Uninsured rate on the rise—up 4M since 2016
Years of gains in insurance coverage since the Affordable Care Act (ACA) are beginning to reverse, according to a new report from the Commonwealth Fund that found 15.5 percent of working age adults are uninsured, representing an increase of about four million people since 2016.
The same survey in 2017 found the uninsured rate had begun to creep up, going to 14 percent from 12.6 percent in 2016. The Commonwealth Fund’s vice president of healthcare coverage and access Sara Collins and her coauthors wrote the loss in coverage has likely been driven by both congressional inaction to “improve specific weaknesses in the ACA” and regulatory actions from President Donald Trump’s appointees at HHS and CMS to cut advertising for the ACA exchanges, shorten open enrollment and create “a general sense of confusion” about the law’s status.
“Signs point to further erosion of insurance coverage in 2019: the repeal of the individual mandate penalty included in the 2017 tax law, recent actions to increase the availability of insurance policies that don’t comply with ACA minimum benefit standards, and support for Medicaid work requirements,” Collins and her coauthors wrote.
Uninsured rates have risen more significantly among lower-income adults (those making $30,000 or less for an individual or $61,000 in a family of four), going from 20.9 percent in 2016 to 25.7 percent in this year's survey. Those making more than 250 percent of the federal poverty level reported a lower rate of being uninsured, at 5.8 percent, though still an increase from the 2016 level of 4.4 percent.
There were exceptions to these increases among certain demographics. Fewer adults aged 18 to 34 were uninsured compared to 2016 (falling from 18.1 percent to 17 percent), while uninsured rates rose among those 35 and over. Divided by political affiliation, the uninsured rate remained steady between 2016 and 2018 for Democrats, while rising sharply among Republicans from 7.9 percent to 13.9 percent.
Gallup’s survey of insurance coverage found a similar upward trend in the uninsured rate after several years of being driven down by the ACA. The Commonwealth Fund survey went further by asking if adults plan to drop coverage in 2019 once the individual mandate penalty is no longer enforced thanks to the tax law passed by Republicans in Congress last year. Only 5 percent said yes, including 9 percent of those with individual market insurance, though those departures would still increase the uninsured rate and potentially raise premiums on those remaining covered if the ACA risk pool worsens.
Collins and her coauthors said this reversal in coverage could be addressed at the federal level with extra funding from HHS and CMS for advertising or a boost in reinsurance from Congress. Those are unlikely scenarios considering the recently finalized ACA rule and Republicans in majorities in Congress, leaving states to come up with their own solutions—either by expanding ACA provisions (like instituting state-level individual mandates) or finding ways around the remaining requirements of the law (like Iowa creating a loophole defining plans offered by the state’s farm bureau as something other than health insurance).
“More broadly, leaving policy innovation to states will ultimately lead to a patchwork quilt of coverage and access to health care across the country, a dynamic that will fuel inequity in overall health, productivity, and well-being,” Collins and her coauthors wrote. “At some point, Congress will likely face pressure to step in to level the playing field.”
John joined TriMed in 2016, focusing on healthcare policy and regulation. After graduating from Columbia College Chicago, he worked at FM News Chicago and Rivet News Radio, and worked on the state government and politics beat for the Illinois Radio Network. Outside of work, you may find him adding to his never-ending graphic novel collection.