WASHINGTON — The rate of uninsured Americans climbed to 13.7% in the last quarter of 2018, the highest level since the beginning of 2014, a Gallup poll found.
“While still below the 18% high point recorded before implementation of the Affordable Care Act’s (ACA) individual health insurance mandate in 2014, today’s level is the highest in more than 4 years, and well above the low point of 10.9% reached in 2016,” the organization noted in a press release. The 2.8-percentage-point increase since that low represents a net increase of about 7 million adults without health insurance.
The poll data were based on Americans’ answers to the question, “Do you have health insurance coverage?,” which was asked of a random sample of about 28,000 adults each quarter. Nationwide, the uninsured rate climbed from 10.9% in the third and fourth quarters of 2016 to 12.2% by the final quarter of 2017; it has risen steadily each quarter since that time, the press release noted.
The biggest increases in the uninsured rate came among women, those living in households with annual incomes of less than $48,000 per year, and young adults under the age of 35. That latter category had an uninsured rate of more than 21% in 2018, up 4.8 percentage points from 2016.
Geographically speaking, the West, Midwest, and South all reported increases in the uninsured rate of more than 3 percentage points. The South, for example, had a 3.8-percentage-point increase, to 19.6%, according to the poll. The rate in the East, at 7.1%, was pretty much unchanged since the end of 2016.
The Gallup organization suggested several possible reasons for the increase in the uninsured rate, including increased premiums for policies on the ACA’s insurance exchanges. “For enrollees with incomes that do not qualify for government subsidies, the resulting hike in rates could have had the effect of driving them out of the marketplace,” the release stated. “Insurers have also increasingly withdrawn from the ACA exchanges altogether, resulting in fewer choices and less competition in many states.”
Trump administration actions related to the federal exchange also may have played a role, the organization suggested. For example, publicly funded marketing efforts for the exchange have been cut, as has funding for ACA “navigators” who help people sign up for coverage; funding for the latter dropped from $63 million in 2016 to $10 million in 2018. Open enrollment also was cut to 7 weeks, about half of what it had been previously. Overall, enrollment on the federally run ACA exchange fell from 9.6 million in 2016 to 8.4 million in 2019, a 12.5% decrease.
Another factor might have been the administration’s decision in October 2017 to stop paying the cost-sharing reduction (CSR) payments that reduce deductibles and other out-of-pocket costs for lower-income enrollees in the federal exchange, Gallup suggested. Health insurers have sued over that move, and litigation is ongoing.