- Though the uninsured rate fluctuates throughout the year, 2018 saw the first annual increase in the number of uninsured Americans in almost a decade amid Trump administration actions that have destabilized the Affordable Care Act and cut enrollment in safety net programs.
- Last year, 8.5% of people didn't have health insurance at any point during the year, a slight increase from 2017 according to U.S. Census Bureau data released Tuesday. That's 27.5 million Americans without insurance, up by roughly 2 million people from 2017's figure of 25.6 million.
- The percentage of people with public coverage fell by 0.4 percentage points between 2017 and 2018, while the percentage of Americans with private coverage did not change.
Following the passage of the ACA, the uninsured rate declined as health insurance became more affordable for many Americans and many states decided to expand Medicaid to cover more low-income residents. However, ongoing Republican efforts to weaken the legislation and pare back safety net programs like Medicaid seem to be shrinking positive gains in the nation's insured rates.
A total of 91.5% of Americans had health insurance coverage for all or part of 2018, lower than the year before, which saw 92.1% coverage, according to the Census figures. That's the first decrease in the uninsured rate since 2008 to 2009, one year before the ACA was signed into law and during a sustained financial crisis.
The Census Bureau found 3.3%, or 10.7 million Americans, were covered by the ACA exchanges last year, down from 3.5% or 11.2 million in 2017.
Since he took office in 2016, President Donald Trump's administration has introduced a number of healthcare initiatives to weaken the ACA, many with that being the stated goal.
Additionally, the Department of Justice declined to defend the wide-reaching law against a coalition of Republican state attorneys general trying to declare the it unconstitutional. The case, which is currently under appeal in the conservative-leaning Fifth Circuit Court of Appeals, would be a "complete nightmare if it happens," Lanhee Chen, a public policy researcher at Stanford University, said at an American Enterprise Institute event Tuesday, and throw the U.S. healthcare landscape into turmoil.
Though the number of Americans covered by Medicare saw a small increase between 2017 and 2018 as more people age into the program, the number of low-income Americans covered by Medicaid decreased sharply, dropping to 17.9% — a 0.7 percentage point drop.
That decrease was more prominent in the 14 states that did not expand Medicaid on or before Jan. 1 last year, the Census Bureau found. Despite increasing popularity of expanding the safety net program to 138% of the federal poverty level among red and blue states, some Republican state legislators and governors have tried to hamstring or slow voter efforts in past months, notably in Nebraska, Utah and Maine.
"For adults aged 19 to 64, the relationship between poverty status, health insurance coverage in 2018, and the change in coverage between 2017 and 2018 may be related to the state of residence and whether or not that state expanded Medicaid eligibility," Census Bureau researchers wrote.
The Trump Administration has approved controversial work requirements tying Medicaid eligibility to community engagement, work or education hours in nine states, though most of those requirements have not yet taken effect and district courts have blocked the programs in three: Arkansas, Kentucky and New Hampshire.
Before a judge blocked work requirements in Arkansas, the first state where they went into effect, about 18,000 low-income Americans lost their health insurance coverage.
Three states (New York, South Carolina and Wyoming) reported increased health insurance coverage, while eight (Alabama, Arizona, Idaho, Michigan, Ohio, Tennessee, Texas and Washington) reported decreased coverage.
Private coverage continues to insure the majority of Americans. The Census Bureau found 67.3% of the population has commercial coverage, compared to 34.4% covered by public plans Medicare, Medicaid, the Children's Health Insurance Program and coverage for the military and veterans.
Employer-based insurance remains the most common, covering more than 55% of the country.