The Affordable Care Act was signed into legislation nearly 11 years ago (March, 2010) and while it has faced hurdles and scrutiny from the public and the public policy world, data shows it has expanded healthcare coverage to Americans. As we continue to battle the COVID-19 pandemic, access to healthcare arguably grows more and more important.
As shown in the first graph below, Wayne County had the highest percentage of individuals without health insurance in 2019 at 6.8, according to the U.S. Census Bureau. Washtenaw County had the lowest percentage at 3.7 percent. The second graph shows that Wayne County, despite continuously having the highest percentage of uninsured individuals, experienced the greatest decline in the percentage of those without insurance between 2010 and 2019 at 8.8 percentage points. In 2010 15.6 percent of the Wayne County population did not have health insurance, and by 2019 that decreased to 6.8 percent.
Overall, all seven counties in Southeastern Michigan experienced a decline in the percentage of individuals without insurance. It should be noted that it was 2014 when the marketplace for health insurance opened, and Medicaid eligibility was expanded. In this time frame Wayne County had the largest decrease in the percentage of individuals uninsured at 7.1 percent, followed by St. Clair County at 6.3. percent. While access to the marketplace has certainly helped in providing individuals with access to health insurance, the expansion of Medicaid has been key, particularly for lower income individuals.
While the percentage of individuals without health insurance remains concerning, we must also be aware of how those with health insurance obtain it. In Southeastern Michigan, majority of the population obtained health insurance from their employers in 2019. In Livingston County, 59.3 percent of the population had employer-based health insurance, which was the highest percentage in the region. Conversely, Livingston County had lowest percentage of individuals with public health insurance at 10.9 percent (Medicaid or Medicare). Additionally, 6.8 percent of the population in Livingston County purchased their insurance directly in 2019.
In Wayne County, 29.2 percent of the population utilized public health insurance, while 41.6 percent of the population received health insurance from an employer and 3.3 percent purchased it directly (6.8 percent of the Wayne County population was uninsured, bringing the total to 100 percent). Wayne County had the lowest percentage of individuals with employer provided health insurance and direct purchase health insurance but the highest percentage of individuals with public health insurance. Additionally, Wayne County had the highest percentage of individuals without health insurance. This sheds light on the fact that many individuals working in Wayne County have jobs where health insurance is not offered or affordable and may not have the means or access to obtain it through other outlets.
Overall, the data shows that the Affordable Care Act has had an impact on individuals in Southeastern Michigan, with fewer individuals going without health insurance. There is still room for improvement though in ensuring the uninsured gap is filled.