Census data show health insurance coverage gains for Black workers and children in 2021, but we can go further with better policy


The number of workers with health insurance coverage grew between 2020 and 2021 as the economy recovered from the massive job losses associated with the coronavirus pandemic. Most people (91.7%) had health insurance coverage at some point during the year and the share of uninsured people fell from 8.6% in 2020 to 8.3% in 2021.  

Notably, the share of Black people who were uninsured fell from 10.4% in 2020 to 9.0% in 2021, marking a rare occurrence in which the Black uninsured rate fell below double digits.  

In 2021, most people (54.3%) had health insurance through an employer (either their own employer or a family member). The share of people with private health insurance of any kind (employment-based or through individual purchase) fell slightly to 66.0%, while the share of those with a public plan rose to 35.7% (note that coverage types are not mutually exclusive – one person can have two types of health insurance coverage).  

The drop in private coverage in 2021 came largely from rates falling among those aged 65 and older, while those under the age of 65 saw increased utilization of public health insurance, particularly Medicaid. This trend has been consistent throughout the pandemic as states expanded coverage in response to the federal “continuous coverage requirement,” where states that allow participants to maintain coverage even through a change in income eligibility saw an increased federal Medicaid match rate of up to 6.2%. In the previous measurement period before the pandemic (2018-2020), Medicaid coverage remained basically flat while private insurance coverage fell, which increased uninsurance rates among Black Americans and those living below the poverty line.1

 This expansion in public health insurance coverage drove the uninsurance rate down to 9.0% for Black people in 2021. Black children and working-age adults saw their uninsured rates fall significantly, from 5.9% to 4.3% for children and from 14.2% to 12.7% for adults. We can see consonant improvements in insurance rates in the South and for those living below the poverty line—all signs indicate the expansion in Medicaid enrollment eligibility through the public health emergency has had a significant, positive impact on health insurance coverage.

Expanded public health insurance coverage reduced Black uninsured rates in 2021: Uninsured rate by race and Hispanic origin, 2020 and 2021

 

Race 2020 2021
White, non-Hispanic 5.4% 5.2%
Black 10.4 9
Asian 5.9 6.2
Hispanic (any race) 18.3 18.3
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