HHS Attributes Record Low Uninsurance Rate to ACA Enrollment

Following the Affordable Care Act (ACA) open enrollment period that concluded in January 2023, the United States Department of Health and Human Services (HHS) reported that uninsurance among American adults plunged, breaking previous records.

The process of composing this report entailed an analysis of NHIS data from the Centers for Disease Control and Prevention (CDC). In doing so, researchers considered changes that took place among different age and income groups. HHS also reviewed data from the National Health Interview Survey and the American Community Survey (ACS).

Between 2020 and early 2023, 6.3 million people gained coverage. This contributed to the decline in uninsurance.

Research also indicated that among adults, uninsured rates fell from 14.5 percent in late 2020 to 11 percent in early 2023. Also, 4.4 percent of adults had marketplace coverage in 2020, which rose to 5.8 percent in early 2023. Among children, uninsured rates went from 6.4 percent in late 2020 to 4.2 percent in early 2023.

The report also indicated that the most noticeable changes in uninsured rates took place among those below 100 percent of the Federal Poverty Level (FPL).

These results are attributed to various factors. The enhanced Affordable Care Act subsidies through the American Rescue Plan and the Inflation Reduction Act which extended these subsidies may have played a role. Additionally, continuous enrollment in Medicaid, state Medicaid expansions, and increased enrollment outreach may have influenced the results.

“The Inflation Reduction Act has played a critical role in helping more Americans afford coverage through the Affordable Care Act. And this year, the nation's uninsured rate reached an all-time low, even breaking last year's record," said HHS Secretary Xavier Becerra in the press release. "HHS will continue to do everything we can to help Americans keep or get coverage and have access to quality, affordable health care.”

Despite these results, the report also noted that this is likely as low as the uninsured rate will get in 2023. Prior evidence indicates that the first quarter of the year generally contained the lowest uninsured rate.

Researchers witnessed a similar trend in 2022. According to data from the Assistance Secretary for Planning and Evaluation’s Office of Health Policy (ASPE), the national uninsurance rate fell to 8 percent in the first quarter of 2022. At the time, this was a record-breaking low.

At the time, research indicated that between 2020 and 2022, at least 5.2 million Americans gained healthcare coverage. Also, low uninsurance rates existed regardless of age and income during the first quarter of 2022.