The census report on health insurance coverage showed that the percentage of people with health insurance decreased by 0.4 percent last year. That represents the first decrease in coverage since the Affordable Care Act and the first increase since the 2008-2009 period. The health insurance report is based on both the Current Population Survey and the American Community Survey.

The exact reason for this decline is uncertain but many critics look to the Trump Administration’s ongoing efforts to undercut and attack the ACA. The Administration has stripped out the individual mandate put in place through the tax code, they have pushed states to impose Medicaid work requirements as a condition of access to health care, attempted to undercut the minimum standards of health insurance coverage through new Department of Labor regulations, reduced the end-of-year campaigns to promote enrollment, and reduced the open enrollment period each year.

In 2018, Census report data shows that about 27.5 million people or 8.5 percent of people did not have health insurance at any point during the year. The uninsured rate and number of uninsured increased from 2017 (7.9% or 25.6 million). This is the first year-to-year increase in the percent of uninsured since 2008-2009 and stops a pattern of increased coverage since the ACA.

Of the population with health insurance, private health insurance coverage continued to be more prevalent than public coverage, covering 67.3% of the population that have insurance and 34.4% of the population getting coverage through public health insurance. Employer-based insurance remained the most common, covering 55.1% of the population (of that 67.3 percent figure). Between 2017 and 2018, the percentage of people covered by Medicaid decreased by 0.7 percentage points to 17.9%. The rate of Medicare coverage increased by 0.4 percentage points. The Medicare increase was driven by growth in the number of people age 65 and over while it is unclear what is driving the Medicaid decrease. This is one area where the Trump Administration has driven state waivers or block grants and new mandated work requirements. Alarming, the number of uninsured children under the age of 19 in the U.S. increased by 0.6 percent from the previous year to 5.5 percent for the second year in the row.

The number of children without health insurance in 2018 was significantly higher than in 2017. 4.3 million children under age 19 were uninsured, a 5 percent increase or 3.9 million from previous year with 5.5 percent of children under the age of 19. The Census reported that 425,000 children lost health insurance coverage in 2018, a 10 percent increase from the previous year. Some characteristics in the increase of uninsured rates were geographical, children in the south had the highest uninsured rates and the greatest increase than all other regions in the U.S., rising from 6.5 percent to 7.7 percent. The Census reports indicated that an increase in uninsured rates among children including children of color and those living in poverty. Latino children were more likely to be uninsured than black or white children and states without Medicaid expansion has twice as high of an uninsured rate among children than expansion states.

Adults aged 65 and over had the highest coverage rate than any other group with children under the age of 19 having the lowest overall coverage rate, in 2018. Young adults between 19 to 25 years of age were more likely to be uninsured among adults aged 19 to 64, with an uninsured rate of 14.3 percent. Health insurance coverage is also indicative of your household income, wherein 2018 people with lower income had lower health insurance coverage rates. People in households with an income of $50,000 to $74,999 and people with an income of $100,000 or more, health insurance coverage decreased between 2017 and 2018. People living below 100 percent of poverty were least likely to have health insurance coverage compared to people living at or above 400 percent of poverty.

To read the full report, click here.

About the Author:

John Sciamanna is CWLA's Vice President of Public Policy.

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