The past few years have given people plenty of reasons to skip health insurance. Prices are higher. The signup period is shorter. The penalty for having no health insurance is $0. These and other factors have helped push the uninsured rate to a four-year high, according to a Gallup survey published Jan. 23.
The uninsured rate among U.S. adults reached 13.7% in the fourth quarter of 2018, according to the Gallup National Health and Well-Being Index, a nationwide survey conducted since 2008. The latest rate is the highest in four years. Gallup estimates that an additional 7 million adults are uninsured since the rate hit a low of 10.9% in 2016.
Gallup asks a sample of 28,000 people each quarter if they have health insurance. Uninsured rates increased the most among women, people living in households earning less than $48,000 a year and adults under the age of 35.
Why did the uninsured rate rise?
Many factors likely played a role in the rise of the uninsured rate, said Dan Witters, research director for the Gallup National Health and Well-Being Index. One is cost. Insurance premiums have increased in many states for the most popular plans offered on Healthcare.gov. While Americans eligible for federal subsidies may have been spared these increases, many people who couldn't get aid were priced out of the market.
Policy decisions could have also increased the uninsured rate. The Trump administration significantly reduced marketing for Healthcare.gov and cut the enrollment period in half. Congress tried to repeal the health care law for most of 2017 and 2018 and President Donald Trump declared, "Obamacare is dead." The messaging was probably confusing for people and discouraged them from signing up, said Katie Keith, a faculty member of the Georgetown University Center on Health Insurance Reforms and a contributor to Health Affairs.
Congress in 2017 also reduced the penalty for skipping health insurance to $0. While this move didn't take effect until 2019, its announcement may have led people to avoid buying health insurance. The latest numbers from the Centers for Medicare & Medicaid Services show enrollment on federal health insurance exchanges for 2019 plans was slightly down from last year.
What do other surveys say?
Gallup's numbers for the uninsured rate generally show a higher trend than federal surveys, Keith said. A Census Bureau estimate released in September showed the uninsured rate stayed stable from 2016 to 2017. The National Center for Health Statistics estimated in August that the uninsured rate was unchanged from the first quarter of 2017 to the first quarter of 2018.
However, a report released in December by the Center for Children and Families showed the share of children without health insurance rose from 2016 to 2017.
These numbers are less recent than Gallup's. Updated federal statistics may be delayed by the recent government shutdown. (Worried about another one? Learn how to manage your money during a furlough.)
"Folks will be closely waiting to see the next round of reports from the Census Bureau and the National Center for Health Statistics," Keith said.
Will the uninsured rate keep rising?
Despite the headwinds facing coverage rates, Medicaid expansion may keep the numbers stable. Maine, Virginia, Utah, Idaho and Nebraska recently opted to expand Medicaid coverage to all low-income residents. Kansas may follow. (Eligible recipients can apply for Medicaid all year. This guide outlines each state's Medicaid requirements.)
"Although this is significant, these states don't have the highest populations so I'm not sure how much of an impact this will have on the national uninsured rate," Keith said. "It is nonetheless significant to the folks in those states."
Medicaid expansion may keep the uninsured rate stable, but any gains in coverage are probably far off, Keith said.
Open enrollment is over, but there are still ways to get health insurance if you missed the deadline. We covered the most common options.