Americans without insurance on the rise

Little improvement for the poorest in Texas, where coverage was limited

The number of Americans without health coverage, which declined for years after passage of the Affordable Care Act, shot up in President Donald Trump’s first year in office, according to data from a new national survey.

WASHINGTON — The number of Americans without health coverage, which declined for years after passage of the Affordable Care Act, shot up in President Donald Trump’s first year in office, according to data from a new national survey.

At the end of 2017, 12.2 percent of U.S. adults lacked health insurance, up from 10.9 percent at the end of 2016, as President Barack Obama was completing his final term.

The increase of 1.3 percentage points, although modest, marks the first time since at least 2008 that the share of adults without insurance increased from the previous year, according to the report from Gallup, which conducts a widely followed survey asking Americans about their health coverage.

Losses follow big gains

The increase indicates that 3.2 million Americans lost health coverage in 2017, Gallup concluded.

The decline was most pronounced among slices of the population on which the Obama administration and its allies had focused enrollment efforts: young adults, blacks, Latinos and households making less than $36,000 a year, Gallup found.

The losses follow years of historic insurance gains driven by the health care law’s expansion of coverage, which started being fully implemented in 2014.

National survey data from the federal government and other sources suggest that more than 20 million previously uninsured Americans gained coverage between 2013 and 2017.

There is increasing evidence that these gains are improving patients’ access to medical care and relieving financial pressure, particularly on poorer households.

A recent study of data from two states that have dramatically expanded coverage, Arkansas and Kentucky, found, for example, that low-income patients with chronic illnesses are now much more likely to seek recommended care.

By contrast, there has been significantly less improvement among such patients in Texas, which has not expanded coverage fully through the health care law.

Weakened markets

But many Republicans, including leading Trump administration officials, have dismissed the coverage gains as meaningless. They have argued that the coverage provided under the health care law is unaffordable — because out-ofpocket costs are too high — or that patients face too many restrictions in their choice of doctors.

Trump came into office last January pledging to roll back the law, commonly called Obamacare. His administration undertook a sustained campaign throughout 2017 to discredit the law while congressional Republicans tried to repeal it.

The repeal campaign failed. But it helped weaken health insurance markets around the country, particularly in regions that already had few insurers and higher prices than the rest of the country.

At the same time, the Trump administration dramatically cut outreach and advertising efforts.

It is unclear how much each of those actions contributed to the erosion in health coverage, but the Gallup survey indicates a decline in the percentage of adults who bought insurance on their own rather than got it from an employer or a government program such as Medicare or Medicaid.

Eliminating penalty

That is the part of the insurance market that has been affected most by political turmoil surrounding the health law.

“Further, media coverage of the policies to repeal and replace the health care law may have caused some consumers to question whether the government would enforce the penalty for not having insurance,” the Gallup report notes.

Enrollment for coverage in 2018 has been roughly on pace with last year, despite the Trump administration’s continued hostility to the law.

But the Republican tax bill that passed last month will eliminate the penalty on Americans who don’t get coverage in 2019. The elimination of that penalty, the so-called individual mandate, is widely expected to further reduce the number of Americans with coverage, although forecasts vary about how big a decline to expect.

And recent moves by the Trump administration to weaken insurance rules are expected to further destabilize insurance markets.

“It seems likely that the uninsured rate will rise further in the years ahead,” the Gallup report notes.

The survey was based on a random sample of 25,072 adults living in all 50 states and the District of Columbia who were interviewed between Oct. 1 and Dec. 31. The margin of error is plus or minus 1 percentage point.