Across the U.S., millions of people have been able to gain health insurance coverage over the past several years as a result of various provisions of the Patient Protection and Affordable Care Act. Whether it's more young adults being able to stay on their parents' plans until age 26, expanded Medicaid eligibility in a number of states or broader availability of personal coverage through the ACA's mandated marketplaces, the uninsured rate nationwide has fallen substantially.
However, thanks in large part to administrative changes made at the federal level in the past year-plus, it now seems as though the uninsured rate is flat-lining a bit, as the number of people without coverage for the entirety of the year nationwide actually grew in 2017 according to new data from the U.S. Census Bureau. While the national uninsurance rate remained unchanged from 2016 to 2017 - at 8.8 percent - the number of people without coverage actually ticked up by about 400,000, from 28.1 million to 28.5 million.
This came after a significant increase from 2016 to 2017 in the number of people with insurance for at least part of the year, driven in large part by the uncertainty surrounding the future of health insurance requirements. The Census Bureau data showed that the number of people with coverage grew by 2.3 million.
So while there was an overall net positive in terms of coverage expansion, it should be noted that only three states saw their uninsurance rates (at the time the survey was conducted) shrink from 2016 to 2017, the report said. Meanwhile, the number of people without coverage when they were interviewed actually increased in 14 states, and remained relatively static in the rest.
A closer look at coverage
Not surprisingly, the share of people who had private health insurance, rather than coverage obtained through government agencies, was significant, the report said. In all, more than two-thirds of people had privately purchased insurance, whether through an employer (56 percent) or direct individual plans (16 percent). Meanwhile, 19.3 percent of respondents were on Medicaid, 17.2 percent were on Medicare, and 4.8 percent had insurance through the military.
These numbers don't add up to 100 percent because people occasionally split coverage between different plan types throughout the year.
Meanwhile, other government data - this time in the National Health Interview Survey from the Centers for Disease Control and Prevention - showed that there was a similar flattening for coverage rates among consumers in 18 specific states. The CDC found that while the uninsurance rate of 9.1 percent was up slightly from the previous year's 9 percent, the number of people who went without coverage nationwide had still declined by 19.3 million since the ACA was first passed in 2010.
Young people impacted?
It's also worth noting that these trends seem to be affecting younger Americans differently from older ones, the CDC data showed. While the rate of uninsurance for adults between 24 and 35, and children under 18, has dropped appreciably since 2010, the uninsurance rate for kids has largely leveled off in recent years, across both public and private coverage channels. Meanwhile, adults in that relatively young age group were nearly twice as likely to go without insurance (17.2 percent) as adults between 45 and 64 (9.3 percent), highlighting just how difficult it can be for people to get coverage without the help of their parents.
In addition, 33.2 million people were uninsured for at least part of the 2017 calendar year, comprising more than 1 in 6 Americans, the data showed. That number was down from 51 million in 2010 - nearly 27 percent of the population - but still quite high and also starting to show signed of leveling off. Furthermore, 15.3 million people (7.8 percent of Americans) reported having been uninsured for more than a year at the time of the interview.
Is cost a factor?
While more has been done to broaden the accessibility of coverage in the past year - especially where it concerns flexible, low-cost coverage - there are lingering concerns about what broad adoption of that coverage might mean, according to health reform expert Steve Venick, writing for the Nashville Tennessean. The so-called "association plans" that have been given broader allowances by the Trump administration are intended to help people obtain health insurance - albeit with slim coverage - when they previously couldn't afford it.
However, experts believe that coverage is most likely to be purchased by young people, meaning that while their availability could help cut the overall uninsurance rate, it could also significantly reshape the pool of people with more traditional health insurance coverage, the report said. For instance, the reason to allow so many younger people into the broader private insurance pool is that it would bring down average costs for everyone, but if lots more young people shift to association plans, that could move more of the share of costs back to older people who, while more likely to have insurance, would potentially see their premiums balloon.
Meanwhile, health insurance premiums for policies purchased on the individual market continue to be a bit of a mixed bag nationwide, according to data compiled by ACA Signups. While residents of 14 states will see average unsubsidized premiums drop for the 2019 coverage year, those in 21 others will see their premiums rise by at least 5 percent. In fact, people in six states will see unsubsidized costs rise by at least 10 percent.
Altogether, the average premium seen for consumers across the U.S. will likely rise more than 3.6 percent for 2019, the report said.
With these issues in mind, it's vital for health insurance companies to continue their efforts to educate consumers about all of their coverage options for the coming year and what they could mean given every individual's unique financial situation. When people have a better idea of what might be available to them in terms of health insurance and what kind of care it grants them affordable access to, they are far more likely to be satisfied with their coverage than if they buy insurance without the proper research.