Maybe Trump Hasn’t Driven Up the Uninsured Rate After All

MIAMI, FL - NOVEMBER 01: Isabel Diaz Tinoco  (L) and Jose Luis Tinoco speak with Otto Hernandez, an insurance agent from Sunshine Life and Health Advisors, as they shop for insurance under the Affordable Care Act at a store setup in the Mall of Americas  on November 1, 2017 in Miami, Florida. The open enrollment period to sign up for a health plan under the Affordable Care Act started today and runs until Dec. 15.  (Photo by Joe Raedle/Getty Images)
A couple speaks with an insurance agent as they shop for insurance under the Affordable Care Act at a store setup in the Mall of Americas.
Joe Raedle/Getty Images

The share of Americans without health insurance remained essentially flat last year, a newly released government survey has found, suggesting that efforts by the White House to cut back on Obamacare outreach at the time didn’t lead to any overall decline in coverage despite fears from the law’s supporters (myself included) that they might.

According to the results of the National Health Interview Survey, 9.1 percent of Americans were uninsured through the end of 2017, statistically unchanged from the previous two years. Among adults aged 18 to 64, 12.8 were without coverage, the same as in 2015. The survey did show a significant increase in the uninsured rate in states that chose not to expand Medicaid under Obamacare, where more than twice as many residents are now uncovered compared to states that accepted the expansion.

NHISI Uninsured Rates

This is somewhat encouraging news. Obamacare signups did dip slightly in 2017, after the Trump administration cut spending on advertising and programs to help customers navigate the open enrollment process. Surveys offered some mixed evidence about whether the overall uninsured rate bumped up: Gallup, for instance, showed a small increase as did a tracking poll by the Commonwealth Fund, but the latter wasn’t statistically significant. The NHIS, released by the Centers for Disease Control and Prevention, is much a much larger survey, with data from more than 78,000 participants covering the whole year.

What it doesn’t tell us, though, is where things stand now or where we’re headed. Obamacare signups fell very slightly again this year, possibly thanks to the large premium increases that resulted from Trump’s decision to cut off certain important subsidies to insurers, or because Republican repeal efforts left some Americans confused about whether the law was still in place. Based on results gathered in February and March, after the completion of the latest Obamacare open enrollment period, the Commonwealth Fund reported that the uninsured rate rose by a statistically significant 1.8 percent from 2015 to 2018. And either way, the repeal of Obamacare’s individual mandate is likely to drive the uninsured rate up next year, both because some healthy people will probably decide they’re better off not spending on insurance, and because rising premiums could price some people out of the market. The uninsured rate may have held steady in years one and two of the Trump presidency, but I’m still not convinced we should expect that to last.