The number of Americans with health insurance is decreasing. Why?

Headshot of Derek Silva


Derek SilvaSenior Editor & Personal Finance ExpertDerek is a former senior editor and personal finance expert at Policygenius, where he specialized in financial data, taxes, estate planning, and investing. Previously, he was a staff writer at SmartAsset.

Published|3 min read

Policygenius content follows strict guidelines for editorial accuracy and integrity. Learn about our editorial standards and how we make money.

The number of people with health insurance decreased for the first time since the Affordable Care Act passed in 2010.

In 2018, 8.5% of the population didn’t have health insurance coverage, according to new data from the U.S. Census Bureau. In 2017, 7.9% people didn’t have health insurance.

This means an additional 1.9 million people went without health insurance in 2018.

Is the drop in coverage a result of a struggling economy?

Higher uninsured rates can signal a struggling economy. The last time uninsured rates rose was from 2009 to 2010, during the Great Recession.

But the economy isn’t struggling. In fact, it’s performing quite well. The number of full-time, year-round workers increased by nearly 2.3 million from 2017 to 2018, median annual earnings for all workers increased by 3.4% and the poverty rate decreased from 12.3% in 2017 to 11.8% in 2018.

What’s happening with health insurance coverage?

1. Private coverage rates aren’t increasing with employment Private health insurance is the most common form of health insurance in the U.S. — 67.3% of the population had it 2018. Private coverage includes plans provided through an employer, union or TRICARE. It also includes plans purchased by an individual through the federal marketplace or directly from an insurance company. But coverage has decreased for most forms of private insurance.

The Trump administration has worked to lessen the impact of Obamacare since taking office in 2016. The individual mandate has been indefinitely suspended, so there’s no longer a tax penalty for going without health insurance. In 2017, the Trump administration decreased the length of open enrollment, the time when people can sign up for a plan through the marketplace. The administration also decreased spending on Obamacare advertising by 90%, leaving many unaware of when the enrollment deadlines even were.

We have an explainer on why most Americans don’t know anything about Obamacare.

2. Public coverage rates dropped Public health insurance, which covered more than 111 million people in 2018, includes programs that help cover low-income individuals, seniors, those living with certain disabilities and veterans. This includes programs like Medicaid and Medicare.

From 2017 to 2018, the percentage of people with public health insurance coverage decreased from 34.8% to 34.4%.

Medicaid coverage, which is designed primarily to help low-income individuals and families, was expanded in many states under Obamacare. Since taking office, President Trump has worked to decrease the coverage of Medicaid. You can learn more about state eligibility for Medicaid here.

Making sure you have enough health coverage

Here are a few things to keep in mind as you think about your health insurance coverage.

1. Understand what kind of coverage you need One key to having sufficient health insurance coverage is to know what kind of coverage you actually need. Some plans make it harder than others to visit a specialist. Here’s a health insurance guide to get you started.

2. Know the limits of employer-sponsored coverage Health insurance coverage from employers isn’t necessarily expanding as the economy does. Even if your employer offers coverage, it may not be enough. Make sure to read the details of your plan so you know what services are covered, and which are not, so you can avoid a surprise bill.

3. Know when open enrollment is The federal government has done less in recent years to make sure Americans know the deadlines for open enrollment on the individual health insurance marketplace (the time when you can sign up for a new health plan). That means it’s important to know that open enrollment in 2019 is from Nov. 1 to Dec. 15. During that time, you can sign up for a new plan or change the details of your current plan. Open enrollment for employer-based plans is usually around the same time, but check with your human resources department.

If you have experienced a major life change, like a marriage or the birth of a baby, you may qualify for special enrollment, which allows you to get a new plan outside of the open enrollment period.

Correction, Nov. 13, 2019: An earlier version of this article incorrectly described association health plans. The description has been removed.

Ready to shop for life insurance?