Health Insurance

Within the past decade, there have been several big changes to the American health care system. The Affordable Care Act (ACA), signed into law in March 2010, enacted several insurance reforms. The law gave more Americans access to health care, required insurance plans to include essential benefits and forbade insurers from denying coverage based on preexisting conditions.

Several years later, some pieces of the ACA were dismantled, including the requirement to choose between purchasing health insurance or paying a penalty.

At the same time, the elderly population is growing in America. Events like these make it necessary to look back over the past decade and evaluate how these systematic changes impacted the overall health insurance landscape.

Decade changes in health insurance

Decade Changes in Health Insurance

Nationally, Medicaid enrollment increased the most over the past decade (18%)

Additionally, enrollment in military insurance increased by 17% overall, while employer health care and ACA insurance decreased by 22% and 15%, respectively. The number of policyholders with Medicare as their primary source of insurance grew by 14%.

Top 5 Medicaid

More than half of states (35) increased Medicare enrollment

Medicare coverage kicks in at age 65, so it's no surprise enrollment has increased over the past decade. In 2011, the first round of baby boomers — people born between 1946 and 1964 — hit the age of eligibility. The entire generation will rely mostly on Medicare for health coverage within the next decade.

Top 5 Medicare

72% of U.S. states saw a decrease in individuals who were covered by private health insurance

Top 5 Individual

Private health insurance, which includes policies bought through the ACA marketplace exchanges, has seen a drop in enrollment in recent years. This is partly due to a rise in premium costs. The average 40-year-old in 2020 might spend $403 a month on health insurance, which is a 140% increase over the price of a policy a decade ago.

Enrollment also dropped after the individual mandate was repealed in 2018.

Top 5 Group

The largest increases in military insurance occurred in Louisiana (598%), Alabama (205%) and New Mexico (158%)

Military insurance has become an extremely cheap alternative for individuals in the service. A typical Tricare policyholder pays $289 a year for a policy, plus a few minor cost-sharing expenses. For this reason, it is not surprising that service members are choosing this coverage over a private health care policy.


ValuePenguin used the IPUMS Current Population Survey (CPS) database, which contains microdata regarding the U.S. labor force. The survey data is compiled jointly by the U.S. Census Bureau and the Bureau of Labor Statistics. Select health insurance survey variables were included in the analysis to compile a better understanding of where individuals are getting their insurance. Survey samples from 2008 to 2019 were included in the analysis.

Variables analyzed in this study include:

  • Age
  • FIPS codes
  • Year

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