sequestration budget cuts, that restrained economic growth.  The changes in federal spending and tax policies that took effect in 2013 reduced economic growth last year by about 1.1 percent of gross domestic product (GDP), according to Goldman Sachs.  The Congressional Budget Office projected that these policy changes cost the economy more than 1 million jobs.  We would have been wiser to invest more in infrastructure and education and training to put more people back to work in the short term and to strengthen productivity and economic growth in the long term.

Health care provides a brighter story.  The share of Americans without health insurance fell slightly in 2013, based on data from the Census Bureau’s American Community Survey.  In addition, an array of studies and data — including new data that the Centers for Disease Control and Prevention (CDC) issued this morning — show that the number of Americans without insurance has fallen markedly in 2014 with implementation of health reform.

These studies also show that the states that expanded Medicaid under health reform experienced much larger declines in their uninsured populations this year than states that rejected the expansion.  Since today’s Census and CDC data also show that people in the more than 20 states that rejected the expansion were likelier to be uninsured in 2013 than people in states that took the expansion, this means the gap in health insurance coverage between the two groups of states is widening.

Today’s data also provide some evidence about other areas (beyond health reform) where the safety net is producing results.  Programs like the Supplemental Nutrition Assistance Program (SNAP, formerly known as food stamps) are not counted in the official poverty measure, but the Census data issued today show that when SNAP assistance is counted as income — as analysts generally believe it should be — it lifted 3.7 million people above the official poverty line in 2013, including 1.5 million children.

Census Data Show Uninsured Rate Fell Slightly in 2013, Continuing Earlier Progress

September 16, 2014 at 12:55 pm

Some 14.5 percent of Americans were uninsured in 2013, Census figures released today based on the American Community Survey (ACS) show, a slight but statistically significant reduction from 2012’s 14.8 percent and well below the recent high of 15.5 percent in 2010 (see graph).

The most widely used source of health coverage information is the Current Population Survey (CPS), but, as Census officials explained this morning, changes instituted to it in 2013 don’t allow for a historical analysis using CPS data.

Much of the improvement in health coverage since 2010 reflects health reform provisions permitting young adults to stay on their parents’ health plans until age 26 and building upon previous coverage gains for children under Medicaid and the Children’s Health Insurance Program by requiring states to keep their existing eligibility rules and procedures.

The results are for 2013 and so do not reflect the coverage gains in 2014 resulting from the major ACA coverage provisions, which took effect on January 1 — namely, the Medicaid expansion and subsidized marketplace coverage.  But updated data from four independent surveys show substantial reductions in the number and percentage of uninsured in 2014, particularly among states taking up the Medicaid expansion.

Consistent with those independent surveys, the Centers for Disease Control and Prevention (CDC) today released preliminary survey results showing a 1.3 percentage-point decline in the uninsured rate between 2013 and the first quarter of 2014, reflecting a 3.8 million reduction in the number without health coverage.  CDC data that include the second quarter of 2014 (as some of the independent surveys cited above did) will likely show even larger coverage gains.

The CDC’s estimated 13.1 percent uninsured rate is the lowest since it began collecting these data in 1997.  (The CDC data are not directly comparable to the Census data cited above.)