Healthcare Insurance Coverage in Pennsylvania: 2010 to 2017
In 2010, just over 1.25 million (12.1%) of Pennsylvanians lacked healthcare insurance coverage according to the U.S. Census Bureau’s Small Area Health Insurance Estimates (SAHIE). Coverage under the new healthcare exchange created by the Affordable Healthcare Act went into effect in 2014 and the next year Governor Tom Wolf chose to expand Medicaid in Pennsylvania.
Medicaid expansion made any family with an income-to-poverty ratio (IPR) of 138 percent or lower eligible for federally funded insurance through Medicaid. By 2017, only 674,739 (6.6%) of Pennsylvanians remained uncovered.
Figure 1. Percentage of Pennsylvanians lacking healthcare insurance coverage, 2010 to 2017.
The number of Pennsylvanians under 65 years of age lacking healthcare insurance coverage decreased by 46.2 percent from 2010 to 2017. Most of the decline, approximately 64.3 percent, occurred after the opening of the exchange.
Trends in the Uninsured Population by Age Cohort
The SAHIE program includes only individuals 64 years of age and younger as persons 65 years of age and older are very likely to have their healthcare insurance covered by Medicare (99.5% ). Of individuals under 65 years of age, children under 18 years of age typically have the lowest rates of uninsured persons in Pennsylvania due to the Children’s Health Insurance Program (CHIP).
From 2010 to 2017, the rate of uninsured children peaked in 2011 at 5.4 percent. The 18 to 39 years of age cohort had the highest rate of uninsured Pennsylvanians between 2010 and 2017 and peaked at 20.1 percent in 2010. The rate of uninsured persons age 40 to 49 years peaked in 2011 at 13.1 percent while the rate of uninsured person age 50 to 64 peaked in 2011 and 2012 at 9.6 percent.
Figure 2. Percentage of Pennsylvanians lacking health insurance coverage by age cohort.
The number of uninsured persons age 40 to 49 years had the highest decrease (52.5%) since 2010 while those uninsured and under 18 years of age decreased by the least (19.9%). By 2017, only 4.3 percent of persons under 18 years of age and 5.0 percent of persons 50 to 64 years of age were uninsured while 9.5 percent of those 18 to 39 years of age remained uninsured.
Trends in the Uninsured Population by Sex
Men are more likely than women to be uninsured in Pennsylvania due to a variety of factors including higher percentages of poverty among women and increased eligibility in programs like Medicaid for expecting and existing mothers. From 2010 to 2017 the rate of uninsured men peaked in 2010 at 13.3 percent and for women in 2010 and 2011 at 10.8 percent.
Figure 3. Percentage of Pennsylvanians lacking health insurance coverage by sex.
The number of uninsured men decreased by 44.1 percent while the number of uninsured women decreased by 48.8 percent since 2010. By 2017, only 7.6 percent of men and 5.7 percent of women in Pennsylvania still lacked health insurance. Pennsylvanian men, who accounted for 54.8 percent of uninsured persons in 2010, were approximately 56.9 percent of the uninsured persons in 2017.
Trends in the Uninsured Population Race and Hispanic Origin
Non-Hispanic white Pennsylvanians had the lowest rate of uninsured persons compared to non-Hispanic black residents and those of Hispanic origin. The rate of uninsured was highest for non-Hispanic white residents in 2010 and 2011 at 10.4 percent, for non-Hispanic black residents in 2010 at 16.1 percent, and for those of Hispanic or Latino origin in 2011 at 23.3 percent.
Figure 4. Percentage of Pennsylvanians lacking health insurance coverage by race and Hispanic origin.
The number of uninsured Hispanic or Latino residents of any race decreased by just 22.8 percent since 2010 while the number of uninsured non-Hispanic white and non-Hispanic black residents experienced was halved (-48.7% and -53.8%, respectively). By 2017, approximately 13.7 percent of Hispanic or Latino residents of any race were uninsured compared to 5.7 percent of non-Hispanic white and 7.4 percent of non-Hispanic black residents.
Trends in the Uninsured Population by Income
The Federal Poverty Level (FPL) is a measure of income used to define poverty based on characteristics like household size, and it is used to determine eligibility in programs like Medicaid or CHIP and savings through the exchange. Family income is usually divided by the poverty level to determine a family’s Income-to-Poverty Ratio (IPR). The SAHIE program contains data for the number of uninsured persons under several IPR scenarios including:
- At or Below 138% of FPL: Families and individuals in this category can qualify for expanded Medicaid
- At or Below 250% of FPL: Used to determine eligibility in CHIP and CDC’s NBCCEDP
- At or Below 400% of FPL: Families and individuals in this category may qualify for subsides in the exchange
This analysis will compare individuals at or below 138 percent of the Federal Poverty Level to individuals at or below 400 percent of the Federal Poverty Level. Just under a fifth (19.9%) of Pennsylvanians have an IPR of 138 percent or less while approximately 59.8 percent have an IPR of 400 percent or less .
For a household with two persons, the 2017 Federal Poverty Level was approximately $16,240. That means that those at the 138 percent benchmark would have to have a household income of $22,411 or less while those at the 400 percent benchmark would have to make $64,960 or less.
Figure 5. Percentage of Pennsylvanians lacking health insurance coverage by income.
Individuals in the 138 percent IPR cohort had the highest uninsured rate from 2010 to 2017 with the peak in their uninsured rate occurring in 2011 at 22.6 percent. Those in the 400 percent IPR cohort were the least likely to be uninsured from 2010 to 2017 with their peak uninsured rate occurring in 2010 and 2011 at 16.8 percent.
The number of uninsured persons in the 138 percent IPR cohort decreased by 56.7 percent since 2010. The number of uninsured individuals in the 400 percent IPR cohort decreased by 48.8 percent during that time. By 2017, 11.0 percent of the 138 percent IPR cohort and 9.4 percent of the 400 percent IPR cohort remained uninsured.
Trends in the Uninsured Population by County
Lancaster County had the highest rate of uninsured persons in the state in 2017 at 12.0 percent, followed by Philadelphia County (9.7%) and Franklin County (9.4%). Lancaster County also had the highest uninsured rates for women (11.3%), children under 18 years of age (13.9%), and individuals with incomes at 400% or higher than the poverty level.
Chester County had the highest rate among individuals with IPRs of 138 percent. Mifflin County had the highest rate among those 40 to 49 years of age, and Wayne County had the highest rate among those age 50 to 64 years of age.
Butler County had the lowest rate of uninsured persons in the state in 2017 at 4.5 percent. Butler also had the lowest rates among females and those 18 to 39 years of age. Other counties that ranked lowest included Cambria County for both IPR categories (138 percent and 400 percent), Montgomery County (for males and those 40 to 49 years of age), Westmoreland County (for those under 18 years of age), and Montour County (for those 50 to 64 years of age).
How did rates in healthcare insurance vary by age, sex, and income-to-poverty ratio in Pennsylvania’s other counties? Find out in our interactive dashboard below! Note: Race data is not available below the state level.
Click here to explore the Pennsylvania County Healthcare Coverage Dashboard.