Advocates sound alarm as uninsured rate rises under Trump

Advocates sound alarm as uninsured rate rises under Trump
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The uninsured rate is rising for the first time since ObamaCare passed, two recent studies show, alarming advocates who fear the problem could get worse. 

Data from the Centers for Disease Control and Prevention released in July show there were 2.1 million more uninsured people between 2016 and 2018. And a study from the Urban Institute this month, using Census Bureau data, found 700,000 more uninsured people just between 2016 and 2017. 

The increase is especially noteworthy given the strong economy, signaling the uninsured rate will rise even higher if the economy worsens and people start losing the coverage they get at their jobs. 

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Liberal advocates are blaming Trump administration policies, such as repealing the mandate to have coverage and cutting funding for outreach to help people enroll.    

“The broader economy would say we should be going the other direction,” said Eliot Fishman, senior director of health policy at the liberal advocacy group Families USA. “I think it’s for sure because of Trump administration policies.”

The uptick in the uninsured rate is not massive, and there are still significant gains in insurance coverage since ObamaCare went into effect in 2014. The uninsured rate for people under 65 fell from 16.7 percent in 2013 to 10.3 percent in 2016, according to the CDC survey, which translates to 16.7 million people gaining coverage. 

But since then, the gains have started to reverse, with the uninsured rate ticking up to 11 percent in 2018. 

Tom Miller, a health policy expert at the right-leaning American Enterprise Institute, said the concerns of liberal advocates were overblown, dismissing finger-pointing at the Trump administration over a relatively small increase in the uninsured rate.

“I think they’d point to that if the temperature went up half a degree,” Miller said. He added that dire warnings that repealing the mandate to have coverage would cause chaos in the market had not come to pass.  

But liberal experts say a range of lower-profile actions have combined to have an effect. 

“Numerous smaller actions the Trump administration has taken really add up to people losing coverage,” said Emily Gee, a health economist at the liberal Center for American Progress. 

Advocates point to the repeal of ObamaCare’s mandate for people to have coverage in the 2017 GOP tax law as one factor driving up the uninsured rate. Though the mandate repeal technically did not take effect until 2019, experts say some people could have thought it was already repealed earlier. 

Republicans argue that mandate repeal simply allows people not to have coverage if they decide they do not want it. 

Liberals also highlight other actions as well. For example, the Trump administration cut funding for advertising and other outreach to sign people up for ObamaCare coverage by 90 percent in 2017.

Fishman also pointed to leaks about a coming “public charge” rule from the Trump administration, which was finalized this month, to penalize immigrants who use public benefits like Medicaid. He said rumors of the coming move could have discouraged legal immigrants from using the program and signing up for coverage. 

The Trump administration argues that some people have dropped coverage because premiums rose too steeply, which officials point to as a sign of ObamaCare’s failings. The administration released a report this month showing that 1.2 million people who make too much money to qualify for financial assistance under ObamaCare dropped individual market coverage between 2017 and 2018. 

Miller, of the American Enterprise Institute, also pointed to premium increases causing people to drop coverage if they do not qualify for financial assistance. “That’s something where you can see a real cause and effect,” he said. 

Asked to respond to the increase in the uninsured rate, a spokesperson for the federal Centers for Medicare and Medicaid Services (CMS) pointed to the agency’s report this month and a statement from CMS Administrator Seema Verma at the time.

“ObamaCare is failing the American people, and the ongoing exodus of the unsubsidized population from the market proves that Obamacare’s sky-high premiums are unaffordable,” Verma said. 

But liberals counter that the Trump administration actually caused some of the premium increases they are blaming, through actions that siphoned healthy people away from the market, such as repealing the mandate and opening up a skimpier, cheaper insurance option known as short-term health insurance. 

Larry Levitt, a health policy expert at the Kaiser Family Foundation, said that premiums rose significantly between 2016 and 2017 in a “one-time market correction” as insurers looked to shore up their finances. But he said subsequent increases between 2017 and 2018 are more directly traceable to Trump administration actions and uncertainty about whether ObamaCare would be repealed by Republicans. 

There are also state-level actions that could be driving up the ranks of the uninsured. For example, in Missouri, the Associated Press reported that 90,000 children and 23,000 adults have lost Medicaid coverage in the past year. Advocates blame the state’s faulty new system, which forced some enrollees to provide additional documentation proving their eligibility with just 10 days to respond. 

Missouri officials have responded by pointing to the improved economy and a crackdown on people who are not eligible for Medicaid to explain the declines. 

Amid chatter about a coming recession, Fishman, of Families USA, is worried the increase in the uninsured rate could worsen. 

“[The numbers are] especially concerning for what they signal about what could happen if we continue the way that we’re going,” Fishman said.