The rate of uninsured Americans rose for the first time in roughly a decade in 2018, and the Trump administration is placing the blame of the trend squarely on Obamacare.
The Trump administration was quick to brush off any responsibility for the trend and blame Obamacare, or the Affordable Care Act. Specifically, CMS targeted high premiums for health insurance plans as the cause of the rising uninsured rate.
“As usual, critics of President Trump have been quick to blame the Administration’s healthcare policies for this increase,” CMS Administrator Seema Verma wrote in a blog post Sept. 13. “But a review of key facts suggests the rising uninsured rate stems largely from Obamacare’s failure to deliver affordable health insurance premiums and has created a new class of uninsured.”
According to CMS, the ACA did “nothing” to lower underlying costs of healthcare and failed to deliver on the promise of lower healthcare costs.
However, a review of the Census Bureau data finds that most of the higher uninsured rate comes from lower Medicaid enrollment, the Associated Press pointed out in its reporting.
One of the hallmarks of the ACA was allowing states to adopt into Medicaid expansion to cover more Americans and receive more federal funding to provide this access to the federal program. While the majority of states expanded Medicaid, some did not, but the uninsured rate plummeted to new lows in the first few years after the ACA was implemented.
The Trump administration, for its part, has been making it easier for states to reduce Medicaid enrollment by allowing work requirement programs that require eligible beneficiaries to report work or work-related activities every month or face being kicked off the program. In the handful of states where these work requirement programs are underway, thousands have already lost their health insurance.
CMS pointed out that the number of uninsured people with incomes greater than 400%, which is the cutoff threshold to be eligible for subsidies to purchase insurance plans off the ACA marketplace, rose 1.1 million in 2018. At the same time, insurance premiums rose, according to CMS.
However, according to the Census Bureau, “between 2017 and 2018, the percentage of people with public coverage decreased 0.4 percentage points, and the percentage of people with private coverage did not statistically change.”
For Medicaid, which covers the poorest, most vulnerable population in the nation, coverage declined 0.7 percentage points from 2017 to 2018. Enrollment of those with private coverage, including employment-based, direct-purchase and TRICARE, “did not statistically change between 2017 and 2018,” the Census Bureau report reads.
In addition to Trump administration policies potentially having an impact on Medicaid enrollment, other factors may be at place, such as immigration, according to the AP.
While the administration’s public charge rule, which states that migrants could be denied green cards if they used government benefits like Medicaid, was only finalized this year and not relevant to the report year, other efforts restricting immigrant use of public programs may have been relevant. Namely, immigrants may have felt increasingly fearful of enrolling in Medicaid with anti-immigration rhetoric and policy threats occurring, as the Trump administration forcefully pushed through it border wall dialogue.
This could be backed up in the data: “Hispanics were the only major racial and ethnic category with a significant increase in their uninsured rate,” the AP reported. Nearly 18% of Hispanics lacked coverage in 2018, up 1.6% from the previous year. Similar changes did not occur in other demographics.
Still, the uninsured rate could have risen for other reasons, including a lack of health insurance coverage from employers by workers who previously qualified for Medicaid but were no longer eligible after earning higher wages. As Verma argued in her blog post, a significant group of people may have been priced out of health insurance from the individual market without subsidies, as well.