The number of people in the United States without health insurance grew by nearly two million last year, the U.S. Census Bureau reported Tuesday, the first significant decrease since the passage of the 2010 Affordable Care Act.
Some 27.5 million Americans were uninsured in 2018, compared to 25.6 million the year before. The uninsured rate rose to 8.5 percent, according to census data.
The new figures are a turnabout from a pattern that began after a Democratic Congress passed the health law shortly after the end of the Great Recession. At the time, the uninsured rate stood at nearly 16 percent, and it fell steadily in subsequent years until plateauing in 2016.
The economic and political consequences of this new trend could intensify leading up to the 2020 elections, with Republicans alleging that the law is flawed and Democrats alleging the Trump administration has dismantled it in a way that leaves many Americans vulnerable.
The new report was part of a series of reports the Census Bureau releases annually on the state of the economy. It also reported Tuesday that the U.S. poverty rate fell to its lowest level since 2001 last year and middle-class income topped $63,000 for the first time, although that is roughly the same in inflation-adjusted terms as middle-class income was in 1999.
The Census Bureau painted a picture of an economy pulled in different directions, with a falling poverty rate but high inequality and more people at risk because of a lack of health insurance. The health insurance change is a possible side-effect of the Trump administration’s efforts to weaken President Obama’s 2010 health care law, though officials believe there were numerous factors. Census officials said a drop in Medicaid coverage drove the trend.
Health insurance has long been recognized as crucial to people’s ability to get medical care when they need it. The availability of insurance is influenced by a variety of factors, including economic conditions, because most insured U.S. residents get their health plans through an employer. In recent years, however, both supporters and opponents of the ACA have looked at Census’ yearly insurance data as a portrait of how well the law is working.
Expanding access to insurance was a main goal of the ACA, the statute forged by Democrats nearly a decade ago that has reshaped much of the health care system. President Trump and other Republicans contend the law is fatally flawed, while Democrats maintain it has been undermined by recent GOP policies. Trump has tried, with mixed success, to gut the Affordable Care Act.
A 2017 tax law Trump signed successfully stripped out one of the health law’s key features.
As Trump works to dismantle the law and liberal Democratic candidates seek to replace it with a government-financed health-care system, both sides can find ammunition for their interpretation of why the nation’s uninsured rate has started rising again.
Republicans can point to how, as premiums escalate, fewer people buy health plans through the ACA’s marketplaces unless they qualify for federal subsidies. Democrats can point to how major tax changes, adopted by a Republican Congress at the end of 2017, eliminated the financial penalty for those who violate the ACA’s requirement that most Americans carry health insurance — removing one motivation to stay insured.
A consistent decline in the number of uninsured Americans that began in 2011 actually stopped in 2017, according to census data, with about 400,000 more people than in 2016 reporting that they lacked coverage. But that did not amount to a statistically significant change in the uninsured rate.
The new figures for 2018 show that the uninsured rate increased to 8.5 percent of the population from 7.9 percent the year before. Both years cover the U.S. population from birth to age 64, just before people become eligible for the federal Medicare program for older Americans.
In contrast, some 9 million Americans gained coverage between 2013 and 2014, the year that Medicaid expanded in many states and ACA insurance marketplaces opened for individuals and families that cannot get an affordable health plan through a job.
Tuesday’s data make clear that the contraction of insurance has been broad. Around the country, insurance coverage worsened in eight states and improved in three states.
For the first time, the Census Bureau breaks out the proportion of Americans buying health plans through the ACA’s insurance marketplaces . They show that 3.3 percent of people last year got their coverage through such a marketplace. The breakout reinforces how the ACA’s health plans, while attracting considerable political attention, account for only a fraction of the nation’s health insurance.
The official U.S. poverty rate fell to 11.8 percent in 2018, the lowest since 11.7 percent in 2001 and a sign that the devastation from the Great Recession had faded. Businesses have been hiring minority and low-skilled workers at unusually high rates lately, helping give jobs and opportunities to Americans who struggled for years to get a chance.
The fall in the poverty rate is coming as more people get jobs and move from part-time to full-time work, helping boost incomes. Last year alone, 2.7 million people found jobs, according to the Labor Department.
“We have found quite a big increase in full-time, year-round work that would tend to bring up incomes for working people,” said Trudi Renwick, assistant division chief at the U.S. Census Bureau.
The median U.S. household earned $63,179 last year, meaning half of the families in the country earned more than this amount and half earned less.
The Bureau’s Current Population Survey is widely regarded as the most reliable portrayal of health insurance in the United States, but there have been other clues the ranks of the uninsured are swelling. In July, the U.S. Centers for Disease Control and Prevention issued findings from the National Health Interview Survey that the number of Americans uninsured at the same they were asked increased from 28.9 million in 2017 to 30 million last year.
The Census’s CPS counts people as uninsured if they lacked coverage throughout the year.
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