The National Center for Health Statistics 2017 National Health Interview Survey found the percentage of uninsured Americans dropped to 8.8% in the first quarter of 2017, which was 500,000 fewer uninsured people compared to a year ago. There were 20.5 million fewer uninsured Americans in the first quarter compared to 2010.
The report said 12.1% of adults between 18 and 64 were uninsured in the first quarter and 5.3% of children 17 and under were uninsured.
High-deductible health plans (HDHP) also continue to grow. The report said 42% of people who are under 65 with private insurance were enrolled in HDHPs in the first quarter, which is an increase from 39.4% last year.
The Affordable Care Act (ACA) has its share of critics, but one proven positive from the legislation has been more insured Americans. Health policy experts, though, are also watching the increase in HDHPs. These plans are popular among consumers because they have lower premiums than other options. The overall increased out-of-pocket costs typical with these plans can catch people of guard, though.
Much of that coverage increase happened as a result of states expanding their Medicaid programs. The National Center for Health Statistics report found the percentage of uninsured adults in Medicaid expansion states dropped from 18.4% in 2013 to 8.6% in the first quarter of 2017. In non-expansion states, the percentage dropped from 22.7% in 2013 to 17.5% in 2015, but trended up to 18.4% in the first quarter.
Having more people covered through Medicaid and through ACA plans leads to less uncompensated care and bad debt for hospitals. The Kaiser Family Foundation (KFF) recently released a report that showed uncompensated care, including charity care and bad debt, dropped 17% after costing hospitals $34.9 billion in 2013. Nearly all of the decrease in 2014 came from Medicaid expansion states.
“The cost of uncompensated care has declined among hospitals in Medicaid expansion states, while such costs have remained flat among hospitals in states that did not expand Medicaid,” said KFF.
However, proposed Medicaid cuts and ACA changes have hospitals, especially safety net facilities and children's hospitals, concerned the reforms may erase recent gains. President Donald Trump released a proposed budget earlier this year that would cut Medicaid by about $600 billion over a decade, and proposals in Congress have been even harsher to the program. If these cuts were approved, Medicaid expansion states would need to decide whether to cut Medicaid or maintain the program's volume by taking on more of its costs.
Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities, recently told Healthcare Dive hospitals with a disproportionate number of low-income patients who are more reliant on Medicaid could get severely hurt if Congress cuts Medicaid.
“There are questions about whether those hospitals will be viable,” said Park. “That could be the death knell for those hospitals over the long run as a result.”