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Americans Without Health Insurance Increased by 1.1 Million in 2018

2018 is the second consecutive year that number has risen after several years of declines under the Affordable Care Act, a Centers for Disease Control and Prevention survey shows.

Efforts by the Trump administration and Congress to challenge and loosen requirements of the Affordable Care Act probably played a role in some going without coverage, analysts said.

“I don’t think it’s too shocking with efforts to undermine the Affordable Care Act as part of the Tax Cuts and Jobs Act,” said Daniel Derksen, a University of Arizona professor and health policy expert. The Tax Cuts and Jobs Act of 2017 eliminated the health care law’s individual mandate that required people to get health insurance or pay a penalty. It formed the legal basis for a coalition of Republican-led states to argue in federal court that the entire health law should be tossed out – a challenge the Trump administration supports.

The CDC survey says the number of Americans in high-deductible plans reached an all-time high, covering 45.8% of people with private health insurance in 2018. In 2010, 25% of people with private coverage had high-deductible plans.

High-deductible plans are popular among companies seeking to defray the spiraling cost of health care. A survey by Kaiser Family Foundation and the Los Angeles Times found that many employees in high-deductible plans postponed care or cut spending on household expenses such as food and clothing.

Read the story in USA Today

The Commonwealth Fund’s latest Biennial Health Insurance Survey assesses the extent and quality of coverage for U.S. working-age adults. Conducted since 2001, the survey uses three measures to gauge the adequacy of people’s coverage:

  • whether or not they have insurance
  • if they have insurance, whether they have experienced a gap in their coverage in the prior year
  • whether high out-of-pocket health care costs and deductibles are causing them to be underinsured, despite having continuous coverage throughout the year.

Highlights from the survey:

  • Today, 45 percent of U.S. adults ages 19 to 64 are inadequately insured — nearly the same as in 2010 — though important shifts have taken place.
  • Compared to 2010, many fewer adults are uninsured today, and the duration of coverage gaps people experience has shortened significantly.
  • Despite actions by the Trump administration and Congress to weaken the ACA, the adult uninsured rate was 12.4 percent in 2018 in this survey, statistically unchanged from the last time we fielded the survey in 2016.
  • More people who have coverage are underinsured now than in 2010, with the greatest increase occurring among those in employer plans.
  • People who are underinsured or spend any time uninsured report cost-related problems getting care and difficulty paying medical bills at at higher rates than those with continuous, adequate coverage.
  • Federal and state governments could enact policies to extend the ACA’s health coverage gains and improve the cost protection provided by individual-market and employer plans.

Read more from The Commonwealth Fund

The economy and labor market are doing well right now, but business cycles haven’t disappeared and will rear their ugly head sooner rather than later. While the numbers of uninsured are high now, they could easily approach 20% of the population when the next recession hits.

Some previously insured individuals forego health insurance as there’s no longer a penalty or because of premium increases in the exchange and commercial markets. Others have lost coverage due to insurers pulling out of ACA exchanges, or because their employers no longer offered healthcare benefits.

Read more about the implications in Forbes



Contact Alexis Hertel at

(303) 322-2228

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HCCA, publishers of the Colorado Managed Care Newsletter, began reporting on the financing of healthcare in Colorado in December of 1983. As we begin our 35th year, we are grateful for the opportunity to be one of your sources of information in this ever-changing, healthcare market.