Re­port: Progress re­duc­ing unin­sured rate comes to a halt

South Florida Times - - BUSINESS - As­so­ci­ated Press

By RI­CARDO ALONSO-ZALDIVAR

WASH­ING­TON -- Five years of progress re­duc­ing the num­ber of Amer­i­cans with­out health in­sur­ance has come to a halt, ac­cord­ing to a gov­ern­ment re­port out Tues­day. More than a fac­toid, it shows the stakes in the Repub­li­can drive to roll back the Af­ford­able Care Act.

The re­port from the Cen­ters for Dis­ease Con­trol and Preven­tion es­ti­mates that 28.6 mil­lion peo­ple were unin­sured in 2016, un­changed from 2015. It was the first year since pas­sage of the health care over­haul in 2010 that the num­ber of unin­sured did not budge.

The unin­sured rate for 2016 was 9 per­cent, an in­signif­i­cant dif­fer­ence from 9.1 per­cent the pre­vi­ous year. When former Pres­i­dent Barack Obama signed the ACA in 2010, the unin­sured rate had been 16 per­cent.

Tues­day's re­port sug­gests that the ACA was run­ning low on gas in Obama's fi­nal year as pres­i­dent. Pre­mi­ums for pri­vate in­sur­ance were about to jump, and 19 states con­tin­ued to refuse the law's Med­i­caid ex­pan­sion.

Now, the num­ber of unin­sured could start climb­ing again un­der poli­cies be­ing con­sid­ered by Pres­i­dent Don­ald Trump and con­gres­sional Repub­li­cans.

The po­lit­i­cally un­pop­u­lar GOP bill passed nar­rowly by the House would limit Med­i­caid fi­nanc­ing and cur­tail sub­si­dies for many con­sumers buy­ing their own pri­vate poli­cies. Repub­li­cans also would re­peal the re­quire­ment that most Amer­i­cans carry health in­sur­ance or risk fines, a much-dis­liked nudge to get healthy peo­ple cov­ered.

The leg­is­la­tion would lead to an es­ti­mated in­crease of 24 mil­lion unin­sured peo­ple within 10 years, ac­cord­ing to con­gres­sional an­a­lysts. Un­der "Oba­macare," there are 20 mil­lion fewer unin­sured since 2010.

"It's dis­ap­point­ing that it's stalled out," said health econ­o­mist Gail Wilen­sky, a Repub­li­can. "The real ques­tion is, will we be able to keep the gains that we have made?" Crit­i­cal of the ACA and co-au­thor of an al­ter­na­tive plan by GOP pol­icy ex­perts, Wilen­sky none­the­less sup­ports the goal of ex­pand­ing cov­er­age. She's con­cerned about the im­pact of the House bill on Med­i­caid, the fed­eral-state pro­gram for low-in­come and dis­abled peo­ple.

The new num­bers come from CDC's Na­tional Health In­ter­view Sur­vey, which is con­sid­ered an au­thor­i­ta­tive source, and pub­lishes find­ings ear­lier than the Cen­sus Bureau. Es­ti­mates for 2016 were based on data for nearly 97,500 peo­ple.

"It looks like we are kind of stick­ing a land­ing and hold­ing on to the gains," said Kather­ine Hemp­stead, who di­rects re­search on health in­sur­ance at the non­par­ti­san Robert Wood John­son Foun­da­tion.

"To in­crease cov­er­age, you would have to see more states take up the Med­i­caid ex­pan­sion, and some re­forms to in­crease take-up in the in­di­vid­ual (pri­vate) mar­ket."

Could the num­ber of unin­sured start ris­ing again? Ab­so­lutely, say both Wilen­sky and Hemp­stead.

"This re­lease is re­ally timely be­cause it just helps ev­ery­body fo­cus on what's at stake," said Hemp­stead.

The re­port found a sig­nif­i­cant in­crease in the per­cent­age of peo­ple un­der age 65 cov­ered last year through gov­ern­mentspon­sored in­sur­ance mar­kets like Health­Care.gov. About 11.6 mil­lion (4.3 per­cent) had mar­ket­place in­sur­ance in the last three months of 2016, com­pared with 9.1 mil­lion (3.4 per­cent) in the same pe­riod the pre­vi­ous year.

States that ex­panded Med­i­caid were more ef­fec­tive at re­duc­ing the num­ber of unin­sured. Of the 16 states with adult unin­sured rates sig­nif­i­cantly lower than the na­tion as a whole, 15 ex­panded Med­i­caid. In that group, only Wis­con­sin had not ex­tended cov­er­age for low-in­come peo­ple.

Con­versely, of the nine states that had sig­nif­i­cantly higher unin­sured rates, only New Mex­ico ex­panded Med­i­caid.

The CDC num­bers do not re­flect any changes di­rectly at­trib­ut­able to Trump, who took of­fice this year on Jan. 20.

Dur­ing the cam­paign and since, the pres­i­dent has made some big prom­ises about health in­sur­ance, talk­ing of cov­er­age for ev­ery­body and much more af­ford­able pre­mi­ums and de­ductibles. But Trump has also em­braced a GOP bill that would make more peo­ple unin­sured, even if it de­liv­ers on his cam­paign pledge to re­peal "Oba­macare." And he's threat­ened to stop pay­ing sub­si­dies that re­duce outof-pocket costs such as de­ductibles for peo­ple with mod­est in­comes.

Hil­lary Clin­ton, whom Trump de­feated, had promised to in­crease gov­ern­ment as­sis­tance for pri­vate in­sur­ance costs, and also work to con­vince hold­out states to ex­pand their Med­i­caid pro­grams.

"This is re­ally pre-elec­tion ac­tiv­ity" re­flected in the CDC sur­vey, said Wilen­sky. "It's news be­cause peo­ple need to know we seem to have reached a plateau." What that will look like a year from now is un­clear, she added.

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