Government stats show number of uninsured declined in 2022, though experts question methodology, conclusion

The number of uninsured individuals dropped slightly in 2022, with 8.4% or 27.6 million people of all ages in the U.S. falling into that category compared to 9.2% or 30 million in 2021, according to initial estimates (PDF) from the National Center for Health Statistics (NCHS).

The data, from surveys of 27,654 adults and 7,464 children taken throughout 2022, also show that 12.2% of adults aged 18 to 64 were uninsured, while 22% in that age group had public coverage, and 67.8% had private health insurance.

Among children from birth to 17 years old, 4.2% were uninsured, 43.7% had public coverage and 54.3% had private health insurance coverage.

The report found that among non-Hispanic white adults aged 18 to 64, the percentage of uninsured people declined from 10.5% in 2019 to 7.4% in 2022. Meanwhile, people under 65 who purchased coverage on the Affordable Care Act (ACA) exchanges rose from 3.7% in 2019 to 4.3% in 2022.

Richard Stefanacci, D.O., of the Jefferson College of Population Health at Thomas Jefferson University, told Fierce Healthcare that the NCHS report leaves too much out. 

“In population health, the uninsured is something we very much focus on,” said Stefanacci. “A great deal is missing here. There’s no information on non-U.S. civilians, which is a major issue for some health systems caring for this uninsured population.”

Stefanacci said that ages 18 to 64 is too broad a classification. The group that's most likely to be uninsured is people aged 26 to 30, he said, as they no longer qualify for expanded coverage to age 26 and may either not have access to coverage at work or choose to go without.

In addition, the NCHS report provides no information on the underinsured and therefore lacks data on the “increasing population buying catastrophic coverage which often times results in lower screening or preventive care.”

Paul Ginsburg, Ph.D., a senior fellow at the USC Schaeffer Center, told Fierce Healthcare in an email that he’s not surprised that the number of uninsured declined in 2022, saying that the American Rescue Plan Act of 2021 doled out larger subsidies allowing more people to buy insurance on the ACA exchanges, and the Inflation Reduction Act extends that process. In addition, Ginsburg cites the strong labor market and low rates of unemployment.

“Some of the stability that you see in recent years is from the ACA making insurance less cyclical,” Ginsburg said. “If unemployment increases, more who lose job-based coverage will be able to gain insurance from Medicaid (in expansion states) and through the ACA marketplaces. So, the uninsured rate is likely to be a lot more stable going forward.”

NCHS researchers worked around COVID constrictions while gathering their data.

“Due to the COVID-19 pandemic, data collection switched to a telephone-only mode beginning March 19, 2020,” the report said. “Personal visits (with telephone attempts first) resumed in all areas in September 2020. In addition, from August through December 2020, a subsample of adult respondents who completed the National Health Interview Survey in 2019 were recontacted by telephone and asked to participate again.”

The authors also note that response rates were lower and “respondent characteristics” differed from April to December of 2020 than in previous surveys, and those differences may have influenced the findings.

Kevin Kavanagh, M.D., founder and president of the patient advocacy organization Health Watch USA, told Fierce Healthcare in an email that “healthcare marketplace plans will end the pandemic’s special enrollment period and will no longer maintain coverage if premiums cannot be paid. Unfortunately, I expect the rate of uninsured to increase in the United States as the PHE provisions are lost and those disabled with long COVID lose their employer’s private coverage but do not yet qualify for disability in Medicare.”

Arjun K. Venkatesh, M.D., professor of emergency medicine and chairperson of the department of emergency medicine at Yale University who was not involved with the NCHS report, told Fierce Healthcare in an email that “after steady year-over-year improvements in insurance coverage through the pandemic there are three gaps that remain—first lower income adults who may just be above Medicaid income requirements remain persistently at highest risk of [lack of] insurance, second any recent improvements in coverage had minimal effect on race- or ethnicity-based disparities in access, and third too many Americans remain uninsured a decade after passage of the ACA putting millions at risk of premature disease and even mortality.”  

Hispanic adults were most likely to lack health insurance coverage (27.6%) in 2022, followed by Black adults (13.3%), according to the NCHS report. Asian adults and white adults had the lowest percentage of uninsured, 7.1% and 7.4%, respectively.

“Among white adults aged 18–64, the percentage who were uninsured decreased from 8.7% in 2021 to 7.4% in 2022,” the report states. “Among Hispanic and Black adults aged 18–64, the observed decreases in the percentage of uninsured from 2021 to 2022 were not significant.”

Kavanagh said that Hispanic and Black patients are “also the racial groups which predominate in many of our frontline occupations and are at high risk for COVID-19. The ending of the PHE does not mean the ending of COVID. Adequate insurance coverage of minorities and economically disadvantaged populations is of utmost importance.”

Among adults aged 18 to 64, 22.7% had family incomes of less than 100% of the federal poverty level (FPL). They were followed by those with 100% to less than 200% of the FPL (22.3%), 200% to 400% of the FPL (14.2%) and above 400% of the FPL (4.1%).

“No significant differences were observed in the percentage of adults who were uninsured from 2021 to 2022 for any of the family income subgroups shown,” the report states. “Among adults aged 18–64 with family incomes from 100% to less than 200% FPL, the percentage who were uninsured decreased from 26.8% in 2019 to 22.3% in 2022. The observed decreases from 2019 to 2022 in the percentage of uninsured adults aged 18–64 with family incomes less than 100% FPL, at 200%–400% FPL, and greater than 400% FPL were not significant.”

Federal Poverty Level
Federal Poverty Level for 2021 and 2022 (Department of Health and Human Services)