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Private Health Insurance Use Rises in States

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Private health insurers appear to be doing a better job of keeping, and adding, working-age adult enrollees in states that use than in other states.

Here’s what happened to private insurance coverage rates for adults ages 18 through 64 in the first half of this year, when compared with coverage rates for 2017:

Pure states: Increased to 69.2%, from 68.4%. partnership states: Increased to 73.7%, from 73.3%.

State-based exchange states: Fell to 67.9%, from 69.5%.

Analysts at the National Center for Health Statistics is an arm of the U.S. Centers for Disease Control and Prevention (CDC), have reported those figures in a new batch of data from the National Health Interview Survey (NHIS) program.

(Related: Moderate-Income Uninsured Market Is Booming: CDC Data)

The center runs the NHIS program to find out what’s happening in the U.S. health care system. The survey team collected information from about 39,000 people during the first half of 2018.

NHIS managers classify many different forms of as private health insurance. The definition includes individual or family coverage purchased through an Affordable Care Act public exchange as well as employer-sponsored coverage and individual coverage purchased outside the public exchange system.

Overall Insured and Uninsured Rates

The overall NHIS private health coverage use rate for U.S. residents ages 18 to 65 fell to 69.2% in the first half of this year, from 69.3% in 2017.

The NHIS uninsured rate for that age group fell to 12.5% in the first half of this year, from 12.8% in 2017.

Uninsured rates, by state type:

Pure states: Fell to 15.7%, from 16.2%. partnership states: Fell to 7.5%, from 8.9%.

State-based Exchange rates: Increased to 9.1%, from 8.7%.

The NHIS public health plan coverage rate for adults ages 18 to 64 increased to 20%, from 19.3%.

Public health plan coverage rates, by state type:

Pure states: Increased to 17%, from 16.7%. partnership states: Increased to 20.6%, from 19.6%.

State-based exchange rates: Increased to 24.7%, from 23.2%.

What is

The drafters of the Affordable Care Act wanted to create a family of “health insurance exchanges,” or web-based supermarkets for health coverage, to help people shop for high-quality private health plans on an apples-to-apples basis, and use government subsidies to pay for the coverage.

The Centers for Medicare and Medicaid Services (CMS) — an arm of the U.S. Department of Health and Human Services (HHS) — set up to provide ACA exchange programs in states that are unwilling or unable to provide all exchange services.

For 2019, is providing exchange plan enrollment services in 39 states.

In 32 states, the federal government handles all exchange-related services.

In seven “partnership” states — Arkansas, Delaware, Illinois, Iowa, Michigan, New Hampshire and West Virginia — states handle some exchange duties and the federal government handles other exchange duties. Most of those states have used ACA subsidies to expand access to their Medicaid and Children’s Health Insurance Program (CHIP) plans.

In California, New York, the District of Columbia and nine other jurisdictions, locally run exchange programs handle all exchange duties. All of those states have accepted ACA Medicaid and CHIP expansion funding.


The latest batch of NHIS health insurance coverage data is available here.

NHIS background information is available here.

The government does not copyright its survey data. Insurance agents and brokers can use the NHIS data on their websites and in social media campaigns free of charge.

— Read Middle-Income Consumers Drop Private Coverageon ThinkAdvisor.

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