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Share of Americans without health insurance increases, Census Bureau reports

  • Author: Amy Goldstein, The Washington Post
  • Updated: September 10, 2019
  • Published September 10, 2019

WASHINGTON - The proportion of Americans without health insurance grew significantly last year for the first time this decade, according to new federal figures that show the number of people lacking coverage rose to 27.5 million.

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

With health care already a central issue in the 2020 presidential campaigns and a prime voter concern, the fresh evidence that insurance is slipping further out of Americans' reach can be expected to escalate partisan warring on the subject.

The uninsured rate rose, as well, in 2018, marking the first time since 2009 that both the number and rate of uninsurance rose 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 show.

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.

Expanding access to insurance was a main goal of the ACA, the statute forged by Democrats nearly a decade ago that has reshaped much of the health care system. President Donald Trump and other Republicans contend the law is fatally flawed, while Democrats maintain it has been undermined by recent GOP policies.

As Trump works to dismantle the law and liberal Democratic candidates seek to replace it with a government-financed health-care system, both sides can find ammunition for their interpretation of why the nation's uninsured rate has started rising again.

Republicans can point to how, as premiums escalate, fewer people buy health plans through the ACA's marketplaces unless they qualify for federal subsidies. Democrats can point to how major tax changes, adopted by a Republican Congress at the end of 2017, eliminated the financial penalty for those who violate the ACA's requirement that most Americans carry health insurance - removing one motivation to stay insured.

A consistent decline in the number of uninsured Americans that began in 2011 actually stopped in 2017, according to census data, with about 400,000 more people than in 2016 reporting that they lacked coverage. But that did not amount to a statistically significant change in the uninsured rate.

The new figures for 2018 show that the uninsured rate increased to 8.5 percent of the population from 7.9 percent the year before. Both years cover the U.S. population from birth to age 64, just before people become eligible for the federal Medicare program for older Americans.

In contrast, some 9 million Americans gained coverage between 2013 and 2014, the year that Medicaid expanded in many states and ACA insurance marketplaces opened for individuals and families that cannot get an affordable health plan through a job.

Tuesday's data make clear that the contraction of insurance has been broad. Around the country, insurance coverage worsened in eight states and improved in three states.

For the first time, the Census Bureau breaks out the proportion of Americans buying health plans through the ACA's insurance marketplaces . They show that 3.3 percent of people last year got their coverage through such a marketplace. The breakout reinforces how the ACA's health plans, while attracting considerable political attention, account for only a fraction of the nation's health insurance.

The Bureau's Current Population Survey is widely regarded as the most reliable portrayal of health insurance in the United States, but there have been other clues the ranks of the uninsured are swelling. In July, the U.S. Centers for Disease Control and Prevention issued findings from the National Health Interview Survey that the number of Americans uninsured at the same they were asked increased from 28.9 million in 2017 to 30 million last year.

The Census’s CPS counts people as uninsured if they lacked coverage throughout the year.