Urban Institute: Uninsured rate ticked up in 2017, largely in nonexpansion states

Stack of health insurance application forms with stethoscope on top
A new report shows a slight increase in the uninsured rate in 2017. (Getty/vinnstock)

The uninsured rate went up in 2017 after several years of declines, and the trend particularly affected people in states that did not expand Medicaid, a new study shows. 

Researchers at the Urban Institute, a left-leaning think tank, found that 700,000 people became uninsured between 2016 and 2017 following several years of declines in the uninsured rate dating back to 2013. 

The uninsured rate remained at 7.6% in Medicaid expansion states in 2017 but increased from 13.7% to 14.3% in states that did not expand the program, the study found. In addition, the rate went up despite strong economic indicators and growth in employer-sponsored coverage. 


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Laura Skopec, a senior research associate at Urban Institute’s Health Policy Center and one of the study’s authors, told FierceHealthcare that policy changes increasing uncertainty in the private, nongroup markets—and the Affordable Care Act (ACA) exchanges—had a greater effect on people in non-expansion states. 

RELATED: Undocumented immigrants significantly more likely to be uninsured—KFF  

The coverage declines were not clustered in a certain demographic group and were noted among both whites and blacks, according to the study. The researchers also found an increase in the uninsured among people with very low incomes and those making above 400% of the federal poverty level. 

“These coverage losses cut across a wide variety of groups,” Skopec said. 

Looking ahead, the researchers note policy changes such as the rollback of the individual mandate penalty and the expansion of alternatives like short-term health plans as examples of policies that could lead to further increases in the uninsured rates, as these also largely impact the individual markets. 

Other recent studies also note a rise in the uninsured rate after multiple declines following the rollout of the ACA. 

Gallup estimated that the uninsured rate among adults was 13.7% at the end of 2018, a four-year high, and Georgetown University researchers found that the rate of uninsured children increased in 2017 for the first time in a decade. 

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