Minnesota's uninsured rate hit historic low in 2021 but racial disparities increased


April 22, 2022

The Minnesota Department of Health (MDH) released new data showing mixed news regarding health insurance coverage in Minnesota during 2021. While actions taken by state officials helped drop the state's uninsured rate to the lowest level ever measured, racial disparities in coverage worsened.

Federal and state policies and funding during 2021 shielded Minnesota's health insurance coverage against the pandemic's economic shock. With the help of these efforts, the state's uninsured rate fell to 4.0%, the lowest-ever measured level, essentially tying the 2015 rate.

Economic downturns often result in higher rates of uninsurance in the U.S. due to the link between employment and health insurance coverage. With the help of state and federal funding, Minnesota took steps to prevent insurance loss in 2020 and 2021, including government efforts to maintain coverage for low-income Minnesotans and premium subsidies in the individual market. Data from the Minnesota Health Access Survey found that 34,000 fewer Minnesotans went without health insurance in 2021 compared to 2019. Fewer Minnesotans also said they went without some type of needed health care due to cost in 2021 (20%) compared to 2019 (25%).

However, not all Minnesotans were equally able to access or retain coverage. Racial disparities worsened as the uninsured rate among Minnesotans of color and American Indians rose from 7.6% in 2019 to 10.2% in 2021. In contrast, the uninsured rate dropped among non-Hispanic Whites from 3.7% in 2019 to 2.4% in 2021.

"The investments we made before and during the pandemic to ensure Minnesotans had access to affordable health coverage helped more people stay insured, even in the midst of job losses and economic instability," said Minnesota Commissioner of Health Jan Malcolm. "Sadly, we saw that people of color and American Indians did not benefit as much from these efforts. We must learn about what worked and what didn't so we can adapt our approach to reach the goal of ongoing and equitable access to affordable health care for all Minnesotans."

The number of Minnesotans with public insurance increased by 238,000 so that 41.2% of those insured had coverage through public sources in 2021, including Medicare, Medical Assistance and MinnesotaCare. This growth in public coverage made up for a decrease in private coverage – down from 57.8% in 2019 to 54.8% in 2021.

While most Minnesotans weathered the first two years of the pandemic with health insurance, there are concerns about maintaining coverage moving forward. Many government programs that added financial supports to families, increased subsidies for private health insurance plans sold through MNsure to make insurance more affordable or allowed people to stay on Medicaid longer ended or are set to expire this year.

"Historically, Minnesota has enjoyed a strong labor market and a strong employer-sponsored insurance market," said Kathleen Call, a professor with the University of Minnesota School of Public Health and an investigator at the State Health Access Data Assistance Center. "However, alongside the crisis of the pandemic, the long-term erosion of private coverage over the past two decades, combined with the fact that not all employees are offered insurance and not all Minnesotans can afford it, reminds us that continued commitments are needed to support and promote Medical Assistance, MinnesotaCare and premium subsidies in the individual market available through MNsure."

The survey suggests that COVID-19 had an impact in delaying care in 2021 but didn't keep most people from getting that care eventually. In the second year of the pandemic, COVID-19 concerns affected only 8% of people not receiving health care. The primary reasons for not using health care were cost or not needing it.

Both physical and mental health declined during the pandemic, according to the survey. The number of unhealthy days reported for a 30-day period climbed to an average 3.3 days for physical health and 4.3 days for mental health, compared to 2.8 for physical health and 3.7 for mental health in 2019.

"The reports of Minnesotans having fewer healthy days in 2021 are concerning, particularly in light of the continued strain on the state's health care workforce and our structural weaknesses in mental health care," said Stefan Gildemeister, MDH state health economist. "We will continue to monitor how effective our investments in community connections and resources during the pandemic are in reversing lingering harms to physical and mental health as the state moves into the next stage of the pandemic and as the economy recovers."

The Minnesota Health Access Survey is a biennial state-based population survey that collects information on how many people in Minnesota have health insurance and how easy it is for them to get health care. The survey is conducted as a partnership between MDH and the University of Minnesota School of Public Health, State Health Access Data Assistance Center. The survey had responses from more the 18,000 Minnesotans across the state and was conducted between October 2021 and January 2022. More findings from the survey are available on the MDH Health Economics Program website.



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