As of May 2018, the numbers of people in the U.S. without health insurance have risen to 15.5%, up from 12.7% two years ago, according to the latest Commonwealth Fund tracking survey. This translates to an increase of four million uninsured people nationwide.
The economy and labor market are doing well right now, but business cycles haven’t disappeared and will rear their ugly head sooner rather than later. While the numbers of uninsured are high now, they could easily approach 20% of the population when the next recession hits.
President Trump’s attempts to unravel the Affordable Care Act appear to be working. Nevertheless, the president's position on access to healthcare is unconventional. It’s certainly not in line with his Republican colleagues. Previous statements by Trump, such as “Can’t we do Medicare for everybody?” and the hyperbolic “Everyone should have healthcare, we shouldn’t have people dying on the streets,” aren’t standard talking points for Republicans. Yet, at the same time, Trump is boasting he’s “gutted” Obamacare. Perhaps he's changed his mind on healthcare access, or it might simply be a personal issue he has with the former president.
Originally, the replacement “plan” Trump and the Congressional Republican leadership sought - the American Health Care Act - would undo the individual mandate, reduce some of the regulatory requirements on insurers, restructure community rating provisions to allow for age-related premium differences, while maintaining key provisions on maintaining coverage for persons with pre-existing conditions. There is no replacement plan, however. The Affordable Care Act (ACA) limps along, defanged by Trump’s removal of the mandate and also the termination of federal cost-sharing subsidies that reimburse insurers for reducing the deductibles and co-payments of lower-income ACA enrollees.
Some previously insured individuals forego health insurance as there’s no longer a penalty or because of premium increases in the exchange and commercial markets. Others have lost coverage due to insurers pulling out of ACA exchanges, or because their employers no longer offered healthcare benefits.
To dismiss the problem of un-insurance is folly. Saying, for example, the uninsured will “get care when they’re sick or show up at a hospital” is denying a real problem. Medical bills are the number one cause of personal bankruptcy. Lack of insurance exacerbates this problem. Additionally, there is a correlation between the uninsurance rate and bad hospital debt.
Most importantly, access to healthcare matters from the perspectives of health outcomes and equity. There is an abundant amount of evidence from inter-state comparisons that better population-wide access improves health outcomes and allows for a more equitable distribution of resources. As access decreases, the uninsured are much more likely to forego medically necessary care. In addition, fewer will make use of preventive care.
