By Phil Galewitz SEPTEMBER
12, 2018
Despite
Republican resistance to the federal health law, the percentage of Americans
without health insurance in 2017 remained the same as during the last year of
the Obama administration, according to a closely watched report from the Census Bureau released
Wednesday.
However,
the uninsured rate did rise in 14 states. It was not immediately clear why,
because the states varied dramatically by location, politics and whether they
had expanded Medicaid under the federal health law. Those states included
Texas, Florida, Vermont, Minnesota and Oregon.
The
uninsured rate fell in three states: California, New York and Louisiana.
An
estimated 8.8 percent of the population, or about 28.5 million people, did not
have health insurance coverage at any point in 2017. That was slightly higher
than the 28.1 million in 2016, but did not affect the uninsured rate. The
difference was not statistically significant, according to the Census report.
About
17 percent of Americans were uninsured in 2010, the year the Affordable Care
Act was enacted.
The
Census numbers are considered the gold standard for tracking who has insurance
because the survey samples are so large.
(Courtesy of the U.S.
Census Bureau)
Analysts
credit the health law with helping drive down the number of uninsured. But also
a factor: The proportion of people without insurance typically falls as
unemployment rates decline. That’s because more people can get health coverage
at work or can better afford buying insurance on their own.
The
nation’s unemployment rate has generally been falling since before 2011 and
was 4.1 percent for the last quarter of 2017,
the lowest level since
before the Great Recession began in December 2007.
Critics
of the health law said the report emphasized its deficiencies. “Today’s report
is another reminder that Obamacare has priced insurance out of the reach of
millions of working families,” Marie Fishpaw and Doug Badger of the Heritage
Foundation said in a statement. “Despite a growing economy and very low
unemployment rate, the uninsured rate remains virtually unchanged.”
But the
law’s supporters instead saw the glass as half full.
“These
numbers show the resilience of the Affordable Care Act,” said Judith Solomon,
senior fellow at the Center on Budget and Policy Priorities. She said people
still value the coverage they receive from the health law even as it’s been
under attack by President Donald Trump and Republicans who want to repeal it.
“It’s good news because the numbers show the strength of the ACA but bad news
in that we have not seen further progress.”
Solomon
expressed concern, though, about the large number of states seeing uninsured
rates increase.
Uninsured rates last
year ranged from a high of more than 17 percent in Texas to low of just under 3
percent in Massachusetts.
West
Virginia had one of the sharpest increases in uninsured.
About
14 percent of the state’s residents were uninsured in 2013 before the ACA’s
premium subsidies and Medicaid expansion began. That rate fell by nearly
two-thirds by 2016. Last year, however, West Virginia’s uninsured rate crept up
0.8 percentage points to 6.1 percent, according to the Census report.
Carol
Bush, 58, of Elkins, W.Va., expects to lose coverage Oct. 1 because her job is
ending.
It’s an
unfortunate irony: Elkins has served for the past three years as a navigator
helping people in her community find coverage in the health law marketplaces.
Federal officials have largely scrapped that program.
The Trump administration cut funding by
more than 80 percent during the past two years, saying it had no proof that
navigators were helping people find coverage. Only if consumers signed up in
the presence of the navigator was a session considered a success.
Bush
had coverage through the University of West Virginia, which has a navigator
contract that ends at the end of this month. Without employer coverage, Bush
said, the cheapest insurance she could find would be about $1,100 a month. She
won’t qualify for a federal subsidy to lower her premium because of her
family’s income. Her husband is insured through Medicare.
Although
she said she has strongly considered going without insurance because of the
cost, she knows she needs it.
“In all
honesty, I’ve always had some kind of health insurance, and the thought of
being without it worries me,” she said. “I can’t risk getting seriously ill and
incurring enormous debt at this point in my life. Peace of mind has a value
too.”
Shenandoah
Community Health Center, a federally funded health clinic in Martinsburg,
W.Va., has started to see an increase in uninsured patients the past year,
although it’s still below levels it saw before the health law’s coverage
expansion began in 2014, said CEO Michael Hassing. Hassing said he believes
many patients have dropped coverage, thinking the ACA’s individual mandate was
repealed.
“Folks
say, ‘I don’t need to have it anymore,’ and they let it go,” he said.
While
the GOP failed last year to repeal the law, Congress was able to strip out one
of its key features — the individual penalty for not having coverage. The vote
last December eliminated that penalty starting in 2019 — meaning Americans are
still required this year to have health coverage or face the consequences on
their 2018 taxes.
Phil Galewitz: pgalewitz@kff.org,
@philgalewitz
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