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January 24, 2019

Uninsured rate reaches highest levels since ACA coverage expansions took effect, poll finds

Daily Briefing

    The share of U.S. adults without health insurance rose by 1.5 percentage points in 2018, reaching the highest level since the Affordable Care Act's (ACA) coverage expansions took effect in 2014, according to a Gallup National Health and Well-Being Index poll released Wednesday.

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    The poll is based on surveys completed by mail or web with a random sample of 115,929 U.S. adults. The surveys were conducted throughout 2018.


    The poll found the uninsured rate among U.S. adults rose from 12.2% in the fourth quarter (Q4) of 2017 to 13.7% in Q4 of 2018.

    According to the poll, the 2018 uninsured rate among U.S. adults is still well below a peak of 18% in the third quarter of 2013, the final year before the ACA's coverage expansions took effect. However, it marks the second year in a row the uninsured rate has grown. According to the poll, the U.S. uninsured rate among U.S. adults from 2014 to 2016 had consistently declined, but that trend reversed in 2017.

    The poll found the uninsured rate among U.S. adults has increased by 2.8 percentage points since reaching a record low of 10.9% in Q4 of 2016—representing a net increase of about seven million adults without health insurance.

    The poll found that the increase in uninsured adults from 2016 to 2018 occurred among most demographic groups, though the uninsured rate rose the most among "women, those living in households with annual incomes of less than $48,000 per year, and young adults under the age of 35," according to the poll.

    Reasons for the increase

    The poll attributed the recent rise in uninsured U.S. adults to a number of factors, including:

    • Higher exchange plan premiums;
    • Funding cuts for so-called "navigator" organizations, which help U.S. residents enroll in exchange plans;
    • Insurers withdrawing from the exchange market; and
    • The ACA's shorter open enrollment period.

    Chris Hansen, president of the advocacy arm of the American Cancer Society, said, "After years of progress it is deeply troubling to see more Americans becoming uninsured." He said, "Research shows uninsured individuals are more apt to skip cancer screenings, delay getting necessary care, and ultimately are more likely to have their cancer diagnosed at a later stage when survival is less likely and costs are higher." Hansen added, "We urge the [Trump] administration and Congress to reverse this alarming trend and work together to enact bipartisan measures to protect access to quality health care for all Americans" (Baker, "Vitals," Axios, 1/23; Japsen, Forbes, 1/23; Levey, Los Angeles Times, 1/23).

    Cheat sheet: What you need to know about the ACA


    The Patient Protection and Affordable Care Act, otherwise known as the ACA, is the comprehensive health care reform bill passed by Congress in March, 2010. The law reshapes the way health care is delivered and financed by transitioning providers from a volume-based fee-for-service system toward value-based care.

    Download the ACA cheat sheet to get a quick overview of this significant U.S. health care legislation.

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