The percentage of uninsured American adults has risen to its highest rate in four years, with women, young people and those with low incomes hit hardest, according to a new Gallup poll.
Since a historic low of 10.9% reached in the second half of 2016, the uninsured rate rose almost 3 percentage points, hitting 13.7% by the end of 2018. That rate, a four-year high, is still far below the high of 18% reached in 2013—before most of the Affordable Care Act's provisions had gone into effect.
"Potential factors include political forces that may have increased uncertainty surrounding the ACA marketplace. Early in his presidency, for example, President Donald Trump announced, 'I want people to know Obamacare is dead; it's a dead healthcare plan,'" Gallup wrote in a release.
The drop in insurance rates could also be an effect of the rise in premiums, Gallup said.
Most notably, health coverage under the ACA sustained two hits under the Trump administration following a decision to end cost-sharing reduction payments and the repeal of the individual mandate. Both moves increased the uncertainty in insurance markets, leading insurers to raise premiums to account for future losses. The repeal of the individual mandate may have also reduced participation among adults who would have otherwise complied, Gallup wrote.
Furthermore, the administration reduced outreach and marketing aimed at getting uninsured people signed up.
"The open enrollment periods since 2018 have been characterized by a significant reduction in public marketing and shortened enrollment periods of under seven weeks, about half of previous periods. Funding for ACA 'navigators' who assist consumers in ACA enrollment has also been reduced in 2018 to $10 million, compared with $63 million in 2016," Gallup wrote.
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Younger people, women and those with low incomes experienced the highest reductions in insurance since 2016. The rate for 18- to 34-year-olds rose from 16.8% in 2016 to 21.6% in 2018.
Households earning under $24,000 a year hit an uninsurance rate of 25.4%, up from 22.6% in 2016, and households earning $24,000 to $48,000 experienced a similar 3-percentage-point increase, from 16.1% to 19.1%.
As in previous years, women had higher rates of insurance than men. But those rates are decreasing faster than those of any other group. The percentage of uninsured women hit 12.8% in 2018, up almost four points from 8.9% in 2016.
The East Coast appears to have been mostly spared these problems. The Midwest, South and West regions each experienced 3- to 4-point increases in uninsurance between 2016 and 2018, while the uninsured rate decreased from 7.5% to 7.1% on the East Coast. Part of this distinction could be explained by some states declining to expand Medicaid, but Gallup didn't fully explore the implications.