On Wednesday, Gallup released a report showing that the number of Americans without health insurance has reached a four-year high. The rate peaked in 2014, then began to decrease with the roll-out of the Affordable Care Act. Now, after hitting a low of 10.9 in 2016, the uninsured rate has risen to 13.7 percent.
According to Gallup, this percent increase means that seven million more adults are going without health insurance. That's on top of the more than 20 million Americans who were already uninsured in 2017. All of these uninsured Americans will now be less likely to receive care for health conditions or chronic diseases, as a large body of research shows.
Gallup notes that these rates are increasing particularly among groups that already face severe health disparities—women and low-income people—as well as a population whose participation in the market makes plans more affordable for everyone: young people.
Just a few years after Obamacare drastically reduced the number of uninsured people with Medicare expansions and the individual mandate, experts now fear this trend will dismantle historic gains.
Here's why that's happening—and who will be affected.
There's a Host of Factors, but One Common Denominator: Trump
Why are more people passing on the ACA? Experts blame several factors.
One explanation is that premiums increased as insurers withdrew from the marketplace, leading to fewer choices and less competition—a vicious cycle. (Recent analysis shows that the repeal of the individual mandate has made 2019 plans 16 percent more expensive, an increase of $168 a month on average). There's also the fact that, after a steep decline of insured people in 2014, the rates simply plateaued. "We never expected we'd reach a 0 percent uninsured rate, so it's partially just the natural course of implementation," says Rachel Garfield, a senior researcher at the Kaiser Family Foundation who studies Medicaid and the uninsured.
But people aren't just stingy. Many also believed that they had no choice. A number of President Donald Trump's policy changes and misleading statements fomented confusion about the law, leading to lower enrollment. In March of 2017, Trump announced: "I want people to know Obamacare is dead. It's a dead health-care plan." It wasn't, but "some people believed that to be true," Garfield says. The administration also slashed the ACA's marketing budget last summer.
Other factors include removing the individual mandate, ending cost-sharing reduction, and pursuing anti-immigration policies that had a chilling effect on participation in public programs among undocumented people.
Uninsured Rates Are Highest Among Women, Young People, and Poor People
Studies show that when people don't have coverage, they are less likely to receive care. If this trend continues, "the expectation is more people would face those kinds of challenges," Garfield says. Gallup finds that the increase in uninsured rates was greatest among women, low-income people, and adults under the age of 35; of these, women experienced the fastest-rising increase.
This Doesn't Portend the End of Obamacare's Gains—Yet
This week, some experts disputed the exact numbers in Gallup's survey, or at least urged caution. Gallup collects its data from the Gallup National Health and Well-Being Index, which asks adults whether they are insured. Other surveys use different populations, survey sizes, and questions, but, overall, the trend remains the same: The ACA is floundering.
"It's important to note that, while we are seeing a slight reversal in trend, according to most of the data, the uninsured rate is still much lower [than it was before the ACA]," Garfield says. "I would not say the last two years have reversed the progress that was made, but it is troubling that things are starting to go in the other direction. That shows that the implementation and policy environment does matter."
Miranda Dietz, health policy researcher at the University of California–Berkeley's Labor Center, calls this environment "Trump sabotage." Dietz studies health-care reform in California, a state that she says has been able to resist the trend by extending its enrollment period and outreach, picking up where the federal government left off. Still, she has projected a significant drop in coverage for the state after the repeal of the individual mandate, finding that 4.4 million Californians could go uninsured by 2023.
If Obamacare is failing to continue its historic gains, she notes, it's because of the actions of the current administration—not the law.