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Uninsured rate rose again last year, ahead of the pandemic

Experts warn current outlook could be worse amid downturn

People wait in line for COVID-19 testing in Washington in June. Lower-wage employees who don’t receive health
insurance through work have been more likely to lose their jobs during the pandemic.
People wait in line for COVID-19 testing in Washington in June. Lower-wage employees who don’t receive health insurance through work have been more likely to lose their jobs during the pandemic. (Tom Williams/CQ Roll Call file photo)

The number of Americans who had health insurance dropped last year although incomes rose, according to new federal data, ahead of the coronavirus outbreak that led to dual health and economic crises.

In 2019, 9.2 percent of people, or 29.6 million, reported not having health insurance coverage when they were interviewed last year, compared with 8.9 percent, or 28.6 million, in 2018, U.S. Census Bureau data that was released Tuesday found.

A separate survey conducted this year, which officials cautioned was interrupted by the COVID-19 pandemic so that fewer people than usual responded, found that 8 percent of people, or 26.1 million, did not have health insurance for all of last year. 

The new numbers come two months before the November election, in which Democrats are trying to focus on health care, which polls show is a top priority for voters. Last year marked the third consecutive year that the uninsured rate grew in the U.S., after going down regularly after implementation of the Democrats’ 2010 health care law.

At the same time, a separate report published Tuesday showed that median household income rose 6.8 percent between 2018 and 2019, which Trudi Renwick, Census Bureau assistant division chief for economic characteristics, said was among the highest increases on record. Real median earnings for full-time, year-round workers rose 0.8 percent. 

Poverty rates also fell in 2019 to 10.5 percent compared with 11.8 percent in 2018, with last year’s rate marking the lowest observed since the Census Bureau began reporting the statistic in 1959, according to a news release.

Some studies have shown that federal assistance Congress provided in relief packages earlier this year helped keep people out of poverty as the pandemic set in. But Congress has not extended much of that aid since it expired this summer, meaning people who lost their jobs are more likely to be strapped financially.

Experts warned that the economic downturn of the past six months likely means that the snapshot is outdated and does not reflect the current state of health care coverage in the United States.

“You’re going to see much wider disparities in the impact of the twin health and economic crises across states,” said Katherine Baicker, the dean at the University of Chicago Harris School of Public Policy.

Lower-wage workers and employees who don’t receive job-based health insurance have been more likely to lose their jobs during the pandemic. There could be disparities between states, since many Democratic-led states implemented special enrollment periods for people to sign up for federally subsidized marketplace insurance and some states have fewer barriers to signing up for coverage than others. 

The data shows that health insurance coverage rates were falling before the coronavirus outbreak led to rises in unemployment that led to more people losing their employer-sponsored benefits. Most Americans continue to receive their insurance through their jobs, with 56.4 percent of people receiving coverage this way last year.

The census report shows the uninsured rate was higher for Hispanics and Blacks than it was for non-Hispanic whites and Asian Americans in the U.S., leaving groups of people who have been more vulnerable to the virus that causes COVID-19 uninsured as the pandemic hit.

While the percentage of people enrolled in an employer-sponsored health plan in 2019 rose to 56.4 percent from 55.1 percent, enrollment in direct-purchase plans, including plans sold on the exchanges set up under the 2010 health care law, inched down from 10.8 percent to 10.2 percent.

Enrollment in Medicare grew as the population aged, while enrollment in Medicaid for low-income people fell.

The report found that 19 states saw a statistically significant decline in overall coverage, while just one state, Virginia, saw its coverage rates increase, likely because the state expanded eligibility for Medicaid last year.

The uninsured rate among children also rose by 0.4 percentage points to 5.7 percent.

Democrats, seeking to repeat their successful 2018 effort to win control of the House, are increasingly focusing on health care as the campaign enters the final stretch before the election. They blamed Republicans for the growing number of uninsured people, saying their actions left people vulnerable ahead of the pandemic.

“The latest Census numbers prove once again that the Trump-GOP sabotage agenda and their mismanagement of the pandemic has left millions of Americans without coverage when they need it the most,” Leslie Dach, the chairman of Protect Our Care, a group formed to defend the 2010 health care law, said in a statement. 

Republicans, meanwhile, have focused less on health insurance issues and more on the economy, although President Donald Trump had said he would release an alternative to the 2010 law this summer, which he did not do.

Trump’s health care record 

Some of the reasons why insurance coverage fell during the Trump administration are that federal officials spent less money on advertising and enrollment efforts than the Obama administration did, and 2019 marked the first year that the law’s so-called individual mandate to get insurance was not enforced, which experts say likely depressed coverage rates.

The Trump administration has argued the mandate was expensive for people who did not qualify for the law’s tax credits that subsidized monthly premiums. Baicker said that while the end of the mandate likely decreased enrollment in insurance plans, the subsidies — for those who qualify — have proved to be more effective than the mandate.

Aviva Aron-Dine, vice president for health policy at the left-leaning Center on Budget and Policy Priorities, said that about 10 percent of gains in health insurance coverage made after the implementation of the 2010 health care law have been been reversed since 2016, even as unemployment went down and several states expanded Medicaid eligibility.

“That’s why today’s data are something close to a smoking gun, showing that the Trump administration’s ongoing attacks on health coverage programs have taken a toll,” she said.

The Trump administration is asking the Supreme Court to overturn the 2010 health care law and is scheduled to make oral arguments in the case, Texas v. California, on Nov. 10. If the Supreme Court decides to strike down the law in full, more than an estimated 20 million people could lose their health insurance coverage.

Aron-Dine pointed to several Trump administration policies that she said likely contributed to the higher uninsured rate, including a rule redefining the so-called public charge policy that said immigrants could be denied changes to their immigration status based on past or potential future use of certain benefits, including Medicaid. Immigration advocates said the change could suppress enrollment in Medicaid among people who qualify.

The administration also allowed states to move forward on requirements for Medicaid recipients to work, which could lead to fewer people qualifying for the public health insurance programs. Many of the states that implemented work requirements are now defending those plans in court.

Those changes and others compounded the effects of the administration’s 2017 decision to slash the budget for advertising and outreach to help people sign up for coverage, and the effective end to the individual mandate penalty through the 2017 tax law.

Aron-Dine said that an annual survey typically released in November, the National Health Interview Survey, could provide the first federal research on the pandemic’s effects on insurance coverage.

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