Despite constant undermining from the Trump administration, nearly 8.8 million Americans got covered during the last open enrollment period on HealthCare.gov. That’s nearly as high as the previous enrollment period, and a testament to people’s desire for health coverage. Still, it seems the administration’s actions didn’t go without impact.
In new numbers from Gallup, the percentage of U.S. adults without health insurance went “essentially” unchanged in the last quarter of 2017, at 12.2%. However, it is up 1.3 percentage points from the record low of 10.9% in the last quarter of 2016. The increase translates into 3.2 million Americans becoming uninsured. It also represents the biggest single-year jump since Gallup began tracking the uninsured rate in 2008. The poll results are based on more than 25,000 interviews with U.S. adults ages 18 and older between Oct. 1-Dec. 31.
Beyond the congressional ACA repeal attempts and the president boasting that the ACA is “dead” and “gone,” the Trump administration shortened this year’s open enrollment period on HealthCare.gov by more than a month, slashed the federal ACA advertising budget by 90 percent, and made significant cuts in grant funding to state and local navigator groups.
Before Trump, the U.S. uninsured rate had been steadily declining since ACA implementation, with 20 million more people gaining coverage since 2010. In the Gallup report, a graph shows that from a peak uninsured rate of 18% in 2013, the Affordable Care Act drove a steady decline in U.S. uninsured numbers until shortly after Trump’s election, when the rate began inching back upward. The poll tracked higher rates of being uninsured in all demographic groups (though not among those 65 and older — Medicare for all, anyone?), but the increases were greatest among young adults, Hispanics and low-income Americans.
The data point on young adults ages 18 to 25 — their uninsured rate went up two points in 2017 — is particularly worrisome from a policy perspective. Having young, healthy adults in the insurance risk pool helped balance out the cost of insuring people with pre-exiting conditions and guaranteeing consumers a set of essential health benefits. Unfortunately, a primary mechanism for keeping those young healthy people in the risk pool — the individual mandate — was repealed when Trump signed his tax cut legislation into law. That mandate was key to getting insurance companies to participate in the new marketplace, and its repeal is predicted to increase the number of U.S. uninsured by 13 million by 2027 and boost yearly premium hikes. Gallup researchers noted that efforts to repeal and replace the ACA “may have caused some consumers to question whether the government would enforce the penalty for not having insurance.”
Other findings from the Gallup survey show that the uninsured rate among black and Hispanic adults went up 2.3 and 2.2 points, respectively, compared to less than one point among white adults. The uninsurance rate went up two points for low-income adults in 2017 and less than one point for high-income Americans. (Previous research showed that the ACA had been making real progress in closing gaps among whites, blacks and Hispanics, with disparities narrowing on the percentage of uninsured, percentage who skipped care due to cost and the percentage who lacked a usual source of care. Researchers had also documented a dramatic narrowing of coverage gaps between the rich and poor, particularly in states that expanded Medicaid.)
Unfortunately, Gallup predicts the uninsured number will only get worse, especially with elimination of the individual mandate, and that premiums will continue to rise.
“Having passed their tax bill, congressional Republicans’ 2018 legislative goals include reforming funding mechanisms for Medicaid and Medicare — programs that subsidize health care coverage for low-income, disabled and elderly Americans,” writes Zac Auter, author of the Gallup report. “With less federal assistance from these programs to help offset the rising cost of health insurance, fewer Americans may be able to afford health insurance.”
On the Gallop data, the Washington Post Editorial Board put it well: “Obamacare was never perfect, but it was steadily bringing down the share of Americans without health insurance. Why would anyone want to reverse that achievement?”
Read the new Gallup numbers here.