The Trump administration’s unrelenting sabotage of the Affordable Care Act seems to be paying dividends — for the administration, if not the people it serves. The Census Bureau reported on Tuesday that for the first time since 2014, the year Obamacare went into effect, the uninsured rate in America has risen.
In 2018, 27.5 million Americans lacked health insurance — an increase of 2 million from the previous year, for an overall rate of 8.5 percent uninsured, versus 7.9 percent in 2017. It’s the first time the rate has gone up since 2009.
The Census also reported that the poverty rate in America had dropped, making the rise in the uninsured particularly stark, and less likely to be correlated with overall economic conditions.
According to the agency, most of the dropoff came as a result of fewer enrollees in Medicaid, the program that assists lower-income people. There was also a small decline in private insurance rolls.
A 2012 Supreme Court decision affirmed the Affordable Care Act’s legality, but made expanding Medicaid to cover more people, one of the key planks of the law, optional for states instead of required. Since then, 37 states have expanded the program, with the federal government picking up the vast majority of the cost. The states with the highest uninsured rates, Texas and Florida, are the two most prominent holdouts.
State inaction does not explain the surge in uninsured people, but federal negligence probably does. Since the Trump administration took over in 2017, the government has become an unwilling steward of a law that has expanded insurance coverage to tens of millions of people. Among other steps, the administration has dramatically slashed the budget for advertising the law during enrollment periods, promoted “junk insurance” plans that do not meet Obamacare’s thresholds, and vowed to label some immigrants who use the program as “public charges.” And, of course, President Trump endorsed Republicans’ efforts to repeal the law in 2017, which ultimately failed.
For all that, the uninsured rate is still significantly down from the pre-Obamacare days, when it hovered around 16 percent.
But the fact that it is moving in the wrong direction is both a perverse “win” for the Trump administration and a handy piece of ammunition for Democrats who ran successfully on health care in 2018, and want to run the same playbook in 2020.