The U.S. adult uninsured rate for healthcare reached 13.7 percent at the end of 2018––a four-year high, according to a recent Gallup poll. The findings underscore the actions of the Trump administration to undermine the Affordable Care Act over the last two years.
The ACA and Medicaid expansion in 36 states helped the uninsured rate in the nation drop to historic lows since the healthcare law’s passage. Medicaid expansion and the introduction of the individual market helped spur a dramatic decline in the uninsured rate at the beginning of 2014. Since taking office, the Trump administration has actively worked to limit the impacts of the ACA, including expanding non-ACA short-term, limited-duration health plans and cutting marketing to the individual exchange.
Furthermore, Republicans in Congress gutted the individual mandate in the 2018 Bipartisan Budget Act, effectively reducing the financial penalty of being uninsured to $0.
The 2018 uninsured rate is still below the 18 percent high point in 2014, when the individual mandate when into effect, but it is well above the low point of 10.9 percent reached in 2016. The 2.8 percentage point increase represents about 7 million adults without health insurance, according to Gallup. The poll surveyed 28,000 adults per quarter in 2018 on whether they had health insurance.
During the fourth quarter of 2018, the uninsured rate increased most among women, those with household incomes below $48,000 per year and young adults under the age of 35, Gallup found. Those younger than 35 reported an uninsured rate above 21 percent, 4.8 points above 2016 levels. The rate of uninsured women rose from 8.9 percent in late 2016 to 12.8 percent at the end of 2018.
Regionally, the South saw the greatest increase in uninsured adults, rising 3.8 points to 19.6 percent at the end of 2018. Adults in the West and Midwest had increases of more than 3 points, while the East region saw a 0.4 percent decline in uninsured adults.
The increase in uninsured Americans comes at a time when healthcare plan premiums have largely stabilized for the 2019 plan year, though higher premiums could influence the higher uninsured rate for those who do not qualify for government subsidies. The other big factor is likely policy decisions, such as the significant reduction in public marketing and shortened enrollment periods for the ACA exchange, according to Gallup.
Other uncertainties around the ACA may be causing some adults to let their insurance coverage fall to the wayside. Republicans unsuccessfully tried numerous times to repeal and replace the ACA during the first year of the Trump administration, while President Trump declared Obamacare as “a dead healthcare plan” early on in his presidency, Gallup noted. The elimination of the individual mandate reduced participation in the most recent enrollment period, as well.