ACA, COVID-19’s impact on uninsured Americans: Two steps forward, one step back

Gabriel Perna | September 22, 2020

The U.S. Census Bureau released a report last week that the percentage of Americans who were uninsured in 2019 was 9.2 percent (29.6 million) when they conducted the survey, up from 8.9 percent in 2018. In 2019, 8 percent of people, or 26.1 million, did not have health insurance at any point during the year.  

That is a number that has undoubtedly gone up significantly since the COVID-19 pandemic and subsequent recession. In fact, data science consultancy firm, Civis Analytics recently released a report that reveals approximately 6.7 million more people lost their health insurance during the pandemic from February to September.  

Their estimates have the uninsured population around 36 million people as of September 2020. In 2010, according to the Census Bureau, the uninsured rate was 15 percent nationally before the Affordable Care Act was put into place. For vulnerable communities, the problem is even more pronounced.  

When you peel back the data, you see that there are groups, Black and Latinx communities for instance, that have seen a more disproportionate increase in their uninsured status over the last six months,” said Crystal Son, Director of Applied Data Science and Healthcare Analytics at Civis Analytics during a webcast hosted by Civis and Finn Partners.  

In fact, according to Civis’ data, more than a quarter (26 percent) of Black Americans were uninsured by September rising steadily from 17 percent in February and 21 percent in June. By comparison, 11 percent of white Americans were uninsured in February, rising only slightly to 12.5 percent in June and actually dipping to 12 percent in September. 

These trends correlate with the numbers from the Census Bureau. For the Hispanic community, 16.7 percent were without health insurance coverage at all in 2019. It was 9.6 percent for Black Americans, 6.2 percent for the Asian Americans, and 5.2 percent for the White Americans. 

Avalere, a health care consulting firm, released its own analysis that predicts at least 1 million Asian, 2 million Black, and 3 million Hispanic people are likely to lose their employer-sponsored health insurance in 2020.  

“This is going to make things worse, but we weren’t starting out from a great place before,” said Chris Sloan, Associate Principal, Avalere Health, during the webcast. “Black and Hispanic communities already had higher rates of not being insured, they had higher rates in Medicaid. Things are getting worse, but they’re compounding the historical issues we’ve already had.” 

The Census data backs up Sloan’s point. Before the pandemic, between 2018 and 2019, Hispanics experienced the largest change in uninsured rates among race and Hispanic origin groups, increasing from 17.9 percent in 2018 to 18.7 percent in 2019 

Other data on the uninsured  

Not surprisingly, the Census data found that the uninsured rate in 2019 was highest among people in poverty (living below 100 percent of their poverty threshold) at 15.9 percent. For those living at or above 400 percent of poverty had the lowest uninsured rate (3.0 percent). 

The Census data also compared uninsured rates by State. The percentage of people without health insurance at the time of interview in each state ranged from 3.0 percent (Massachusetts) to 18.4 percent (Texas)Five states and the District of Columbia had an uninsured rate of less than 5.0 percent, and seven states had an uninsured rate of 12.0 percent 

The Civis data looked at age in terms of uninsured trends: 17 percent in the 18-26-year-old population in February were uninsured to 27 percent in September, compared to 11 percent in the 50-64-year-old population in February to 12 percent in SeptemberCivis also found that 46 percent of respondents without health insurance said in September that they don’t plan to purchase it this year, up from 33 percent in February 2020. This presents a potential problem for payers.  

“Payers are dealing with enrollment issues. Enrollment of health plans are down and it’s been the white whale of the health insurance industry on how to get people into a plan, particularly young people. A high percentage of job loss has been 18 to 34 year olds, they have the highest unemployment rates and those are the people who are least likely to think they need health insurance,” Sloan says.  

About the Author

Gabriel Perna, Senior Manager, Digital Content

Gabriel Perna is the Senior Manager of Digital Content at Health Evolution. He brings 10+ years of experience in covering the intersection of health care and business. Previously, he was at Chief Executive, Physicians Practice and Healthcare Informatics. You can reach him via email at or on Twitter at @GabrielSPerna