The Census Bureau recently issued a couple of batches of data relating to health insurance status of people across the U.S. in 2018. After reviewing the new numbers, we have distilled portions of the new data that are particularly relevant for making sure all people have access to health insurance. Here are our top takeaways:

Nationally, health insurance coverage fell in 2018, despite economic and demographic factors that should have increased it.

For the first time since implementation of the Affordable Care Act (ACA) began, there was a significant increase in the number of uninsured Americans last year. What makes that particularly disappointing is that several economic and demographic factors should have increased the percentage of people with health insurance. For example, median household income and employment were rising, and the poverty rate was falling. In addition, the number of people who are 65 and older and covered by Medicare has been steadily increasing.

The fact that the number of people without insurance jumped last year despite all of those factors strongly indicates that actions taken by the Trump Administration appear to be causing the increase in people who are uninsured. For example, cuts in outreach and enrollment assistance have reduced enrollment in the insurance marketplace created by the ACA. Other factors include the Trump Administration’s support for new state policies that make it harder for low-income families to enroll or stay enrolled in Medicaid, and new federal policies that make it harder for eligible immigrants to participate in Medicaid.

In Wisconsin, there are sharp racial and ethnic disparities in access to health insurance.

The new Census Bureau data continues to show sharp disparities in access to health insurance for people of color. The racial and ethnic disparities can be seen among most age groups, but they are particularly acute among working age adults. While 5.6% of white Wisconsinites ages 19 to 64 were uninsured in 2018, the rate was more than four times higher for Latinx (24.4%) and Native American adults (23.4%), and was twice as high for Black Wisconsinites in that age range (12.3%).

Historical and current policies which perpetuate institutional racism have created racial disparities in health outcomes across the lifespan. Due to the impacts of systemic racism in housing, employment, health care, and education, people of color are more likely to be low-wage earners who disproportionately suffer from diseases like asthma, heart disease, and diabetes. Having health insurance coverage does not guarantee access, and accessing care, doesn’t mean someone is getting the quality of care they need. However, having more adults and children with steady access to adequate health insurance is one small way to begin to address these shameful disparities.

The states that expanded Medicaid have achieved much greater improvements in insurance coverage than the non-expansion states. Between 2013 and 2018 the number of people without insurance fell nearly 48% in the states that expanded Medicaid to all adults up to 138% of the federal poverty level. That very dramatic reduction in the uninsured compares to a decline of less than 23% in the “non-expansion” states that still have income ceilings below the poverty level.  In Wisconsin, which partially expanded Medicaid (and so did not qualify for enhanced federal funding under the ACA), the number of people who are uninsured fell by almost 40% during that five-year period.

 

Huge health care gains could be lost if the court challenge to the ACA prevails

Despite last year’s upturn in the uninsured rate and growth in the U.S. population, there were about 16.5 million fewer people who were uninsured last year than in 2013 – the year before the major components of the Affordable Care Act began to be implemented.

In Wisconsin, the number of people without insurance edged up slightly over the last two years, rising from an estimated 299,000 in 2016 to 313,000 last year. Nevertheless, the number of uninsured Wisconsinites was about 205,000 lower in 2018 than the level in 2013. 

The very substantial gains in health insurance coverage achieved since 2013 could be erased quickly if the appellate courts accept the arguments made by a number of Republican-controlled states that are challenging the constitutionality of the Affordable Care Act. The ACA provides coverage for people with pre-existing conditions, makes health insurance more affordable for millions of US residents, helps to decrease racial disparities in who has health insurance, and prohibits annual and life-time caps. This is but a sliver of the ways the ACA touches the lives of everyone in the US. 

Jon Peacock and William Parke-Sutherland