As the federal government prepares for one of the largest health campaigns in history, the Centers for Disease Control and Prevention has a new portrait of Americans' insurance status, with one demographic of middle class workers especially struggling.
The nation's uninsured rate for the first three months of 2013 decreased slightly since 2010, at the same time that more Americans with incomes that leave them "near poor" are enrolling in Medicaid, according to new survey data by the CDC.
About 46 million Americans were uninsured in the first months of 2013, a rate of 14.8 percent that's down slightly from post-Great Recession high of 16 percent in 2010, according to the CDC.
For some of America's working poor or near-poor, with incomes between 100 percent and 200 percent federal poverty level, "there was a significant increase in the percentage with public coverage," from 37 percent in 2012 to 40.8 percent in the first 3 months of 2013.
"During this time period, there was a corresponding decrease in private coverage from 35.2 percent to 31 percent," CDC researchers wrote in the Early Release of Estimates From the National Health Interview Survey.
Those are people who may have previously been insured through employer-sponsored or individually-purchased health plans, or people who were previously covered through Medicaid.
The CDC data shows some decline in private coverage and the migration to public plans over the last decade, as costs for private plans increased. Between 1997 and 2013, the rate of private coverage for 18-64 year-olds decreased by 9.4 percent, to 63 percent of adults, and decreased among children by almost 15 percent, to 51 percent of children, according to the CDC.
Meanwhile, public coverage for adults 18-64 increased by 10 percent between 1997 and 2013, according to the CDC, and as of March, about 24 percent of all Americans under the age of 65 are covered by public health plans.
Partly in response to the rising costs in private plans came consumer-directed and high-deductible health plans, with health and flex savings accounts. Those too have increased, the CDC found. About 32 percent of Americans with private insurance now have high-deductible health plans, compared to 20 percent in 2008, while about 10 percent are enrolled in a consumer-directed health plan with an HSA, compared to 5 percent in 2008.
Among the uninsured on the eve of the opening of Affordable Care Act marketplaces, are 27 percent of Americans with incomes that classify them as poor, 29 percent of Americans who are "near-poor" and 9 percent of Americans with incomes above 200 percent of the federal poverty level.
More than 26 percent of young adults ages 19 to 25 were uninsured as of March, according to the CDC data, suggesting that their parents also were struggling to find insurance.
Among adults currently aged 18–64 who were not working at the time of the survey, almost half were uninsured, compared to 18 percent of those who were employed.