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U.S. Clings to Health Coverage Gains Despite Turmoil

9.1 percent, or 29 million, were uninsured in 2017, CDC reports

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Roughly 19 million people have gained health insurance coverage since the Affordable Care Act was signed.

The United States maintained its health insurance gains last year, an unexpected outcome after President Trump's repeated tries to take apart the Obama-era coverage expansion, according to a major government survey released Tuesday.

Overall, the survey from the Centers for Disease Control and Prevention (CDC) found that 9.1 percent of Americans, or a little more than 29 million people, were uninsured in 2017.

After nearly a year of Trump, that result was almost the same as toward the end of the Obama administration. For perspective, the uninsured rate has dropped from 16 percent since the Affordable Care Act (ACA) was signed in 2010. That translates roughly to 19 million people gaining coverage.

"It's a testament to the high value people place on health insurance," said Katherine Hempstead, a senior health policy adviser at the nonpartisan Robert Wood Johnson Foundation. "People will tenaciously hang on to their health insurance."

But the CDC's National Health Interview Survey also showed uninsured numbers edged higher for some groups, raising questions about potential problems this year and beyond. It doesn't reflect congressional repeal of the health law's unpopular requirement that individuals carry health insurance, since that doesn't take effect until next year.

The survey found these worrisome indicators of issues potentially ahead:

  • The uninsured rate rose among "not poor" adults (translation: middle class). That increase was statistically significant, rising to 8.2 percent in 2017. Hempstead said it may reflect the impact of sharp premium increases for individual plans for people in the solid middle class, who aren't eligible for subsidized coverage under the ACA. "They are uniquely required to pay the full retail cost of health care," she said.
  • The uninsured rate also rose significantly in states that have not taken advantage of the ACA's Medicaid expansion for low-income people. It averaged 19 percent for adults in states that had not expanded Medicaid, a big difference from about 9 percent uninsured in states that have expanded low-income coverage. The Medicaid expansion survived repeal efforts, and several states are moving to join 32 other states and the District of Columbia that have expanded Medicaid. 

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