Eight States See Rise in People Lacking Health Insurance, Census Data Show

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National estimates indicate an increased share of Americans don’t have coverage.

The share of people without health insurance coverage for at least part of last year decreased in three states and increased slightly in eight others compared to 2017, according to U.S. Census Bureau figures released on Tuesday.

Separate nationwide statistics in the report show that the overall proportion of people in the U.S. who were uninsured during all of last year ticked upwards by about 0.5 percentage points, to 8.5%. An estimated 27.5 million people did not have coverage in 2018, an increase of about 1.86 million from the year before.

Some experts highlighted this change as a troubling trend. “That is a very dramatic increase,” said Elise Gould, a senior economist with the left-leaning Economic Policy Institute. A 0.7 percentage point decline in Medicaid coverage was likely a major contributor to the overall decline in coverage, she said.

Aviva Aron-Dine, vice president for health policy with the Center on Budget and Policy Priorities, another left-leaning group, blamed Trump administration policies for eroding gains in health care coverage through the Affordable Care Act, also known as Obamacare.

“Uninsured rates are moving in the wrong direction, despite a growing economy and a falling unemployment rate,” she added.

The state data in the report reflect whether people who were surveyed had health insurance at the time that they were interviewed, as opposed to whether they had coverage all year. 

In states where the number of uninsured people grew, the increases were 1 percentage point or less. They included: Alabama, Arizona, Idaho, Michigan, Ohio, Tennessee, Texas and Washington. 

The states with decreases in their uninsured population were New York (0.3 percentage points), South Carolina (0.5 percentage points) and Wyoming (1.8 percentage points).

Overall uninsured rates in states ranged from 2.8% in Massachusetts to 17.7% in Texas.

Rachel Garfield, a Medicaid expert with the Kaiser Family Foundation, said that the state uninsured rates in the Census Bureau report were in line with figures seen in recent years.

“The states that have been kind of at the top and bottom of the uninsured rate ranking are more or less still there,” she said. 

“States in the Southeast, most of which have not expanded Medicaid under the ACA, continue to have much higher uninsured rates than states in some other regions,” Garfield added.

She noted the changes in some states’ uninsured rates, but said it’s not always clear from information like the data released Tuesday what’s going on in these places to drive those shifts. Additional figures the Census Bureau is expected to release in the weeks ahead should provide more detail on state level trends.

The national statistics in Tuesday’s report show that in 2018, 5.5% of children under the age of 19 did not have health insurance coverage, a 0.6 percentage-point increase from 2017. 

“Almost a half-million more kids under 19 lost coverage,” Gould said.

People earning lower incomes were less likely to have health insurance last year than those in higher-income households, the Census Bureau report points out. 

About 86% of people in households with annual incomes under $25,000 last year had health insurance, compared to about 96% of people in households earning $150,000 or more.

Aron-Dine flagged several policies the Trump administration has backed that she said were helping fuel the declines in coverage. 

These policies include eliminating the financial penalty for people who opted not to carry health insurance, cutting funding for outreach and marketing related to the Affordable Care Act, and encouraging states to tighten eligibility restrictions for Medicaid.

Thirty-six states and Washington, D.C. have adopted an expansion in Medicaid income eligibility requirements the ACA allowed for.

Medicaid is the nation’s main health insurance program for low-income Americans. States and the federal government share its cost. Total Medicaid spending in fiscal 2017 was around $600 billion, with the federal government covering about 61% of that sum.

A review of 324 studies that Kaiser Family Foundation updated last month found that Medicaid expansion states have experienced significant gains in coverage and reductions in uninsured rates among low-income populations and other vulnerable groups.

Some states have sought what are known as Section 1115 waivers from the federal government, which relax Medicaid guidelines that would otherwise be in place. One way states have sought to use these waivers is to pursue stricter work requirements for the program.

These requirements in some cases have been controversial and led to court disputes.

Because of differences in how the data was assembled year-to-year, it isn’t possible to make fair comparisons between all of the estimates in the latest Census Bureau report and past statistics.

But estimates from one of the surveys that is discussed in the report show that the nation’s uninsured rate was between 14% and 16% from 2008 to 2013, but then fell sharply as provisions in the Affordable Care Act began to go into effect. Since 2015 it’s been closer to 8%. 

Eighteen Republican attorneys general with support from the Trump administration are currently battling in federal court to get the ACA declared unconstitutional. A group of Democratic attorneys general, led by California, are defending the law.

Bill Lucia is a Senior Reporter for Route Fifty and is based in Olympia, Washington.

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