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News | Patient Access

Big drop in Medicaid enrollment drives 2018 increase in uninsured rate

News | Patient Access

Big drop in Medicaid enrollment drives 2018 increase in uninsured rate

  • Most of the newly uninsured formerly were covered by Medicaid.
  • Medicaid expansion states had small declines in their numbers of insured residents.
  • The health insurance coverage rate for Hispanics decreased by 1.6 percentage points.

In 2018, 1.9 million fewer people were covered by some type of health insurance, and they were most likely former Medicaid enrollees, according to new federal survey data.

The number of uninsured increased from 25.6 million in 2017 to 27.5 million in 2018, while the insurance coverage rate declined from 92.1% to 91.5%, according to a report from the U.S. Census Bureau.

The biggest change by insurance type was a decrease of 0.7 percentage points in the share of the population enrolled in Medicaid, amounting to nearly 2 million people.

Where the coverage losses occurred

The increase in the number of uninsured occurred across both Medicaid expansion and non-expansion states, although expansion states generally had lower uninsured rates.

The share of people without health insurance coverage increased in eight states, including:

  • Idaho (1 percentage point)
  • South Dakota (0.7 percentage points)
  • Tennessee (0.6 percentage points)
  • Alabama (0.6 percentage points)
  • Arizona (0.6 percentage points)

Three states had statistically significant decreases in the number of uninsured:

  • Wyoming (1.8 percentage points)
  • South Carolina (0.5 percentage points)
  • New York (0.3 percentage points)

The uninsured rate increased by 0.6 percentage points (to 3%) in states that expanded Medicaid eligibility under the Affordable Care Act and by 1.7 percentage points (to 6.2%) in non-expansion states .

The uninsured rate increased for people living at or above 400% of the federal poverty level (FPL) in both expansion and non-expansion states.

However, in expansion states, the uninsured rate increased by 1.5 percentage points for those living in poverty and by 0.7 percentage points for those with incomes between 100% and 399% of FPL (to 16.9% and 12.7%, respectively). In non-expansion states, the uninsured rate decreased by 1.4 percentage points for people living in poverty.

Another regional factor was that children in the South were more likely to be uninsured than children living in other areas. The uninsured rate for children in the South increased by 1.2 percentage points to 7.7% in 2018. The uninsured rate did not statistically change for children in any other region.

Hispanics drive the increase in uninsured

Hispanics were the only group with any statistically significant 2018 change in enrollment in either public or private insurance. Their overall health insurance coverage rate decreased by 1.6 percentage points in 2018, with enrollment reductions of 1.1 percentage points in private insurance and 1 percentage point in public programs.

Hispanics, who had the lowest rate (82.2%) of overall health insurance coverage, also had the lowest rate of private coverage, at 49.6%. Non-Hispanic whites were among the most likely to have private health insurance in 2018, with 74.8% enrolled in such coverage. Meanwhile, 73.1% of Asians and 55.4% of blacks had private coverage.

About the Author

Rich Daly, HFMA senior writer/editor,

is based in the Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare


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