Mark Farrah Associates does an outstanding job of collecting data from various state insurance department reports to give us a picture of who and how many are covered by private health insurance plans. The current one gives us data from year-end 2018 with comparisons to earlier periods. (MFA Brief) A total of 265.2 million people got their health coverage from a private health plan at the end of 2018. This total was down about 428,000 from year-end 2017, but the individual segment accounted for almost all that decline. The individual segment is 5% of total private insured, managed Medicaid is 19% of the total, Medicare Advantage is 8%, group (most employer-based) risk coverage was 22% and group self-funded was 46%. The number of people with individual coverage declined from 15.5 million in 2017 to 14.5 million in 2018, probably largely due to repeal of individual mandate, as well as ongoing premium increases. This was a 6.7% decline.
Managed Medicaid saw a small decrease from 49.5 million in 2017 to 49.4 million in 2018, basically flat. Medicaid enrollment may be plateauing because of the strong economy and work requirements in some states. Medicare Advantage experienced its usual steady growth, going from 20.7 million beneficiaries in 2017 to 21.4 in 2018, a gain of 730,000 or 3.6%. The group risk segment continued its decline, from 59.1 million in 2017 to 58.2 million last year, or a 1.5% decrease. Employers have ongoing interest in shifting to more lightly regulated self-funding. And that segment had about .7% growth, from 120.8 million in 2017 to 121.6 million in 2018. This number shows just how many people are employed at relatively large employers who can handle self-insurance.
Now the next time you read about the Medicare for All malarkey, remember that 265.2 million Americans, including many Medicare beneficiaries and most Medicaid recipients, get their health care coverage from a private insurer. Medicare for All makes that all go away, but of course the geniuses who conceived this lunacy will have a plan to ensure a smooth transition, both for the people with coverage and for providers and for the millions of Americans who work for those commercial insurers.