National Uninsured Rate Reaches All-Time Low in Early 2022

August 2022

DATA POINT

HP-2022-23

National Uninsured Rate

Reaches All-Time Low in Early 2022

The uninsured rate in early 2022 has reached an all-time low of 8.0% among all U.S.

residents, indicating that 5.2 million people have gained health insurance coverage

since 2020.

Aiden Lee, Joel Ruhter, Christie Peters, Nancy De Lew, Benjamin D. Sommers

KEY POINTS

• The nation’s uninsured rate declined significantly in 2021 and early 2022, reaching an all-time low

of 8.0 percent for U.S. residents of all ages in the first quarter (January-March) of 2022, based on

new data from the National Health Interview Survey.

• Approximately 5.2 million people – including 4.1 million adults ages 18-64 and 1 million children

ages 0-17 – have gained health coverage since 2020. These gains in health insurance coverage

are concurrent with the implementation of the American Rescue Plan’s enhanced Marketplace

subsidies, the continuous enrollment provision in Medicaid, several recent state Medicaid

expansions, and substantial enrollment outreach by the Biden-Harris Administration in 2021-

2022.

• Uninsured rates among adults ages 18-64 declined from 14.5 percent in late 2020 to 11.8 percent

in early 2022. The uninsured rate among children ages 0-17, which had increased during 2019

and 2020, fell from 6.4 percent in late 2020 to 3.7 percent in early 2022.

• Approximately 5.4 percent of adults 18-64 reported having Marketplace coverage in early 2022

compared to 4.4 percent in 2020, reflecting approximately 2 million additional adult Marketplace

enrollees – roughly half of the 4 million adults who gained health coverage over this period.

• Changes in uninsured rates from 2020 to 2022 were largest among individuals with incomes

below 100% of the Federal Poverty Level (FPL) and incomes between 200% and 400% FPL.

• State-specific analyses using the American Community Survey show that the largest changes in

the uninsured rate for low-income adults between 2018-2020 generally occurred in states that

recently expanded Medicaid. More recent state estimates beyond 2020 are not yet available.

• Overall, these results highlight the significant gains in health insurance coverage that occurred in

2021 and early 2022 associated with the Biden-Harris Administration’s policies to support health

insurance expansion. These gains build on the large reductions in the uninsured rate that

occurred after the implementation of the Affordable Care Act (ACA) in 2014, which research

demonstrates produced improved health outcomes, better access to care, and improved financial

security for families.

August 2022

DATA POINT

BACKGROUND

Newly-released federal survey data show the uninsured rate reached an all-time low in early 2022 and suggest

that the Biden-Harris Administration’s efforts to improve access to affordable health insurance coverage have

helped reduce the nation’s uninsured rate in 2021 and early 2022.

Previous reports indicate that health

coverage enrollment related to the Affordable Care Act (ACA) – Marketplace, Medicaid expansion, and the

Basic Health Program – reached an all-time high of more than 35 million people in late 2021/early 2022.

The

2022 Open Enrollment Period saw an all-time high in Marketplace sign-ups of 14.5 million, following

administrative and legislative actions such as an extended 2021 special enrollment period and implementation

of expanded Marketplace subsidies under the American Rescue Plan (ARP).

In addition, recent adoption of

the ACA Medicaid expansion in several states has extended Medicaid coverage to low-income adults up to

138% of the Federal Poverty Level (FPL).

This Data Point examines new National Health Interview Survey (NHIS) data for the first quarter of 2022 to

assess changes in health insurance coverage. The report also examines data from the American Community

Survey (ACS) to analyze state-level uninsured rates for low-income adults, particularly with respect to states

that have expanded Medicaid since 2018.

METHODS

We analyzed newly-released NHIS data from the Centers for Disease Control and Prevention’s (CDC).

Data are

based on household interviews of a sample of the civilian noninstitutionalized population. The NHIS provides a

reliable and consistent data source for assessing long-term changes in coverage, as indicated in a 2014

assessment by the White House Council of Economic Advisors.

NHIS results in 2020 may not be as reliable for

comparisons to survey results before the pandemic, though response rates in 2021 and 2022 have more

closely resembled pre-pandemic levels; more details on NHIS data collection can be found in a previous ASPE

report.

We analyzed changes in coverage over time by age group and income group, as well as source of

health insurance coverage.

We also analyzed ACS Public Use Microdata Sample (PUMS) 1-year data to estimate state-level changes in

coverage for low-income adults from 2018 to 2020, as the NHIS does not have samples sizes to allow for state

estimates for all states.

Several states have expanded Medicaid in the past few years, and a comparison of

low-income adults’ uninsured rates from 2018 to 2020 in these states can provide some indication of

expansion effects in these states.

FINDINGS

National Results

Figure 1 shows the national uninsured rates for the U.S. population (all ages) from 2000 through the most

recent data. The uninsured rate for Q1 2022 was 8.0 percent, the lowest uninsured rate ever recorded in the

NHIS.

Prior to 2022, the lowest full-year uninsured estimate in the NHIS was 9.0 percent in 2016, and the

lowest quarterly estimate was 8.6 percent in Q1 2016 (note that quarterly estimates are somewhat more

_______________________

We note that the ACS is not as timely as NHIS, and there are survey quality issues in 2020 due to the COVID-19 pandemic. The 2020

ACS 1-year data products do not meet the Census Bureau’s statistical data quality standards, and instead the Census Bureau released

experimental estimates from the 1-year 2020 ACS data; we use those experimental data products for our analysis in this report.

August 2022

DATA POINT

volatile than full year estimates, given their smaller sample sizes).

8†

The new results correspond to 26.4 million

uninsured individuals in Q1 2022, compared to an annual estimate of 31.6 million for 2020, indicating that

approximately 5.2 million people gained health care coverage during this time period.

This is a conservative

estimate of the number of people who gained coverage since 2020, since uninsured rates rose in the second

half of 2020; if we compare the Q1 2022 estimate to Q4 2020, the estimated number gaining coverage rises to

7.2 million.

Figure 1 demonstrates that the recent reductions in the uninsured rate built on the large coverage gains that

occurred in the first 3 years after implementation of the ACA in 2014 and reversed a temporary increase in the

uninsured rate from 2017-2019. Overall, the Q1 2022 uninsured population represents a drop of nearly 22

million from the peak of 48.3 million in 2010.

Figure 1. National Uninsured Rate, All Ages (2000 – Q1 2022)

Source: National Health Interview Survey’s Health Insurance Coverage Reports, 2000-2021.

https://www.cdc.gov/nchs/nhis/healthinsurancecoverage.htm; Health Insurance Coverage: Early Release of Quarterly Estimates From

the National Health Interview Survey, January 2021–March 2022.

https://www.cdc.gov/nchs/data/nhis/earlyrelease/Quarterly_Estimates_2022_Q11.pdf

Note: Beginning in the third quarter of 2004, two additional questions were added to the NHIS insurance section to reduce potential

errors in reporting Medicare and Medicaid status, resulting in two methods to estimate uninsurance. Beginning in 2005, all estimates

were calculated using Method 2. Please see “Technical Notes” for the Early Release of Health Insurance Estimates Based on Data From

the 2010 National Health Interview Survey for more information.

Figure 2 shows quarterly changes in health insurance coverage among adults ages 18-64, for whom the

uninsured rate was 11.8 percent in Q1 2022, a 2.7 percentage-point decrease from Q4 2020. Children ages 0

to 17 years also experienced a 2.7 percentage-point decrease in their uninsured rates in the same time frame.

If we focus on full-year estimates for 2020 vs. Q1 2022, the change for adults ages 18-64 was 2.1 percentage

_______________________

†

The NHIS underwent a survey redesign in 2019. While the questions used to assess health insurance coverage did not change, the

questionnaire design and sample weighting were revised. A technical paper conducted by the National Center for Health Statistics

concluded that the redesign “may have shifted upward by 0.7 percentage points due to the methodological change” the national

estimate for the uninsured rate among adults. This upward shift since 2019 means that the Q1 2022 uninsured estimate of 8.0

percent likely represents a record-low by an even larger margin than the 0.6 percentage points compared to Q1 2016 and 1.1

percentage points compared to full-year 2016. See https://www.cdc.gov/nchs/data/nhis/earlyrelease/EReval202009-508.pdf for

further details on the NHIS redesign.

14.9%

(41.3M)

16.0%

(48.3M)

8.0%

(26.4M)

10%

12%

14%

16%

18%

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 Q1

2022

ACA

Takes

Effect

ARP

Takes

Effect

August 2022

DATA POINT

points (from 13.9 percent to 11.8 percent) with approximately 4.1 million adults gaining health coverage, and

the change for children was 1.4 percentage points (from 5.1 percent to 3.7 percent) with approximately 1

million children gaining health coverage.

Figure 2. Uninsured Rate by Quarter, Populations Ages 18-64 and Ages 0-17 (Q4 2020 – Q1 2022)

Source: Health Insurance Coverage: Early Release of Quarterly Estimates From the National Health Interview Survey, October 2020–

December 2021. https://www.cdc.gov/nchs/data/nhis/earlyrelease/Quarterly_Estimates_2021_Q14.pdf; Health Insurance Coverage:

Early Release of Quarterly Estimates From the National Health Interview Survey, January 2021–March 2022.

https://www.cdc.gov/nchs/data/nhis/earlyrelease/Quarterly_Estimates_2022_Q11.pdf

Figure 3 shows the growth in Marketplace coverage (or “Exchange-based private coverage,” as the NHIS refers

to it) among adults 18-64 since 2019. An estimated 5.4 percent of adults ages 18-64 reported having

Marketplace coverage in early 2022, compared to 4.4 percent in 2019. This represents an increase of

approximately 2 million adults, or roughly half of the estimated reduction in the adult uninsured population

during this period. While survey-based information on Marketplace coverage is not as reliable as official

administrative enrollment statistics, this result is consistent with the record-breaking Marketplace Open

Enrollment Period for 2022

and suggests that Marketplace coverage gains in 2021 and early 2022 were a

substantial contributor to the reduction in the uninsured rate.

14.5%

13.8%

14.2%

13.0%

13.1%

11.8%

6.4%

4.6%

4.2% 4.2%

3.5%

3.7%

10%

12%

14%

16%

Q4 2020 Q1 2021 Q2 2021 Q3 2021 Q4 2021 Q1 2022

18-64 Years

0-17 Years

August 2022

DATA POINT

Figure 3. Percentage of Adults Ages 18-64 with Marketplace Coverage (2019 – Q1 2022)

Source: NHIS Interactive Quarterly Early Release Estimates.

https://wwwn.cdc.gov/NHISDataQueryTool/ER_Quarterly/index_quarterly.html

Figure 4 shows that uninsured rates among those under age 65 declined for all income bands since the

beginning of 2021. Those with incomes below 100% FPL had the greatest gain in coverage, with uninsured

rates decreasing 4.5 percentage points (from 20.0 to 15.5 percent). Uninsured rates for those between 100%

and 200% FPL went from 16.6 to 16.0 percent, though when compared to Q2 2021, there was a larger decline

from 19.0 to 16.0 percent. Uninsured rates for those with incomes between 200% and 400% FPL decreased

2.0 percentage points (from 11.7 in Q1 2021 to 9.7 percent in Q1 2022). Those with incomes above 400% FPL

had the lowest uninsured rate throughout the study period, and it declined modestly from 4.2 to 3.7 percent.

In relative terms, these declines represent a 22 percent reduction in the uninsured rate for those below 100%

FPL, a 16 percent reduction for those between 100% and 200% FPL (compared to Q2 2021), a 17 percent

reduction for those between 200% and 400% FPL, and a 12 percent reduction for those above 400% FPL.

These declines in uninsured rates coincide with the implementation of the ARP subsidies, which were

retroactive to January 1, 2021, and boosted the size of premium tax credits for those with incomes between

100% and 400% FPL and extended tax credits to those with incomes above 400% FPL for the first time.

Previous ASPE analyses have shown the impacts of the ARP in lowering Marketplace premiums and improving

plan affordability through increased access to zero- and low-premium plans on the HealthCare.gov

platform.

August 2022

DATA POINT

Figure 4. Uninsured Rate Among U.S. Residents Under Age 65, by Income (Q1 2021 – Q1 2022)

Note: FPL = Federal Poverty Level.

Source: Health Insurance Coverage: Early Release of Quarterly Estimates From the National Health Interview Survey, January 2021–

March 2022. https://www.cdc.gov/nchs/data/nhis/earlyrelease/Quarterly_Estimates_2022_Q11.pdf

State Results

Turning to state-specific analyses using the ACS, Table 1 shows state-level changes in uninsured rates for low-

income adults ages 18-64 from 2018 to 2020. 18 states saw uninsured rates for this population decrease over

this period, with decreases ranging from -0.1 percentage points to -8.4 percentage points. Fifteen of the 18

states experiencing declining uninsured rates have expanded Medicaid. Uninsured rates declined in all 5 states

that expanded Medicaid in 2019-2020, with decreases ranging from -1.4 percentage points (Utah) to -8.4

percentage points (Idaho). Future analyses of the 2 states that expanded Medicaid in 2021 (Missouri and

Oklahoma) are needed to continue monitoring the coverage impacts of expansion.

20.0%

15.5%

16.6%

16.0%

11.7%

9.7%

4.2%

3.7%

10%

15%

20%

25%

Q1 2021 Q2 2021 Q3 2021 Q4 2021 Q1 2022

<100% FPL

100% to < 200% FPL

200% to ≤400% FPL

>400% FPL

August 2022

DATA POINT

Table 1. Uninsured Rates by State Among Adults Ages 19-64, with Incomes Under 138% FPL, 2018 vs. 2020

Medicaid

Expansion Year

Sample Size

for 2020

2018

2020*

Percentage Point

Change, 2018 vs. 2020

Alabama

n/a

6,734

31.9%

32.2%

0.3%

Alaska

2015

1,078

24.7%

25.2%

0.5%

Arizona

2014

7,844

25.2%

26.5%

1.4%

Arkansas

2014

4,430

22.0%

22.8%

0.9%

California

2014

45,611

17.0%

17.4%

0.4%

Colorado

2014

5,362

18.1%

21.2%

3.1%

Connecticut

2014

3,400

12.7%

11.5%

-1.2%

Delaware

2014

961

11.8%

17.7%

5.9%

District of Columbia

2014

980

8.6%

4.5%

-4.1%

Florida

n/a

19,862

34.1%

34.0%

-0.1%

Georgia

n/a

10,803

37.8%

36.9%

-0.9%

Hawaii

2014

2,108

13.3%

10.3%

-3.0%

Idaho

2020

2,023

28.2%

19.7%

-8.4%

Illinois

2014

15,190

18.8%

19.2%

0.4%

Indiana

2015

8,207

20.6%

17.3%

-3.3%

Iowa

2014

3,884

13.5%

15.3%

1.7%

Kansas

n/a

3,605

28.2%

29.6%

1.3%

Kentucky

2014

6,387

13.1%

0.0%

Louisiana

2016

6,017

19.0%

19.5%

0.5%

Maine

2019

1,610

21.3%

16.5%

-4.9%

Maryland

2014

5,942

16.7%

15.7%

-1.1%

Massachusetts

2014

7,514

6.7%

7.4%

0.6%

Michigan

2014

13,189

13.9%

14.1%

0.2%

Minnesota

2014

5,051

11.9%

13.6%

1.6%

Mississippi

n/a

4,220

36.4%

32.2%

-4.3%

Missouri

2021

8,164

27.7%

29.4%

1.7%

Montana

2016

1,374

17.1%

16.5%

-0.6%

Nebraska

2020

2,122

27.9%

25.2%

-2.8%

Nevada

2014

3,321

25.7%

28.5%

2.8%

New Hampshire

2014

1,231

15.9%

0.0%

New Jersey

2014

8,156

21.0%

21.1%

0.0%

New Mexico

2014

2,962

19.4%

17.4%

-2.0%

New York

2014

25,769

12.0%

11.9%

-0.2%

North Carolina

n/a

11,696

30.3%

31.2%

0.9%

North Dakota

2014

755

19.8%

20.4%

0.6%

Ohio

2014

14,187

16.2%

15.5%

-0.7%

Oklahoma

2021

6,632

37.5%

40.3%

2.9%

Oregon

2014

4,416

16.8%

0.0%

Pennsylvania

2015

16,687

15.2%

15.9%

0.7%

Rhode Island

2014

1,101

8.6%

9.5%

0.9%

South Carolina

n/a

6,161

30.0%

0.0%

South Dakota

n/a

1,006

31.3%

35.4%

4.1%

Tennessee

n/a

8,075

29.1%

29.6%

0.5%

Texas

n/a

28,235

44.6%

45.0%

0.4%

Utah

2020

3,484

25.0%

23.6%

-1.4%

Vermont

2014

808

6.1%

9.0%

2.8%

Virginia

2019

8,626

27.4%

20.1%

-7.2%

Washington

2014

7,229

16.8%

15.8%

-1.0%

West Virginia

2014

2,508

15.7%

16.8%

1.1%

Wisconsin

n/a

6,373

15.4%

16.7%

1.3%

Wyoming

n/a

569

27.3%

38.4%

11.1%

Notes: States in bold expanded Medicaid between 2018 and 2020.

*The 2020 ACS 1-year data products do not meet the Census Bureau’s statistical data quality standards. The Census Bureau released

experimental estimates from the 1-year 2020 ACS data, which were used for this analysis; results from the experimental estimates

August 2022

DATA POINT

should be interpreted with caution. For more information, see: https://www.census.gov/newsroom/press-

releases/2021/experimental-2020-acs-1-year-data.html

Source: ASPE analysis of 2018 and 2020 American Community Survey (ACS) Public Use Microdata Sample (PUMS) 1-year data.

CONCLUSION

The Biden-Harris Administration took administrative and legislative actions in 2021 that have helped

individuals gain and maintain health coverage, including robust outreach efforts and expanded Marketplace

subsidies under the ARP. These health coverage gains build on the large reductions in the uninsured rate that

occurred after the implementation of the Affordable Care Act (ACA) in 2014. Medicaid enrollment has grown

under the continuous enrollment provision passed by Congress as part of the COVID-19 pandemic response, as

well as several states’ recent Medicaid expansions. With these policies in effect, the U.S. uninsured rate

declined throughout 2021 and early 2022, reaching an all-time low of 8.0 percent by the first quarter of 2022.

States that expanded Medicaid since 2019 have experienced a decrease in the uninsured rates among low-

income adults. Additional information on state-level changes will be available later this year after release of

the 2021 ACS.

Research over the past decade demonstrates that the ACA has produced improved health outcomes, better

access to care, and improved financial security for families.

Understanding the full nature of these

historic gains in health insurance coverage as a result of the ACA and the ARP will be critical to maintaining

high health coverage rates, assessing their impact on population health, and building on recent progress to

make health insurance affordable and available to all Americans. Future analyses will explore state-level

impacts as well as coverage changes by race and ethnicity and other demographic factors.

August 2022

DATA POINT

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DATA POINT

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August 2022

DATA POINT

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of the Assistant Secretary for Planning and Evaluation

200 Independence Avenue SW, Mailstop 447D

Washington, D.C. 20201

For more ASPE briefs and other publications, visit:

aspe.hhs.gov/reports

ABOUT THE AUTHORS

Aiden Lee is a Public Health Analyst in the Office of Health Policy in ASPE.

Joel Ruhter is an Analyst in the Office of Health Policy in ASPE.

Christie Peters is the Director of the Division of Health Care Access and Coverage for the Office of Health Policy in ASPE.

Nancy De Lew is the Associate Deputy Assistant Secretary of the Office of Health Policy in ASPE.

Benjamin D. Sommers is the Deputy Assistant Secretary of the

Office of Health Policy in ASPE.

SUGGESTED CITATION

Lee A, Ruhter J, Peters C, De Lew N, Sommers BD. National

Uninsured Rate Reaches All-Time Low in Early 2022. (Issue Brief

No. HP-2022-23). Office of the Assistant Secretary for Planning

and Evaluation, U.S. Department of Health and Human Services.

August 2022.

All material appearing in this report is in the public domain and

may be reproduced or copied without permission; citation as to

source, however, is appreciated.

DISCLOSURE

This communication was printed, published, or produced and

disseminated at U.S. taxpayer expense.

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HP-2022-23