Some Indicators of Public Health in Philadelphia Had Improved Before COVID-19

The spread of COVID-19 is placing unprecedented strain on Philadelphia’s hospitals, public health systems, and residents. Although the full effects of the emergency have yet to be realized, newly released data from 2018 and 2019 provides insight on the state of public health in the city before the pandemic.

Share of Philadelphians without health insurance

In 2018, the most recent year for which data is available, just over 7% of Philadelphia residents—approximately 116,000 people—lacked health insurance. That’s half as high as in 2010, when the U.S. census first began tracking these numbers. At that point, about 225,000 people were uninsured. The share of individuals without health insurance had declined by 5.2 percentage points since 2014, primarily as a result of the state’s decision to expand Medicaid eligibility under the Affordable Care Act. Effective in January 2015, Pennsylvania households with incomes up to 138% of the federal poverty line became eligible for medical assistance, not just those living below the poverty line. 

Medicaid is the federal-state medical assistance program that provides health care coverage to low-income families and individuals. At the end of 2019, 649,301 Philadelphians were using this assistance, which was down slightly from the previous year but up significantly since 2014 because of the 2015 expansion of eligibility in Pennsylvania.

Pew’s annual “State of the City” reports compare Philadelphia with nine other cities selected for their similarities to Philadelphia in location, size, and demographic makeup. Philadelphia’s share of uninsured residents in 2018 was the fifth lowest among the cities and was below the U.S. average of 8.9%. Houston—located in Texas, which did not expand Medicaid under the Affordable Care Act—had the highest rate of residents without health insurance on the list at 23.8%.

Disability rate

In 2018, the most recent year for which data was available, Philadelphia still had a high share of residents with disabilities compared with other large cities. At 16.8%, Philadelphia’s rate trailed only Cleveland and Detroit. The rate had increased slightly since Pew’s 2016 analysis on the topic. That report found that people with a physical, emotional, or cognitive disability were more likely to have frequent interactions with the health care system—and explained how age and poverty factor in. Data from Pew’s 2019 “State of the City” report shows that only Philadelphia and two other cities on this list—Cleveland and Baltimore—had increases in their disability rates since 2017.

It remains to be seen whether or how the spread of COVID-19 will affect health insurance coverage or disability rates in Philadelphia. And it will take time before analysts can discern any direct or indirect effects on people with disabilities. Having this initial data offers a good starting point for future comparison once the pandemic subsides.

Larry Eichel is a senior adviser and Katie Martin is a senior manager with Pew’s Philadelphia research and policy initiative.