The number of Americans without health insurance rose slightly last year for the first time since 2009, climbing to 27.5 million, the Census Bureau reported Tuesday. Compared with 2017, the number of uninsured grew by 1.9 million and the share of the population without coverage rose from 7.9% to 8.5%.
The increases are notable because they came even as the economy continued to grow in 2018 and the poverty rate fell 0.5 percentage points to 11.8%, the lowest level since 2001.
A troubling turn: While the uninsured rate is still well below where it was a decade ago, the increase is the first since coverage began expanding under the Affordable Care Act, which introduced government subsidies for private insurance plans for millions of Americans and allowed for the expansion of Medicaid to millions more. The new data “show that insurance gains under the health care law have stalled and are appearing to reverse as the Trump administration focuses on paring back the law's insurance markets and shrink enrollment in safety net programs like Medicaid and the Children's Health Insurance Program,” Politico’s Rachana Pradhan said.
Driving the numbers: The rise in the number of uninsured was driven primarily by a drop in public insurance for the poor. Despite the stronger economy, the percentage of people with private health insurance didn’t change significantly last year. “There are fewer people in poverty and more people working, but the jobs low-income people are getting often don't come with health benefits. So, job-based health insurance isn't growing, even in an economy with low unemployment,” Larry Levitt of the Kaiser Family Foundation said.
But the percentage of people covered by government plans dropped 0.4 percentage points, including a 0.7 percentage point decline in Medicaid coverage to 17.9%. The rate of Medicare coverage grew by 0.4 percentage points to 17.8%, due in part to the continued aging of the population. The share of children under the age of 19 without insurance also rose by 0.6 percentage points, to 5.5%, meaning 4.3 million children lacked coverage.
Overall, the number of Americans covered by Medicaid and the Children’s Health Insurance Program fell by more than 1.6 million last year, according to data cited by The New York Times.
Some groups stand out: Many of those who lost coverage last year — about 574,000 — were non-citizens, Kaiser Health News notes. And the uninsured rate jumped especially among adults who are Hispanic and foreign-born, both both groups seeing losses of coverage three times as large as the national average, according to The Washington Post. Children who are Hispanic and naturalized citizens also saw outsized declines.
“Health policy experts interpreted those patterns as evidence of a chilling effect from the Trump administration’s efforts to restrict several forms of public assistance, including Medicaid, for immigrants seeking to remain in the United States,” The Washington Post’s Amy Goldstein and Heather Long report. “In addition, some state[s] have been clamping down on eligibility rules for Medicaid.”