3.2 million more people were uninsured in 2017

The number of Americans without health insurance saw its biggest increase in nine years in 2017, rising 1.3 percentage points from the year prior, representing an estimated 3.2 million more people being uninsured.

The increase reported by Gallup is the largest single-year increase it has measured since it began tracking the uninsured rate in 2008, prior to the Affordable Care Act (ACA) being passed. The uninsured rate of 12.2 percent remains well below levels before the major ACA provisions went into effect, which peaked at 18 percent in the third quarter of 2013.

Several factors may have led to more people going uninsured, Gallup said, including insurance companies leaving the ACA exchanges and the resulting lack of competition driving up premiums. Customers may have also decided to go uninsured by correctly predicting the individual mandate penalty for not buying insurance was going to disappear.

“Media coverage of the policies to repeal and replace the healthcare law may have caused some consumers to question whether the government would enforce the penalty for not having insurance,” Gallup said, noting Republicans were successful in repealing the mandate through the tax cut legislation passed late in 2017.

Uninsured rates increased across all demographic groups between the ages of 18 and 64 in 2017. The biggest jump was seen among adults aged 18 to 25, where the uninsured rate increased by 2 percentage points to 16.7 percent. The 26-34 age bracket—which covers the years after children can no longer be included on their parents’ insurance plans—retained the largest uninsured rate at 20.1 percent.

Bigger increases in uninsured rates were seen among low-income groups (up 2 percentage points) and among black (up 2.3 points) and Hispanic adults (up 2.2 points).

Much of the change can be attributed to people who buy their own plans, likely including through the ACA exchanges. 20.3 percent of Americans reported purchasing their insurance themselves in 2017, down from 21.3 percent the year before and reversing a climb which began in the third quarter of 2013. Other sources of coverage remained largely unchanged, with the next largest drop being a 0.6 percent decline in those who receive employer-sponsored coverage.

Further declines should be expected, Gallup said, now that the individual mandate has been eliminated. Premiums will likely rise, leading to younger, healthier customers foregoing insurance and driving up premiums even more as the leftover risk pool is sicker and older.

For supporters of the ACA, the blame for more people opting not to be insured falls on President Donald Trump.

“After a year of President Trump’s repeated sabotage—from putting up barriers to healthcare, cutting open enrollment, and expanding loopholes, to trying to throw the entire system into chaos—it’s concerning but unsurprising to learn that fewer families have insurance and the ability to get the healthcare they so badly need,” said Sen. Patty Murray, D-Washington, the ranking Democrat on the Senate health committee.