Share of insured Americans falls from year ago

8.5% of population is without health care, up from 7.9% in 2017

Fewer Americans are living in poverty, but, for the first time in years, more of them lack health insurance.

About 27.5 million people, or 8.5% of the population, lacked health insurance for all of 2018, up from 7.9% the year before, the Census Bureau reported Tuesday. It was the first increase since the Affordable Care Act passed in 2010, and experts said it was at least partly the result of the Trump administration’s efforts to undermine that law.

The growth in the ranks of the uninsured was particularly striking because the economy was doing well. The same report showed the share of Americans living in poverty fell to 11.8%, the lowest level since 2001. Median household income was $63,200, essentially unchanged from a year earlier after adjusting for inflation but significantly above where it was during the Great Recession.

“In a period of continued economic growth, continued job growth, you would certainly hope that you wouldn’t be going backwards when it comes to insurance coverage,” said Sharon Parrott, senior vice president at the liberal Center on Budget and Policy Priorities.

Surveys consistently show that health care is one of the top concerns for voters heading into the 2020 election. And Democratic candidates, several of whom have promised to extend health insurance to all Americans, are sure to use Tuesday’s figures as evidence that the current system is not working.

The declines in health insurance coverage reverse improvements since the passage of the Affordable Care Act, which established new insurance markets and financial assistance for millions of Americans who had previously struggled to obtain coverage.

There was also good news in the Census Bureau report for the White House. The decadelong recovery is at last delivering income gains to middle-class and low-income families. After decades of rising inequality, recent wage gains have been strongest for people at the bottom of the earnings ladder, said Michael R. Strain, an economist at the conservative American Enterprise Institute.

“You’re seeing improvements in employment outcomes for people with disabilities. You’re seeing improvements in employment outcomes for the formerly incarcerated,” Strain said. “These workers who are potentially more vulnerable, you’re seeing the recovery reach them.”

Democrats, however, are likely to highlight ev

idence that income gains have slowed since President Barack Obama’s final years in office. Median income grew 5.1% in 2015 and 3.1% in 2016, compared to less than 1% last year.

And while Tuesday’s report showed the benefits of what now ranks as the longest economic expansion on record, it also highlighted the limitations of that growth. Median household income is only modestly higher now than when the recession began in late 2007 and is essentially unchanged since the dot-com bubble burst in 2000.

David Howell, a professor of economics and public policy at the New School in New York, said economic growth in recent years has helped families recover from recession but done little to reverse the longerrun stagnation in middleclass incomes. Democrats and Republicans alike, he said, have tapped into the sense among many voters that the economy is not working for them.

“If you look at the longrun trajectory from 1979, it’s pretty disastrous,” Howell said.

The drop in insurance coverage in 2018 is relatively small compared to the long-term trend, but it suggests that policy changes under the Trump administration, which has been hostile to the health law, have made a difference.

The administration also cut back on advertising and enrollment assistance, programs that helped low-income people learn about the new insurance programs, among other changes that may have depressed the number of people signing up for health plans. The government also announced it might begin counting Medicaid enrollment as a strike against immigrants who are seeking green cards or citizenship a policy that was finalized this year.

Insurance coverage for Americans of Hispanic origin fell last year, according to the report.

The administration’s decision in 2017 to eliminate a subsidy program contributed to large price increases for health insurance in the Obamacare marketplaces in many parts of the country the following year. Research from the Department of Health and Human Services shows that more than 1 million Americans who were previously buying their own insurance left the market in 2018.

But the Census Bureau figures show that the main change in the uninsured rate came from declines in Medicaid coverage. Urged by the administration, which expressed concerns about the program’s integrity, several states started asking families to prove their eligibility for Medicaid more often in 2018. The number of Americans covered by Medicaid and the Children’s Health Insurance Program fell by more than 1.6 million last year, according to administrative data.

“The way they are doing this seems clearly designed to throw people off this program,” said Eliot Fishman, a senior director at consumer group Families USA, and a former top Medicaid official in the Obama administration.

Fishman said he was particularly disheartened to see declines in the number of children with health insurance.