Almost 21% of adults were uninsured in states that failed to expand Medicaid, compared to about 10% of adults in expansion states.
Despite the job losses spurred by the COVID-19 pandemic, the number of uninsured Americans dropped in 2020 when compared to 2019, according to the Centers for Disease Control and Prevention.
Last year, 31.6 million people, or 9.7% of the population, had no insurance. In 2019, 33.2 million people, or 10.3% of the population, were uninsured.
Adults between the ages of 18 and 64 were most likely to be uninsured, with almost 14% having no insurance in 2020. That compares to about 5% of children with no insurance, and less than 1% of seniors who were uninsured.
For adults aged 18 to 64, private insurance coverage actually ticked up, from 66.8% in 2019 to 67.5% in 2020. Public coverage remained flat, going from 20.4% in 2019 to 20.5% last year.
But differences in uninsured rates were dramatic between states that have expanded Medicaid and those that have not.
Almost 21% of adults were uninsured in states that failed to expand Medicaid, compared to about 10% of adults in expansion states.
Those in non-expansion states were also less likely to have private health insurance coverage. In expansion states, more than 69% of adults had private insurance, compared to more than 64% in non-expansion states.
About 8.6 million adults obtained private health insurance through the federal or state-run health exchanges set up under the Affordable Care Act.
Differences in insurance coverage were stark when examined by race. Nearly 30% of Hispanic adults and almost 15% of blacks had no insurance. That compares to about 9% of non-Hispanic whites and Asians.
The COVID-19 pandemic has shone a spotlight on racial and ethnic disparities. Blacks and Hispanics are 2.8 times more likely than whites to be hospitalized because of COVID-19, according to the CDC. Blacks are twice as likely to die from the virus, and Hispanics are 2.3 times more likely to die.
Social determinants of health such as access to healthcare, socioeconomic status and occupation all can play a role in health outcomes after exposure to COVID-19.
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