Uninsured rate backslides under Trump administration actions

Uninsured rates among lower-income adults jumped from 20.9 percent in 2016 to 25.7 percent in March of 2018.

When asked whether they would drop coverage in 2019 after the repeal of the individual mandate, 5 percent of survey respondents said they would. (Photo: Shutterstock)

The number of Americans covered by medical insurance is falling, thanks to actions and inaction by the federal government under the Trump administration, but there’s one surprising group that seems to be bucking the trend: young, high-income men.

A report from the Commonwealth Fund on the most recent results of its Affordable Care Act Tracking Survey finds that approximately 4 million fewer people have health care coverage since 2016, with uninsured rates among lower-income adults rising from 20.9 percent in 2016 to 25.7 percent in March of 2018.

The report cites two factors likely contributing to the decline:

1. Failure of the federal government to improve specific weaknesses in the ACA

2. Actions taken to exploit the weaknesses , including cuts to Healthcare.gov funding, a shorter enrollment window and “a general sense of confusion about the status of the law.”

While the overall insurance rate may  be climbing, it’s not the case for men ages 26 to 34 making 400 percent or more of the federal poverty level. Uninsured rates in this group declined from 11.7 percent in 2013 to 7.2 percent in 2015.

“The ACA’s mandate increased both the incentive for having insurance and the importance of the decision,” researchers said. “This combination greatly increased coverage among young men.”

Will that trend continue, though? When asked whether they would drop coverage in 2019 after the repeal of the individual mandate, 5 percent of those surveyed overall said they would; among men of any age, 7 percent would drop coverage, but among those earning more than 250 percent of the poverty level, just 4 percent said they would.

The survey also anticipates further increases in the uninsured rate in 2019, because “the repeal of the individual mandate penalty included in the 2017 tax law, recent actions to increase the availability of insurance policies that don’t comply with ACA minimum benefit standards, and support for Medicaid work requirements.”

And although there are steps the federal government could take to keep the uninsured rate from increasing, it points out that under legislative inaction, some states are stepping into the breach—although some state actions present risks as well as possible benefits, such as premium increases, changes to coverage requirements that could lower premiums but weaken coverage and work requirements that will likely cut enrollment further.