Health insurance coverage has steadily increased since the 2010 passage of former President Barack Obama's health care law. Nearly 20% of adults were uninsured in 2013, just before HealthCare.gov launched. After three years the uninsured rate dropped to 12.7%.
But the trend is starting to reverse. About 4 million working-age people have lost health insurance since 2016, and the uninsured rate has crept back up to 15.5%, according to a survey from the Commonwealth Fund, a non-profit promoting greater access to health care. The authors of a Commonwealth blog post on the survey blame the federal government for failing to support the marketplace for individual health care.
The Trump administration cut advertising and outreach during open enrollment and shortened the enrollment period for "Obamacare." That may have left people confused about the health care law.
Insurance coverage could continue to decline in 2019. Congress repealed the individual mandate, which penalizes people who don't buy health insurance. In addition, President Donald Trump is pushing insurance policies that are cheaper than many marketplace plans, but also don't provide as many benefits.
These actions could lead fewer people to buy health insurance and make it more difficult to get coverage.
Who's losing coverage?
SSRS, a market research firm, interviewed a nationally representative sample of 2,403 adults from Feb. 6 through March 30 for the Commonwealth Fund. The survey found people in states that chose not to expand Medicaid have fared worse than others in the past two years. The uninsured rates in states that didn't expand Medicaid reached 21.9% in March, compared to 11.4% in states that did.
Republicans and southerners have also seen coverage rates drop. The uninsured rate for Republicans rose to 13.9% in March, compared to Democrats, for whom the uninsured rate actually dropped to 9.1%. In the South, more than 20% of adults were uninsured, compared to 11% in the Northeast and Midwest.
The individual mandate repeal
The individual mandate, with a few exceptions, requires everyone to buy health insurance or pay a tax penalty. The penalty drops to $0 starting in 2019. 5% of survey respondents said they would drop their insurance coverage as a result, including 9% of those who got insurance through the individual market.
Could things get worse?
Premiums for people who don't get subsidies were high last year, and many experts believe they'll be higher for open enrollment this year. All the uncertainty surrounding the individual market is still there and it doesn't look like it's going away. The Commonwealth Fund highlighted state efforts to shore up the health insurance market by establishing reinsurance programs to help pay for costly claims, and by bringing back the individual mandate.
But other states are raising barriers to coverage. Twelve states have added or are considering work requirements to qualify for Medicaid. The result, as the survey shows, could be a variety of coverage levels depending on where you live.
Can you still get covered?
It's not all doom and gloom. Nearly 12 million people got health insurance for 2018 through Obamacare despite all the headwinds the marketplace faced. A vast majority — 83% — qualified for subsidies, paying an average of $89 in premiums, mitigating eye-popping sticker prices for health care.
As of now, it looks like Obamacare will still be around when open enrollment comes back this fall. But anything can happen in the next few months, and the numbers from this survey aren't encouraging.