The U.S. Census Bureau announced in a report on Tuesday that the percentage of Americans without health insurance is creeping upward. It’s the first rise in the uninsured rate since the Affordable Care Act passed in 2010. In 2018, 8.5 percent of the population, or 27.5 million people, went without health insurance for the full year, compared with 7.9 percent of the population, or 25.6 million people, in 2017. Immigrant children have been particularly heavily hit by the trend: For non-citizens under the age of 19, the percentage without health insurance rose by more than two points, from 15.6 percent to 18.3 percent.
Given that 2018 saw strong economic growth, with 2.6 million new jobs and rising wages, the culprit is likely a range of Trump administration policies designed to discourage participation in public benefits and to undermine the Affordable Care Act. In 2017, President Donald Trump scrapped subsidies to health insurance companies that helped lower the cost of individual plans for low-income Americans. A few months later, he signed legislation eliminating the tax penalty for Americans who forego health insurance. Earlier this year, the administration released new “public charge” rules that will make it easier for the government to deny visa renewals to immigrants who use Medicaid. And across 2017 and 2018, federal officials cut the budget for advertising open enrollment for marketplace health insurance plans by upwards of 80 percent.
The drop reverses a 10-year trend of increasing health insurance coverage among Americans. The biggest change in the insurance rate came from Medicaid, which lost nearly 2 million enrollees. Participation in employer-based plans and individual marketplace plans was also down. These declines in Medicaid and private plans are in part offset by more Americans qualifying for Medicare, which picked up more than 1.5 million new participants. But the Trump administration has given states license to be pickier about who gets covered with Medicaid dollars. In 2018, it started granting waivers to states that wanted to boot unemployed residents from their rolls. And as the New York Times points out, some states have begun asking Medicaid recipients to prove their eligibility more often, a maneuver that can lead people to lose coverage when their incomes rise or they can’t keep up with paperwork.
Randomized studies have shown that having health insurance lets people see the doctor more often and can lead to fewer symptoms of depression and better mental health. Support for the Affordable Care Act is more or less at an all-time-high: Data from the Kaiser Family Foundation says that more Americans have had a favorable than an unfavorable opinion of Obamacare for every month since June 2017. So as the Democratic presidential primary candidates debate whether to expand Obamacare or move to a single-payer system and Trump chooses whether to continue attacking or start defending the Affordable Care Act, health insurance is likely to remain a central issue through the election.