The rate of non-elderly Americans without health insurance increased between 2016 and 2017 despite unemployment numbers dropping and a generally strong economy. The uninsured rate climbed from 10 percent in 2016 to 10.2 percent in 2017, the first increase since 2013, after significant declines driven by the Affordable Care Act (ACA).
The decline resulted in 700,000 more uninsured people in 2017 than in 2016, according to data from a new study from the Urban Institute, supported by the Robert Wood Johnson Foundation.
Using the American Community Survey (ACS), this research showed the uninsured rate held stable in Medicaid expansion states at 7.6 percent but increased from 13.7 percent to 14.3 percent in states that did not expand Medicaid. Non-Medicaid expansion states lost marketplace coverage at twice the rate of expansion states, the data showed.
Factoring in population growth in 2017, gains in electronically stored information (ESI) mitigated but did not overcome reductions in Medicaid and Children’s Health Insurance Program (CHIP) and ACA marketplace coverage, according to the data. Researchers observed broadly distributed losses across all age groups and income levels.
Non-Hispanic white and black non-elderly people, those with at least some college education, and those living in the South and Midwest, experienced disproportionate coverage losses. The study’s authors concluded that these increases in uninsurance will likely occur disproportionally in non-expansion states, given their greater reliance on private coverage.
Coverage losses were concentrated in the 19 states that did not expand Medicaid eligibility under the Affordable Care Act by July 1, 2017. Between 2016 and 2017, uninsurance held stable in Medicaid expansion states but increased by 0.5 percentage points in non-expansion states. Though both expansion and non-expansion states saw increases in employer-sponsored insurance and decreases in Medicaid/CHIP and private non-group coverage over this period, the percentage-point decline in private non-group coverage in non-expansion states was nearly double that in expansion states (-0.6 percentage points versus -0.3 percentage points), precipitating larger coverage losses.
With support from the Robert Wood Johnson Foundation (RWJF), the Urban Institute is undertaking a comprehensive monitoring and tracking project to examine the implementation and effects of health reform. The project began in May 2011 and will take place over several years. The Urban Institute will document changes to the implementation of national health reform to help states, researchers and policymakers learn from the process as it unfolds.
To see the full report, go to https://rwjf.ws/2YYoxwN.