Number of uninsured Americans rises for first time in decade

The proportion of Americans without health insurance grew significantly last year for the first time this decade, according to new federal data that show the number of uninsured rose to

27.5 million in 2018.

The findings released Tuesday, based on a large U.S. Census Bureau survey, reverse the trend that began when the Affordable Care Act expanded opportunities for poor and some middle-income people to get affordable coverage.

Taken together with other reported measures of Americans’ well-being, the Census Bureau paints a portrait of an economy pulled in different directions, with a falling poverty rate but also high inequality and a growing cadre of people at financial risk because they do not have health coverage.

The data show a strong economy that pushed the poverty rate to its lowest level since 2001. The median U.S. income — the point at which half of U.S. families earn less than this amount, and half earn more — topped $63,000 for the first time, although that is roughly the same as middle-class income in 1999 after being adjusted for inflation.

“Median household income today is right where it was in 1999. Two decades with no progress for the middle class,” University of Michigan economist Justin Wolfers tweeted.

The data also reinforced how economic gains are not being felt evenly across the nation: Incomes rose much faster in urban areas. Median income outside of cities declined last year, and poverty rose for adults over 25 without high school diplomas.

“Some of the folks who fueled the Trump candidacy and presidency still aren’t doing great,” said Matt Weidinger, a fellow at the American Enterprise Institute who watches poverty trends closely.

With health care already a central issue in the 2020 presidential campaigns and a prime voter concern, meanwhile, the fresh evidence that insurance is slipping further out of Americans’ reach is virtually certain to escalate partisan warring about Americans’ access to affordable coverage.

The uninsured rate rose as well in 2018, marking the first time since 2009 that both the number of Americans without coverage and the uninsurance rate rose significantly from the year before.

The change was driven primarily by a decrease in public insurance for the poor, with enrollment in Medicaid dropping by 0.7 percent, the data shows. The uninsured rate spiked especially among adults who are Hispanic and foreign-born, with the increase in uninsured among both groups three times the national average.

Health policy experts interpreted those patterns as evidence of a chilling effect from the Trump administration’s efforts to restrict several forms of public assistance, including Medicaid, for immigrants seeking to remain in the United States.

“The word has gone out if you use Medicaid, then you are a public charge and you’re liable not to get a green card,” said Sara Rosenbaum, a George Washington University health law and policy professor, who called the patterns of health coverage for immigrant children “alarm bell territory.”

Health insurance has long been recognized as crucial to people’s ability to get medical care when they need it. The availability of insurance is influenced by a variety of factors, including economic conditions, because most insured U.S. residents get their health plans through an employer. In recent years, however, both supporters and opponents of the ACA have looked at Census’ yearly insurance data as a portrait of how well the law is working.