Employer-based health insurance: Covered 54% of Americans in 2022

An increase in employment-based coverage fueled an overall rise in the percentage of working-age adults with health insurance coverage from 2021 to 2022.

“Employer-based insurance was the most common subtype of coverage overall, covering 54.5% of the population,” said Dave Waddington, chief of the Social, Economic and Housing Statistics Division of the U.S. Census Bureau.

The Census Bureau earlier this week released its Health Coverage in the United States: 2022 report, which showed that the share of working-age adults with coverage rose across many race and ethnic groups, regions and employment statuses. Working-age adults generally have lower rates of insurance coverage than those under age 19 and older adults aged 65 and over, because their coverage often is directly tied to employment. Adults who work less than full-time, year-round may not be eligible for employment-sponsored coverage.

“Changes in health coverage from year to year reflect changes in economic conditions and demographic shifts, such as population aging, and policy changes at the federal and state levels,” Waddington said. “For instance, health insurance rates may have been affected by the 2020 recession and the ensuing recovery. Additionally, policy changes to address the public health emergency may have affected coverage.”

Economic changes include returning to work after the COVID-19 pandemic. Policy changes include updates to the Medicaid program in response to the pandemic or other economic or social forces. For example, Congress extended mandated continuous coverage for those with Medicaid, which continued throughout 2022.

“Historic progress in reducing the uninsured rate reflects the strong economic recovery since 2021 and policy choices, including more generous financial assistance for people purchasing Affordable Care Act health insurance thanks to the American Rescue Plan and then continued through 2025 in the Inflation Reduction Act, recent state Medicaid expansions and administration policies that have made it easier for people to enroll in health coverage,” the Biden administration said in a statement.

Among other highlights of the report:

• 92% of the population (304 million people) had health insurance at some point during 2022, representing an increase in the insured rate and number of insured from 2021.
• In 2022, private health insurance coverage continued to be more prevalent than public coverage, at 65.6% and 36%, respectively.
• Of the subtypes of health insurance coverage, employment-based insurance was followed by Medicaid (18.8%), Medicare (18.7%), direct-purchase coverage (10%), TRICARE (2.4%) and VA and CHAMPVA coverage (1%).
• Between 2021 and 2022, the rate of Medicare coverage increased by 0.3 percentage points to cover 18.7% of people.
• The uninsured rate among working-age adults aged 19 to 64 decreased 0.8 percentage points to 10.8% between 2021 and 2022, driven in part by a decrease in uninsured rates for workers.

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Health insurance coverage rates increased in 2022 for Black, non-Hispanic white and Hispanic working-age adults. The percentage of working-age non-Hispanic white adults with any type of health insurance coverage increased significantly from 92.5% in 2021 to 93.2% in 2022. The increase was driven by employed individuals who had a coverage rate of 94%, up from 93% in 2021.

The coverage rate of working-age Black adults also increased significantly, from 87.3% in 2021 to 88.6% in 2022. Again, the increase was related to employment status. During this period, the percentage of Black workers with any health insurance coverage increased 1.2 percentage points to 89.8%.

Employment also was a factor in the year-to-year improvement in health coverage of working-age Hispanic adults. The share of this group with any type of health insurance coverage increased significantly from 2021 to 2022 (75% to 76.6%). The percentage of all Hispanic workers with health insurance coverage increased 1.8 percentage points to 77.6% during this time.

Working-age Asian adults were the only group without any significant increase in health insurance coverage between 2021 and 2022. This was true for Asian workers in every age category. Health coverage of working-age adults increased significantly in the Northeast, South and West, although increases varied by age and employment status. The Midwest was the only region without a significant increase.

“These findings reflect several factors affecting households in 2022,” Waddington said. “These include the continued recovery from the COVID-19 pandemic, a rise in inflation, shifts in the composition of workers, policy changes and other macroeconomic conditions.”