BEYOND THE NUMBERS
The number and share of Americans without health insurance coverage rose for the third straight year in 2019, recent American Community Survey (ACS) data show, despite three years of strong economic growth and falling unemployment. This follows six straight years of health coverage gains, with the uninsured rate falling from 15.5 percent in 2010 to a historic low of 8.6 percent in 2016 as the Affordable Care Act’s (ACA) major coverage expansions took effect. Some 9.2 percent of Americans — 29.6 million people — were uninsured in 2019, compared to 8.9 percent (28.6 million) in 2018.
While uninsured rates remain far below pre-ACA levels, coverage gains have eroded for nearly every demographic group for which the Census Bureau collects health coverage data (see figure). The uninsured rate has risen since 2016 for Americans at all income, age, and education levels, and among all racial/ethnic groups except Asian Americans — with the biggest uninsured rate increases among children, people with income above 400 percent of the federal poverty line, and people with higher education. The number of uninsured has risen the most for people with income between 138 percent and 400 percent of the federal poverty line (by 1.8 million), those aged 45 to 64 (by 761,000), and those with no higher education (by 611,000). (See the tables linked to the figure for the data.)
Trump Administration policies that depressed enrollment in Medicaid and marketplace coverage were likely a major reason why coverage eroded during a period of strong economic growth. As we’ve explained, these policies included immigration policies that have deterred some immigrants and their family members from enrolling in coverage for which they’re eligible, support for state policies that make it harder to enroll or stay enrolled in Medicaid, repeal of the ACA’s mandate that individuals get insurance or pay a penalty, and cuts to outreach and enrollment assistance in the ACA marketplaces. As a result of the coverage erosion, the nation entered the COVID-19 pandemic with some 2.3 million more people uninsured than in 2016, including over 700,000 children.
These coverage losses are small, however, compared to those that would come if the Supreme Court strikes down the entire ACA, as the Administration and 18 state attorneys general are urging it to do. That would cause uninsured rates to spike across demographic groups, likely reaching or exceeding pre-ACA levels.
Uninsured Rates Fell Sharply Under ACA But Have Risen Across Groups Since 2016
Note: Figures shown are for the civilian noninstitutional population. The federal poverty line for a single person is $12,760. ACA=Affordable Care Act.
Source: CBPP calculations based on the Census Bureau’s American Community Survey data