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The trend line, which had been downward for nearly a decade, is turning
In one of its Current Population Reports issued this week, the US Census Bureau reports that the percentage of uninsured Americans rose in 2018, for the first statistically significant time since 2009-10. Some 27.5 million lacked health coverage; that represents 8.5% of the population, up from 25.6 million, or 7.9% in 2017. Uninsured children (under the age of 19) also rose, from 4.9% to 5.5%.
The Census Bureau report notes that there are technical differences in how data were collected between 2017 and 2018; nevertheless, the 2016-2017 change also indicated a higher rate of uninsured, by a not-statistically-significant 400,000 persons. The longer-term view from the late 2000s shows a flattening in the curve of uninsured, and now it is clearly going up.
Much of the overall change from 2017 to 2018 is from a decline in Medicaid coverage—and that was one of the key elements of the Affordable Care Act. Medicaid insureds dropped by 0.7% (meanwhile, the number of Americans on Medicare rose 0.4% as more Baby Boomers enter retirement age). The number of ACA-supporting states (which entails, among other things, accepting increased federal funding of healthcare and setting up state-based insurance exchanges) is currently 31. Although self-evident, the report notes that “the uninsured rate in states that expanded Medicaid eligibility … was lower than in states that did not expand eligibility” (the uninsured rate in the former is 6.6%, versus 12.4% in the latter). Texas stands out in the data among the 19 non-ACA states; its uninsured rate is the highest in the country, at 17.7%, and, because of its size, that represents 5 million people.
Healthcare coverage is widely recognized as a key issue in the current election season, with Democratic candidates each vying to outdo the other in the breadth of their support, and the Trump administration continuing to try to chip away at federal healthcare support. It’s worth remembering that during the ferocious debates that led to passage of the ACA, the pharma industry, in the form of its trade association, PhRMA, supported it.