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Allison Inserro
Days before open enrollment for health insurance in the individual market for 2019 sold through the Affordable Care Act (ACA) exchanges comes to a close, a new report found health insurance coverage gained between 2013 and 2017 under the ACA is slipping.
Days before open enrollment for health insurance in the individual market for 2019 sold through the Affordable Care Act (ACA) exchanges comes to a close, a new report found health insurance coverage gained between 2013 and 2017 under the ACA is slipping.

According to the Kaiser Family Foundation, the number of uninsured people rose by nearly 700,000 to 27.4 million people in 2017, representing the first increase in the uninsured rate since the implementation of the ACA in 2014. In 2016, the uninsurance rate in the United States fell to a historic low of just under 27 million, down from 44 million in 2013.

Using data from the federal American Community Survey, Kaiser found changes in the uninsured rate in states that used the ACA to expand Medicaid were essentially flat overall, but patterns varied by states and by demographic group. The uninsured rate in states that did not expand Medicaid increased, both overall and for most groups. The largest increases in the uninsured rates in nonexpansion states were among blacks and those living above the poverty line.

Even with the ACA, many uninsured people cite the cost of insurance as the main reason they lack health coverage. Last year, 45% of uninsured adults said that they remained uninsured because the cost of coverage was too high.

In response to those concerns, the Trump administration has pushed for the expansion of short-term, limited duration health plans and association health plans, which are not required to cover pre-existing conditions or all 10 essential health benefits, as originally envisioned under the ACA. The administration made those moves after Republicans were unable to repeal the ACA outright, and instead removed the individual mandate penalty.

Kaiser also noted that some people who are eligible for financial assistance under the ACA may not know they can get help; the administration has slashed marketing and outreach to promote the ACA and also shortened the open enrollment period, compared with the Obama administration. The open enrollment period for 2019 ends Saturday, December 15.

Other low-income and poor adults in states that did not expand Medicaid remain ineligible for financial assistance for coverage.

Even workers who do have access to coverage through work may not be able to afford it, Kaiser reported. Last year, 71% of nonelderly uninsured workers had an employer that did not offer health benefits; 9 out of 10 uninsured workers who do enroll in employer-sponsored coverage report cost as the main reason for declining. From 2008 to 2018, total premiums for family coverage increased by 55%, but the worker’s share increased by 65%, outpacing wage growth.

Reflecting income and the availability of Medicaid, people who live in the South or West are more likely to be uninsured. Most who remain uninsured have been without coverage for long periods of time.

It remains to be seen how the ongoing healthcare debate, which heavily influenced the midterm elections, will affect future enrollment rates. If more states decide to expand Medicaid—as did Utah, Idaho, and Nebraska—it is possible there could be additional coverage gains.

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