The share of Americans without health insurance jumped to 12.3% in the third quarter, up 1.4% since the end of 2016, according to a new poll from Gallup-Sharecare.
The uninsured rate is now the highest it has been since the last quarter of 2014, when it was 12.9%. That was after the first full year of enrollment on the exchanges under the Affordable Care Act (ACA), which President Donald Trump has vowed to repeal.
The poll found that the uninsured rate rose 0.6% in the third quarter alone, accounting for nearly half of the increase since the end of last year.
Uninsured rates, as measured by Gallup and Sharecare, reached a record low of 10.9% in the third and fourth quarters of 2016, according to a statement issued with the results. The increase in the number of insured represents about 3.5 million people who have become uninsured since that time.
Despite the uptick, uninsured rates remain well below the 18% rate Gallup measured in the third quarter of 2013, as ACA enrollment was beginning.
Gallup cited several factors in the rising uninsured rate:
Several insurers have stopped offering coverage on the exchanges, leading to a lack of competition and rising premiums. This has been attributed in part to uncertainty over the fate of the cost-sharing reductions that help insurers hold down premiums on the exchanges. Trump canceled the subsidies earlier this month.
Uncertainty over the fate of the law itself may be driving up uninsured rates. Some insurers have cited a lack of enforcement of the individual mandate in setting their rates for 2018.
Early in 2017, HHS canceled the end of the marketing campaign to enroll people on the exchanges. Historically, healthier and younger people enroll closer to open enrollment deadlines.
The Gallup-Sharecare poll is based on 45,000 interviews with US adults age 18 and older between July 1 and September 30, which were conducted as part of the Gallup-Sharecare Wellbeing Index.
Rates Among Subgroups
Uninsured rates among black and Hispanic adults rose by 1.5% and 1.6%, respectively, since the end of 2016. Among whites, the rate has climbed 1.1%. Rates rose faster (1.7%) among lower-income adults than among moderate-income adults (1.3%), and higher-income adults (1.1%).
The biggest change since 2016 has been the decline in the share of Americans who are insured through self-paid plans. The share of adults ages 18-64 with self-paid plans has dropped from 21.3% to 20.0% since the end of last year. This drop represents an about face from what had been the fastest-rising group of people with insurance, which was a direct result of the ACA’s individual mandate.
But Medicare has seen a decline, too, with a drop of 0.5% since the end of 2016.
States Wait for Answers
The Gallup survey cited the failure of HHS to act on requests from Iowa and Oklahoma for waivers to solve problems in their individual markets, which face premium increases of 30% or more due to a host of factors, including challenges with how to deal with needs of patients with costly pre-existing conditions.
Meanwhile, Senators Lamar Alexander, R-Tennessee, and Patty Murray, D-Washington, have brokered a short-term fix for the individual market
that would pay for the cost-sharing reductions through 2019 and give states additional flexibility. Trump initially endorsed the concept, then came out against it. While the fate of the plan is unclear, it has gathered bipartisan support
in the Senate.