The numbers suggest a surprising resilience of the health
law.
May 22, 2018
Last year, Trump administration officials declared Obamacare
“dead,” pulled enrollment ads offline, distributed social
media videos critical of the law and sent
signals that the law’s requirement to buy health insurance was
no longer in effect.
But the number of Americans with health insurance stayed
largely unchanged. The results of a big, government survey on health insurance
status were published Tuesday, and they show that the uninsured rate remained
basically flat at 9.1 percent in the first year of the Trump presidency.
The numbers suggest a surprising resilience of the
health law, and its expansion of insurance coverage, even in
the face of efforts that the law’s defenders call “sabotage.”
The new
statistics come
from the Centers for Disease Control and Prevention, which monitors the number
of Americans with and without health insurance every quarter. A
smaller survey from Gallup had
shown the uninsured rate rising last year. And a survey from the Commonwealth
Fund showed a small rise, though it was statistically
insignificant. But the C.D.C. research includes a larger sample size, and is
generally regarded as a more definitive study. Tuesday’s study contains data
from the entire calendar year of 2017.
Among states that expanded their Medicaid programs under the
Affordable Care Act, the uninsured rate actually fell last year. Among states
that didn’t expand, it rose a little.
Over all, Obamacare has substantially reduced the number of
Americans without insurance. According to the report, 19.3 million fewer people
were living without health insurance in 2017 compared with 2010, when the
Affordable Care Act passed Congress.
New health insurance options aren’t the only thing that has
changed since the passage of the Affordable Care Act. A strengthening economy
has nudged more Americans into the work force, increasing people’s access to
health insurance at work.
Obamacare has shown other signs of hardiness. This year, the
Trump administration slashed the program’s advertising budget by 90 percent,
and withdrew key subsidies from insurance companies, leading to premium
increases for some customers. But every market had at least one insurer that
continued to offer plans on the Obamacare marketplaces, and sign-ups dipped
only slightly.
That does not mean that the insurance trends will hold
forever. There are several
reasons the uninsured rate may rise in the future:
·
In the face of rising premiums, it is
likely that some who do not qualify for federal subsidies have dropped coverage
this year.
·
Several states are trying to set
up work
or other “community engagement” requirements for some Medicaid
beneficiaries. A few will impose such
rules this year. States requesting such changes estimate they will result in a
declining number of residents covered by Medicaid.
·
The Trump administration is working
on regulations to allow more loosely regulated insurance plans
into the market. These plans could prove appealing to some people who are
currently uninsured. But they could cause prices to rise for insurance plans
with all of the Obamacare consumer protections, prompting other people
to drop their coverage. According to an
estimate from the Urban Institute, about 2.6 million fewer
people may have comprehensive coverage next year.
·
The tax penalty for people who decline
to obtain insurance will
disappear entirely next year. That change alone is likely to cause
several million fewer Americans to have insurance. Early filings by insurance
carriers suggest the change will cause another round of big price increases.
And economists at the Congressional Budget Office estimate that the policy’s
disappearance will also cause fewer people eligible for government help from
even investigating such options.
The combination of those changes is likely to mean some
backsliding. But last year’s data suggest that Obamacare’s policies have helped
create options that are appealing to many Americans who would have gone without
insurance in the years before its passage.
Margot Sanger-Katz is a domestic correspondent and writes about
health care for The Upshot. She was previously a reporter at National Journal
and The Concord Monitor and an editor at Legal Affairs and the Yale Alumni
Magazine. @sangerkatz • Facebook
A version of this article appears in print on May 22, 2018,
on Page A16 of the New York edition with the
headline: Number of Uninsured Isn’t Going Up, or Down. Order Reprints | Today’s Paper | Subscribe
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