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September 11, 2019

The uninsured rate just rose for the first time in nearly a decade. See the impact, mapped.

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    U.S. Census Bureau data released Tuesday shows the country's uninsured rate increased from 7.9% in 2017 to 8.5% in 2018, marking the first year-to-year increase reflected in Census data since 2008 to 2009, when the United States was at the highest point of the Great Recession.

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    The data is based on information collected from the Census Bureau's Current Population Survey Annual Social and Economic Supplement and its American Community Survey. The Bureau said the data "presents statistics on health insurance coverage in the United States in 2018 and changes in health insurance coverage between 2017 and 2018."

    According to Politico, the Census figures are "considered the authority on insurance numbers."

    Uninsured rate rises

    Overall, about 27.5 million U.S. residents were uninsured in 2018, which was up by about two million people when compared with 2017, according to the data. The data showed that the uninsured rate among U.S. residents age 18 and younger increased by 0.6 percentage points between 2017 and 2018, rising to 5.5%, or about 4.3 million children.

    The Census data suggests much of the uninsured rate growth stemmed from declines in Medicaid enrollment. The data show Medicaid enrollment fell by 0.7 percentage points, or about two million individuals, from 18.5% in 2017 to 17.9% in 2018. The percentage of people enrolled in employer-sponsored coverage and private marketplace plans fell by smaller margins, dropping by 0.3 percentage points and 0.2 percentage points, respectively.

    Meanwhile, enrollment in Medicare increased slightly, by 0.4%. Census officials said the increase in Medicare enrollment likely was tied to United States' gradually aging population:

    The report also found consistently higher uninsured rates among low-income individuals living in states that have not expanded their Medicaid programs under the Affordable Care Act, particularly when compared with states that have expanded Medicaid.

    The state with the highest uninsured rate in 2018 was Texas, at 17.7%, followed by Oklahoma, at 14.2%. By comparison, the state with the lowest uninsured rate in 2018 was Massachusetts at 2.8%, followed by Washington, D.C., at 3.2%.

    The data also showed consistent racial disparities in insurance coverage. For instance, the uninsured rate among Hispanics increased by one percentage point from 2017 to 2018, which was the largest increase among any racial or ethnic group.


    The increase in the U.S. uninsured rate occurred as the country's economy strengthened, the Census data shows. The U.S. poverty rate decreased by 0.5 percentage points to 11.8%, marking the country's lowest poverty rate since 2001. The country's unemployment rate also decreased from 2017 to 2018, and median incomes increased by 3.3%.

    According to Politico, HHS did not immediately provide comment on the data.

    Larry Levitt, EVP for health policy at the Kaiser Family Foundation, said decrease in the unemployment rate has not had an effect on the country's uninsured rate because "[t]he jobs low-income people are getting often don't come with health benefits. So job-based health insurance isn't growing, even in an economy with low unemployment."

    House Speaker Nancy Pelosi (D-Calif.) blamed the Trump administration's "cruel health care sabotage" for the increasing the uninsured rate. According to the New York Times, some observers have pointed to the administration's actions to cut spending on advertising and enrollment-assistance programs and strengthen Medicaid enrollment verification as reasons for the enrollment decline in both Medicaid and private market plans.

    Joan Alker, executive director of the Georgetown University Center for Children and Families, said, "If you increase red tape you are going to lose people, many of whom are actually eligible for the coverage." She noted that the uninsured rate increase among U.S. children is particularly concerning after seeing years of declines. "Unless things change immediately, this progress is at riskā€”and our children and their families will pay the price," she said.

    However, Tomas Philipson, acting head of the administration's Council of Economic Advisers, said the data suggests President Trump's policies are working. "Employment is the best way out of poverty. President Trump's critics wrongly assert that government programs and handouts are the only way to lift people out of poverty, but [the Census] data tells a different story"  (Pradhan, Politico, 9/10; Scott, Vox, 9/10; Luhby, CNN, 9/10; Goldstein/Long, Washington Post, 9/10; Romoser, Inside Health Policy, 9/10 [subscription required]; Casselman et al., New York Times, 9/11; Census Bureau report, September 2019).

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