- Gains in health insurance coverage made under the Affordable Care Act are beginning to reverse, according to the seventh iteration of The Commonwealth Fund's ACA Tracking Survey.
- According to the survey, the rate of uninsured people between ages 19 to 64 has increased to 15.5% from 12.7% in 2016, with higher rates in states that have not expanded Medicaid. Uninsured rates are higher in southern states.
- Commonwealth attributes its findings to the repeal of the individual mandate, the rise of non-ACA-compliant insurance policies and support for Medicaid work requirements.
The results of Commonwealth's tracking survey, which collects responses from people who had gained insurance under ACA, imply that gains in rates of insured individuals made under the ACA are rolling back under the current administration.
The implication is consistent with Gallup's findings earlier this year. According to that poll, the percentage of uninsured American adults increased 1.3 percentage points during 2017, the largest single-year increase since Gallup and Sharecare started measuring the rate in 2008, representing about 3.2 million Americans who became uninsured in 2017.
Commonwealth's survey, for the months of February and March, concludes that about 4 million people have lost insurance coverage since that time. Additionally, uninsured rates increased significantly among adults with lower-incomes, and one in five adults living in southern states are estimated to be uninsured.
Continued drops are expected. Commonwealth estimates that 5% of currently-insured adults plan on dropping their insurance coverage because of the individual mandate penalty repeal.
The Trump administration is promoting expanding short-term health plans and association health plans, which supporters say will allow more affordable options for currently uninsured Americans. Several industry organizations and associations have criticized the move, arguing the expansion of short-term plans would undermine consumer protections, lead to higher premiums in the ACA-compliant individual market and jeopardize market stability.
Additionally, the Trump administration’s plans for short-term expansion would primarily impact the middle class, as lower-income people are protected from premium increases through the use of federal subsidies, according to a recent Kaiser Family Foundation report.
Gallup found that the uninsured rate increased in all demographic groups last year except for senior citizens, who are eligible for Medicare.
Some experts have encouraged caution in speculation based on surveys that allow for sampling errors, such as Commonwealth's. Results from the organization's ACA tracking survey are "representative of the approximately 190 million U.S. adults ages 19 to 64" with "an overall margin of sampling error of +/– 2.8 percentage points at the 95% confidence level."