4M lose coverage as insurance gains under ACA start to reverse

Health insurance forms
Coverage gains made by the ACA are eroding as more Americans are now uninsured compared to 2016. (Getty/vinnstock)

The number of uninsured Americans has increased since 2016, and that trend is likely to continue thanks to legislative changes by Republican lawmakers, according to a new report. 

The number of uninsured adults rose to 15.5% in March, up from 12.7% in 2016, according to a Commonwealth Fund survey. A drop in exchange enrollment is the biggest culprit, with about 4 million Americans losing individual coverage since 2016, while employer-sponsored coverage stayed relatively consistent. 

Poorer Americans have been hit hardest by steady premium increases, with many insurance plans becoming increasingly out of reach. The number of uninsured individuals with income under $30,000 rose to 25.7% in March, up from 20.9% two years ago. 

Uninsured rates were also up 5.8% in states that have not expanded Medicaid under the Affordable Care Act. Some states with reluctant governors or state legislatures, like Utah and Idaho, are actively trying to get expansion passed through ballot initiative later this year. 

RELATED: Is Maine's Medicaid lawsuit a harbinger for other anti-expansion governors?

And researchers predict the uninsured rate is likely to worsen within the next year. Up to 9% of adults who get their insurance through the exchanges plan to their drop their coverage because of the GOP's repeal of the individual mandate last year.

Insurers and hospital groups were critical (PDF) of the GOP tax bill and said premiums would skyrocket as younger, healthier people leave the exchanges, snowballing the problem. Providers will also likely be hurt by increased levels of uncompensated and charity care which could be further exaggerated by the White House's plan to expand short-term, low-coverage insurance plans. 

Former Department of Health and Human Services Secretary Tom Price, M.D., appeared to acknowledge concerns about the individual mandate repeal in a speech earlier this week, but later walked back those comments. 

The Trump administration's cuts in advertisement and outreach during open enrollment also likely contributed to a loss in insurance, according to the Commonwealth Fund.