Uninsured rate reaches highest point since 2014

The number of U.S. adults who do not have health insurance was higher in the fourth quarter of 2018 than it has been since the Affordable Care Act was implemented four years before. Women, young adults, and lower-income people have experienced the greatest increases in uninsured rates in the last two years, according to the latest Gallup survey data.

According to Gallup, which has tracked the uninsured rate each quarter since 2008, 13.7% of adults were uninsured during the fourth quarter of 2018, compared with 13.4% in the first quarter of 2014, when the individual mandate requiring most people to purchase insurance went into effect, and two dozen states chose to expand Medicaid to more low-income residents.

While the uninsured rate is rising, it's still much lower than when it hit its peak of 18% in 2013, before the ACA was implemented. The number of adults without insurance hit its lowest point in 2016 at 10.9%.

Over the last two years, Gallup found that women, households with incomes of less than $48,000 per year, and adults under the age of 35 have reported the greatest increases in uninsured rates on a percentage point basis.

Adults younger than 35 reported an uninsured rate of 21.6% in the fourth quarter of 2018, up from 16.8% during the same quarter in 2016. The data also shows that 12.8% were uninsured late last year, while 8.9% were uninsured during the fourth quarter of 2016. More men lack insurance than women, but the uninsured rate among men isn't rising as fast as it is among women.

Gallup's data further showed that among different income levels, adults in households making between $24,000 and $48,000 reported the biggest percentage point increase in the uninsured rate: 19.1% in the fourth-quarter 2018, up from 16.1% two years before. And by region of the United States, the South's uninsured rate rose the fastest to 19.6% from 15.8% over the same time period.

Gallup suggested that the rise in insurance premiums and dwindling insurer participation on the ACA exchanges could be a factor driving the rising uninsured rate, particularly among people who make too much money to qualify for a federal financial subsidy. Moreover, the federal government shortened the ACA open enrollment period and slashed funds for marketing the enrollment period and assisting people with signing up for coverage.

President Donald Trump's negative rhetoric regarding the ACA and Congressional Republicans' attempts to topple it could have also reduced participation in the exchanges, Gallup said. The president's decision to end the cost-sharing reduction subsidies that reduce deductibles and copayments for certain low-income exchange customers, as well Congress' elimination of the individual mandate effective this year are other factors.