- Despite positive economic gains last year, the uninsured rate spiked in 2019 before the coronavirus pandemic further devastated the U.S. economy, according to new data from the U.S. Census Bureau.
- Almost 30 million Americans didn't have health insurance coverage last year, up about 1 million from 2018, the data show. That's about 9.2% of the U.S. population. It's a continued decrease in coverage under the Trump administration, following gains after the passage of the Affordable Care Act about a decade ago.
- The census numbers don't include the effects of the COVID-19 recession, which experts believe has thrown millions more Americans off their employer-sponsored insurance since March this year.
The report shows positive economic indicators overall. Despite the gains, the nation's uninsured rate continued to rise, a trend which could partially be explained Trump administration policy changes hamstringing insurance access and high-deductible plans offered in the ACA marketplaces being out of reach for many middle-class people.
The high cost of U.S. healthcare continues to stress the country's economic outlook overall. About 7.7 million more Americans would be considered low-income if their medical bills were factored in, the Census Bureau said. Trump administration efforts to lower prescription drug and healthcare costs have proved toothless thus far, with the majority of rule changes and executive orders not making it to implementation.
How to fix the nation's insurance crisis has been a key issue of the 2020 presidential election for voters, with many saying healthcare is a top concern for how they cast their ballots. President Donald Trump does not have a list of healthcare priorities on his campaign website, but the incumbent's record includes a litany of actions that experts say could have reduced coverage.
The president is currently backing a Republican state-led lawsuit to fight the ACA, which expanded coverage to some 20 million more people, unconstitutional. The case is currently in front of the U.S. Supreme Court, with the trial scheduled for just a week after the November election.
Trump's health administration has also repeatedly passed policies experts warned could increase the number of the un- and underinsured people in the U.S., including limiting funding and eligibility in the Medicaid safety net insurance program, expanding access to skimpy association and short-term plans, cutting funding for marketplace navigation and shrinking the windows to apply for ACA plans.
The Census Bureau data suggest such actions could have further stressed the ACA exchanges. The number of people who bought direct coverage, including ACA plans, dropped 0.3 percentage points last year, though the number in job-based plans increased. Medicaid enrollment also dipped 0.7 percentage points, while Medicare rolls grew.
On a state-by-state basis, the uninsured rate ranged from just 3% in Massachusetts to a whopping 18.4% in Texas last year. More than a third of states — 19 — reported a statistically significant decline in insurance coverage from 2018. Virginia was the only state to notch a notable increase in its insured population, by 0.9 percentage points. The growth was likely due to its Medicaid expansion that began in January 2019 and enrolled some 380,000 adults in coverage. Medicaid expansion states in general continue to have a lower uninsured rate than the national average.
The data aren't perfect, however, as COVID-19 disrupted the Census Bureau's efforts to get a clear snapshot of last year's insurance landscape. The survey took place in the early months of the pandemic, forcing the agency to suspend in-person interviews and resulting in fewer responses, which could complicate efforts to interpret insurance changes in 2019 versus prior years.