Americans Hold On To Health Insurance Despite ACA Attacks

WASHINGTON - Americans kept up their health insurance last year despite President Donald Trump's all-out push to dismantle the Obama-era expansion of coverage. That's the counterintuitive conclusion from a major government survey Tuesday.

After nearly a full year of Trump, the uninsured rate was 9.1 percent for 2017, almost the same as toward the end of the Obama administration, according the Centers for Disease Control and Prevention. That works out to a little more than 29 million people uninsured.

Overall, the uninsured rate has dropped from 16 percent when the Affordable Care Act was signed in 2010, which translates roughly to 19 million people gaining coverage.

"Despite all the noise and despite the chain-rattling Republicans have done with their failed attempts at repeal, at the end of the day the number of uninsured has stayed flat," said health economist Gail Wilensky, a longtime GOP adviser. "That's good news for the country, and it might turn out to be good news for Republicans when it comes time for the midterm elections."

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.

"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."

Still, the survey found some worrisome indicators of issues potentially ahead:

n 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.

n The uninsured rate also rose significantly in states that have not taken advantage of the ACA's Medicaid expansion for low-income people.

Separately, the CDC survey showed no slowing down of the longstanding shift to high-deductible health insurance, with nearly 44 percent of Americans now in plans that require individuals to pay at least $1,300 of medical bills each year, or $2,600 for family coverage.