The state of American health care, in 5 charts

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In 2016, 8.8 percent of Americans were uninsured, according to new data from the Census Bureau. That’s a new low, down from 9.1 percent in 2015. In people terms, that means 28.1 million Americans don’t have health insurance — still a lot, but fewer than ever before.

During a week that will see Republicans roll out their last-ditch plan to repeal Obamacare while Democrats unveil their Medicare-for-all bill, the Census Bureau data provides a nice baseline for where things stand as Obamacare functions adequately, if not perfectly. This might be an email to print out and save for later use.

If you’ve been following Vox at all, you know we love charts. So here are five to help you make sense of where US health care stood in 2016, before the Trump administration and these new health pursuits got underway.

First, how Americans are insured:


There are some lessons in here for both sides of the health care debate:

  • Most immediately, for Republicans, they are still hoping to fundamentally overhaul Medicaid, a program that covers upward of 60 million people by this estimate (others go higher). Introducing a spending cap on such a big program puts enrollment and benefits at risk.
  • As Democrats take up the single-payer cause, those 56 percent of Americans with employer-based insurance will be tricky. Democrats might be proposing more robust coverage, but people like what they know — and they know they have coverage through work.

Next, which Americans fare better or worse under our current system:


This is not a huge shock, but deep racial and ethnic disparities remain when it comes to health coverage.

Two things to keep in mind: The refusal of nearly 20 states to expand Medicaid under Obamacare, particularly in the South, has left hundreds of thousands of black Americans uninsured. Second, TPM has reported that the Trump administration has cut off contact with Latino groups that had worked with the Obama administration to help sign that population up for coverage.

I thought this next breakdown, by age, was really interesting, if only because we don’t usually get such granular data:


The tale here is pretty clear: America does a great job of covering children (thanks Medicaid and CHIP) and seniors (thanks Medicare), but we’re a little less consistent when it comes to folks of a working age.

You’ll notice the big spike when people hit their mid-20s. Remember that Obamacare lets kids stay on their parents’ insurance until they’re 26. People in that age range are also less likely to have a job that offers insurance and they’re less likely to be able to afford it on their own.

But these are also the elusive young invincibles, who have lagged in enrolling in Obamacare plans and therefore kept costs higher than insurers would like. That spike helps explain some of the law’s struggles.

Now for some geography:


Another area of disparities. Texas still has the nation’s highest uninsured rate, at 16.6 percent. Massachusetts has the lowest: 2.5 percent.

The darker-shaded states also lined up pretty nicely with the states that refused to expand Medicaid under Obamacare, leaving more than 2 million of their poorest residents without coverage under the law.

That brings me to my last chart, disparities by Medicaid expansion:


If you look at the leftmost bars in each graph, you get the picture: States that expanded Medicaid have driven down the uninsured rates among their residents in poverty by 20 percentage points, nearly on the same level as the middle-class population that buys private coverage on the Obamacare marketplaces.

But in non-expansion states, the gains for people in poverty have been more modest — and much deeper disparities persists across income.

Story of the Day

The last hope for Obamacare repeal, Cassidy-Graham, will be released tomorrow. Here is what you should know:

  • The essence of the plan is capping federal health care spending and fundamentally overhauling Medicaid. Sarah broke down an earlier version of the plan in more detail. Here’s how Larry Levitt at the Kaiser Family Foundation summarized things to me: “The ballgame here is the money. If states have a lot less money to play with than under the current system, it’s inevitable that fewer people will be covered.”

Senate Republicans have until September 30 to pass Obamacare repeal using the special process known as budget reconciliation that allows them to move a bill with only 51 votes. I went through all the reasons this will be tough: The bill must be released, scored by CBO, analyzed by the Senate parliamentarian, debated, and voted on in less than three weeks. Oh, and it needs to get 50 Republican senators to support it, when no previous plan could. It’s incredibly unlikely — but not impossible.

Kliff’s Notes

With research help from Caitlin Davis

  • “Pelosi declines to back Bernie Sanders’ health care bill”: “House Minority Leader Nancy Pelosi is declining to endorse Sen. Bernie Sanders’ universal health care bill. The liberal California Democrat says that while she has long supported the idea the bill captures, of everybody getting health coverage, ‘Right now I’m protecting the Affordable Care Act.’” —Associated Press
  • “WH Aide: We Failed To Get Allies On Board Quickly For Obamacare Repeal”: “Marc Short, the White House’s director of legislative affairs, on Tuesday acknowledged that the Trump administration did not do the best job of winning over conservative allies’ support for a plan to repeal and replace Obamacare early on in the process.” —Caitlin MacNeal, Talking Points Memo
  • “How Single-Payer Health Care Could Trip Up Democrats”: “Like ‘repeal and replace,’ ‘single-payer’ is a broadly popular slogan that papers over intraparty disagreements and wrenching policy choices. Republicans fumbled multiple attempts to replace the Affordable Care Act this year. If the Democrats eventually wrested back power, they could find themselves similarly factionalized and stymied over the details.” —Margot Sanger-Katz, New York Times
  • “With funding slashed and no contracts in hand, ACA marketplace ‘navigators’ are shutting down”: “Several navigator organizations, including the University of South Florida, which received the country’s largest federal grant for navigation services in 2016, are suspending education and outreach activities ahead of the 2018 open enrollment period that is slated to begin Nov. 1.” —Shelby Livingston, Modern Healthcare

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