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You are here: Home / Anderson On Health Insurance / Age distribution of uninsurance

Age distribution of uninsurance

by | 24 Comments

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The New England Journal of Medicine has a pretty cool graph of how the uninsurance rate has changed by age and by year:

What are some of the big drivers of this?

65+ is easy. People automatically qualify for either Medicare or Medicare Advantage. There is massive uptake as it is massively (and rightly) subsidized with significant late enrollment penalties.

Kids are pretty easy too. The first source of coverage for kids is employer sponsored insurance if one of their parents or guardians has it through work. But there is a comprehensive safety net in place. The CHIP program is awesome and it provides very good insurance to kids whose parents and guardians in the lower and middle middle class. Most states’ legacy Medicaid programs also covered kids up to the point where they qualified for either fully subsidized or mostly subsidized CHIP coverage. Medicaid usually covers between a third and half of all births in the states. There are a number of programs that create a reasonably effective if not particulary efficient wrap-around health care system for kids.

And then we get to the interesting area. Working age adults. Uninsurance rate decreases by age. This makes sense for three reasons. First, the primary source of coverage for working age adults is insurance through work. Low wage work and intermittent work is far less likely to offer insurance than medium or high wage steady work. Wages tend to increase as people age into middle age so the odds that a particular job with health insurance is filled by a 21 year old is significantly less than the odds it is filled by a 39 year old.

Secondly, a fall back system for older Americans is the disability system. People are more likely to either get on Medicaid for specific disease conditions or long term Medicare disability because incapacitating conditions are more likely to strike older people than younger people. There are 22 year olds on Medicaid for chronic conditions but they are swamped by 58 year olds.

Finally, motivation if a factor. A 62 year old is far more motivated to get insurance as they know that their hip is a bit rickety, that cancer runs in their family, that their breathing is a bit rough. A 22 year old in the prime of their life is far less likely to care as the relative risk of anything short of getting hit by a bus or suffering the consequences after saying “Dude, hold my beer and watch this” are very low. This calculation changes for young women due to pregnancy risk but it is similar.

As a side note, we should see the little jump at age 27 in uninsurance rates. That is the ACA at play there as people are moving off their parents’ insurance to uninsured.

Reader Interactions

24Comments

  1. 1.

    MomSense

    Do “kids” get to stay on their insurance until they turn 27 or do they need to enroll when they turn 26?

    ETA parents’ insurance plan

  4. 4.

    Kylroy

    @Major Major Major Major: Whatever the hell the Insurance company decided it was. After age 18, it usually required semiannual proof the kid was attending school or they’d be booted; even then, 23 was usually the cutoff.

  5. 5.

    Brachiator

    Very cool graph. Simple to comprehend. It easily shows the impact of ACA (liked that age 27 spike) and clearly demonstrates the impact of Medicare.

    The Democrats need to use more stuff like this to show what they have accomplished. Pundits would poke fun at him, but Ross Perot was great at explaining things simply and using graphics to get the point across.

    I wonder what the graph might have looked like in 1960 or 2000?

  6. 6.

    hugely

    Im curious to see how much the unensured rates affect GDP. I know Richard didnt create the graph but is there some simple correlation between better GDP when health care costs are contained through broader population being covered?

  13. 13.

    skerry

    A bit more on the under-65 Medicare participants: People are eligible to participate in Medicare only after 2 years of collecting SSDI (for a total of 29 months without eligibility due to the 5 month wait to receive SSDI after eligibility is established). There is no federal mandate to provide Medicare Advantage or supplemental insurance for these participants, so available benefits are set on a state-by-state basis. For example, I live in Maryland. I can purchase a supplemental policy (only one choice). If I move to DC, there is no supplemental policy available.

    A recent report by the Kaiser Family Foundation provides more details.

  14. 14.

    guachi

    A simple and elegant graph. I plan on sharing it on Facebook as it tells a lot in one picture.

    I have a joke for all of you:
    Knock, knock.
    Who’s there?
    Allah.
    Allah who?
    Allahu Akbar.

  15. 15.

    Calouste

    There are some small peaks in the chart at 40, 45, 50, and 55 in each of the three years measured (40 and 50 are more pronounced than 45 and 55). Those peaks don’t move with each year, as they would be if it was just the same group of people that was uninsured, as they would get a year older.

    So for some reason when people reach one of those 4 ages, they are likely to lose insurance, as there is a higher percentage of people with insurance in the age cohort just below. Does it mean that a lot of people get laid off when they hit 40 or 50?

  17. 17.

    KithKanan

    @MomSense: Depended entirely on the insurance company and the employer. I was able to stay on my Dad’s insurance until my 26th birthday in 2007, but he worked for a CA public agency with excellent benefits.

  18. 18.

    Brachiator

    @OzarkHillbilly:

    I’ll bet a state by state breakdown would be very enlightening.

    Some related information can be found here, Key Facts about the Uninsured Population

    Uninsured rates vary by state and by region, with individuals living in the South and West the most likely to be uninsured. The sixteen states with the highest uninsured rates in 2015 were all in the South and West (Figure 5 and Appendix A). This variation reflects different economic conditions, state expansion status, availability of employer-based coverage, and demographics

  19. 19.

    Another Holocene Human

    It looks like more people in their 20s relatively moved into the ranks of the insured than any other cohort so why is the news claiming that not enough youngin’s signed up for Obamacare and they’re dooming the system?

  21. 21.

    PowerMAD

    I have a somewhat off-topic question: What are the consequences (beyond the obvious gambling that nothing’s going to happen) of dropping health insurance for Nov/Dec, with the plan to re-up for January? I’m about to turn 61, unable to get a full-time job that pays anywhere near what I need to get by, so struggling to make it as a freelancer. My health is okay. Husband is about to turn 53, but he’s got some problems – nothing life threatening, but semi-chronic. A major client of mine has dried up w/o warning; I’ve got a couple new ones in the pipeline, but won’t be generating actual income until January. We have no financial resources left to tide us over. So I’m trying to weigh keeping health insurance vs. being able to pay other urgent bills (you know, things like electricity, mortgage, car insurance, etc.).

  22. 22.

    Mnemosyne

    @PowerMAD:

    I’m not an expert, but my instinct would be to call a Healthcare Navigator in your state and talk it over to figure out the best solution. There may be a way for you to temporarily switch to Medicaid for those two months if you don’t live in an asshole state that didn’t accept the Medicaid expansion, but it will depend on your state.

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