Study Shows Health Coverage Gains Under ACA Starting To Reverse

May 10--Health insurance coverage growth in the years under the federal Affordable Care Act has begun to shrink, a new study shows.

The study attributes the decline mainly to the President Donald Trump administration's attempts last year to undermine the ACA, generally referred to as Obamacare. The drop is greatest in states like Alabama that never expanded Medicaid as part of the ACA -- a drop some area hospital and clinic operators say they've seen this year.

"It's been going on at least a year," said Wayne Rowe, CEO of Quality of Life Health Services, which manages health clinics that provide primary care to the poor in Calhoun and 12 other counties. "And more uninsured means a greater strain on our resources."

The study, published by The Commonwealth Fund, is based on a national survey that tracks insurance coverage rates among 19-to-64-year-olds. The Commonwealth Fund, headed by a former Obama administration official, is a New York-based national foundation that promotes health care improvement.

The study shows that the uninsured rate among working-age people is currently at 15.5 percent, up from 12.7 percent in 2016. That means an estimated 4 million people lost coverage.

For states like Alabama that did not expand Medicaid, the uninsured rate among those of working age rose more to 21.9 percent.

The study states growth in the uninsured can be traced back to actions the Trump administration took last year. Those include deep cuts in advertising and outreach during the marketplace open enrollment periods and shorting of those enrollment periods.

Rowe said his clinics have seen a 14 percent increase in uninsured patients in 2017 compared to 2016.

"That's a sizeable jump," Rowe said.

Rowe said his clinics have a sliding fee scale for the uninsured that's based on income.

"They apply for discount services," Rowe said. "But we see all patients regardless of their ability to pay."

Koko Mackin, spokeswoman for Blue Cross and Blue Shield of Alabama, the state's top private health insurer, said enrollment has dropped this year for the company's health care plans in the ACA marketplace. Under the ACA, Americans who meet income requirements can buy tax-subsidized health care plans.

"This year our marketplace enrollment is down slightly from last year, but is 15 percent higher than our original 2014 enrollment," Mackin said, referring to the start of the marketplace.

Mackin noted that enrollment in the marketplace has fluctuated some over the years since 2014.

Dr. Will Ferniany, CEO of the UAB Health System, said the Birmingham hospital has seen a rise in uninsured patients that could be partially attributed to changes with the ACA. According to UAB, its projected charity, uncompensated care costs are up 14 percent in the 2018 fiscal year over the 2017 fiscal year.

"One trend is the ACA," Ferniany said of why costs are rising. "The other trend is increase in high-deductible plans ... more and more employers are moving toward high deductible plans, and a lot of Americans can't afford the deductibles."

Jim Carnes, policy director for Alabama Arise, a nonprofit that advocates for people in poverty, said the ACA has been beneficial for residents, noting that around 170,000 Alabamians have gained coverage in the marketplace. Any decline in insurance rates would be harmful to poorer Alabama families, Carnes said.

"That's not a trend that I'd be happy to see," he said.

Donald Williamson, CEO of the Alabama Hospital Association, said he'd seen the study and wasn't surprised by its results.

Williamson said the gains made by the ACA took more of the cost burden off of hospitals. Any increase in the uninsured would mean higher costs for Alabama hospitals, many of which operate on tight budgets.

"More insured reduces uncompensated care and bad debt and that helps hospitals, especially those that are financially strained," Williamson said.

Staff writer Patrick McCreless: 256-235-3561. On Twitter @PMcCreless_Star.

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