Healthcare Insurance in Pennsylvania:
2010 to 2015
In 2010, just over 1.25 million (12.1 percent) of Pennsylvanians lacked healthcare insurance coverage according to the U.S. Census Bureau’s Small Area Health Insurance Estimates (SAHIE). By 2014 coverage under the new healthcare exchange created by the Affordable Healthcare Act went into effect and the next year Governor Tom Wolf chose to expand Medicaid in Pennsylvania which made any family with an income-to-poverty ratio (IPR) of 138 percent eligible for federally funded insurance through Medicaid. By 2015, only 786,343 (7.6 percent) of Pennsylvanians remained uncovered by healthcare insurance.
Percentage of Pennsylvanians Lacking Healthcare Insurance Coverage, 2010 to 2015
The percentage of Pennsylvanians under 65 years of age lacking healthcare insurance coverage decreased by 37.2 percent from 2010 to 2015. Most of the decline, however, occurred after the opening of the exchange as the rate of uninsured persons fell by 12.1 percent from 2013 to 2014 and another 25.5 percent from 2014 to 2015.
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 percent1). 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 2015, 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 2015 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.
Percentage of Pennsylvanians Lacking Healthcare Insurance Coverage by Age Cohort
The percentage of uninsured persons age 50 to 64 years had the highest decrease (40.0 percent) after the exchange while those under 18 years of age decreased by the least (22.8 percent). By 2015, only 4.1 percent of persons under 18 years of age and 5.7 percent of persons 50 to 64 years of age were uninsured while 11.6 percent of those 18 to 39 years of age remained uninsured.
Gender Trends in the Uninsured Population
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 2015 the rate of uninsured men peaked in 2010 at 13.3 percent and for women in 2010 and 2011 at 10.8 percent.
Percentage of Pennsylvanians Lacking Healthcare Insurance Coverage by Sex
The percentage of uninsured men decreased by 30.7 percent while the percentage of uninsured women decreased by 38.7 percent with the opening of the exchange and the expansion of Medicaid (2013-2015). By 2015, only 8.8 percent of men and 6.5 percent of women in Pennsylvania still lacked health insurance. Pennsylvanian men, who accounted for 54.8 percent of uninsured persons in 2010, were approximately 57.3 percent of the uninsured persons in 2015.
Racial Trends in the Uninsured Population
Non-Hispanic whites had the lowest rate of uninsured persons compared to non-Hispanic blacks and those of Hispanic origin. The rate of uninsured peaked for non-Hispanic whites in 2010 and 2011 at 10.4 percent, for non-Hispanic blacks in 2010 at 16.1 percent, and for those of Hispanic origin in 2011 at 23.3 percent.
Percentage of Pennsylvanians Lacking Healthcare Insurance Coverage by Race/Ethnicity
The percentage of uninsured non-Hispanic whites decreased by 34.7 percent from 2013 to 2015. The rate of uninsured non-Hispanic blacks and Hispanics of any race experienced declines of 34.8 percent and 30.0 percent, respectively, during that time. By 2015, only 6.4 percent of non-Hispanic whites were uninsured compared to 10.1 percent of non-Hispanic blacks and 15.9 percent of Hispanics of any race.
Income and Poverty-Based Trends in the Uninsured Population
The Federal Poverty Level (FPL) is a measure of income used to defined 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 idividuals 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 (19.8 percent) of Pennsylvanians have an IPR of 138 percent or less while approximately 62.2 percent have an IPR of 400 percent or less2. For a household with two persons, the 2015 Federal Poverty Level was approximately $15,930. That means that those at the 138 percent benchmark would have to have a household income of $21,983 or less while those at the 400 percent benchmark would have to make $63,720 or less.
Percentage of Pennsylvanians Lacking Healthcare Insurance Coverage by Income-to-Poverty Ratio
Individuals in the 138 percent IPR cohort were the most likely to be uninsured from 2010 to 2015 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 2015 with their peak uninsured rate occurring in 2010 and 2011 at 16.8 percent.
The percent of uninsured persons in the 138 percent IPR cohort decreased by 36.1 percent from 2013 to 2015 with the opening of the exchange and the expansion of Medicaid. The percent of uninsured individuals in the 400 percent IPR cohort decreased by 33.1 percent during that time. By 2015, 14.0 percent of the 138 percent IPR cohort and 10.9 percent of the 400 percent IPR cohort remained uninsured.
County Trends in the Uninsured Population
Philadelphia County had the highest rate of uninsured persons (16.5 percent) in 2010 followed by Sullivan County (15.9 percent) and Mifflin County (15.8 percent). Montgomery County (8.1 percent), Bucks County (8.8 percent), and Chester County (9.5 percent) had the lowest rates of uninsured residents.
Sullivan County had the highest percent decrease (48.0 percent) in the rate of uninsured persons after the exchange (2013 to 2015) followed by Forest County (45.4 percent) and Potter County (44.7 percent). Lancaster County and Mifflin County tied for the lowest percent decrease due to the exchange and expansion (20.7 percent) followed by Snyder County (25.5 percent).
By 2015, Lancaster County had the highest rate of uninsured person in the state (11.1 percent) followed by Philadelphia County (11.0 percent) and Mifflin County (10.7 percent). Butler County had the lowest rate of uninsured citizens (4.9 percent) in 2015 followed by Montour County (5.0 percent) and Montgomery County (5.3 percent).
How did rates in healthcare insurance vary by age, sex, and income-to-poverty ratio in Pennsylvania’s 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.