The Decline of Private Health Insurance

I’m not very interested in the underlying dispute between Scott Winship and Mike Konczal, but I did think this Winship chart about health insurance was interesting:

I emailed Winship to ask him what this data looks like if we examine the under-65 crowd. To the eyeball, at least, the big story on this chart seems to be the creation of Medicare and then the aging of the population pushing a larger share of people into Medicare-eligibility. The answer turns out to be a bit interesting. Look at private insurance among working age people:

This decline in private health insurance coverage has, however, been entirely offset by an increase in the number of working age people on Medicaid, which stood at 13 percent in 2008. Among the under-18 set, private insurance is even rarer and public coverage even more common, since children are both poorer-than-average and politically easier to cover. In terms of causation, my understanding is that this is a blend of Medicaid “crowding out” private coverage and Medicaid filling a gap in private insurance’s affordability. The Affordable Care Act is going to continue this trend by substantially expanding Medicaid coverage.