A Better Economy Could Be Causing Fewer Insured

This week, JLF’s Jordan Roberts published a research brief on the recently released Census Bureau report on health insurance coverage in 2018. Roberts writes:

The total number of individuals without health insurance increased from 2017 to 2018. Many media pundits and health scholars contend that these numbers are proof that the Trump administration is attempting to “sabotage” the Affordable Care Act (ACA or Obamacare). However, this notion does not hold up to scrutiny.

The overall uninsured rate went up by .5 percentage points. Notably, much of the decreases in insurance rosters came from Medicaid and private insurance. Medicare and TRICARE both saw raises in enrollment over the same timeframe. Roberts writes that the structure of Obamacare itself may be the reason for these decreases in the total insured population:

Across the country, Medicaid enrollment decreased by 0.7 percentage points. Given the strong economy and low unemployment, we should be encouraged to see a decrease in Medicaid rolls due to increased wages that make some ineligible for Medicaid.

In addition to people waging out of Medicaid, households are waging out of subsidies for the individual market. Roberts quotes Brain Blase, President at the National Economic Council, to explain:

The number of uninsured Americans in households with income above 400 percent of the poverty line increased by 1.1 million from 2017 to 2018, and the number of uninsured in households with income above 300 percent of the poverty line — about $75,000 for a family of four — increased by 1.6 million. (Most other income groups saw small year-over-year changes in the number of uninsured.) These are people in the middle class, often without an offer of employer coverage, who are playing by the rules and simply can’t afford Obamacare plans since they don’t qualify for a subsidy — people the Trump administration’s health-care reforms are designed to help.

Roberts explains:

The ACA did provide coverage for some who previously did not have it, but others were harmed by the ACA. Now, a few years after its implementation we see that many people can’t afford coverage due to rising premiums and no subsidies. This phenomenon is likely the reason for the decline in insurance coverage, not “sabotage” as so many have claimed.

Read the full brief here. Read Roberts’ breakdown of the Trump administration’s health care proposals here.