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After a decade of progress, US uninsured rate grows under Trump

The ACA set out to lower the uninsured rate and it succeeded. Then Donald Trump was elected and his team got to work.
A family practice provider uses a stethoscope to examine a patient in an exam room. (Photo by Andrew Harrer/Bloomberg/Getty)
A family practice provider uses a stethoscope to examine a patient in an exam room.

There were a wide variety of reasons health care reform advocates pushed for the Affordable Care Act a decade ago, but there was no secret about the top priority: the United States had one of the highest uninsured rates in the industrialized world, and reformers believed the ACA would make it better.

They were right. Once "Obamacare" was passed and implemented, the nation's uninsured rate dropped to the lowest point on record. The law set out to achieve a specific goal and it succeeded.

And then Donald Trump took office and his team went to work.

The number of Americans without health insurance edged up in 2018 -- the first evidence from the government that coverage gains from President Barack Obama's health care plan might be eroding under President Donald Trump.An estimated 27.5 million people, 8.5% of the population, went without health insurance in 2018. That was an increase of 1.9 million uninsured people, or 0.5 percentage point.... Though the increase in the number of uninsured Americans last year was modest, it could be a turning point, the first real sign that coverage gains under Obama could be at least partly reversed.

In the abstract, this wasn't entirely predictable. After all, 2018 was a good year for the economy, with steady employment gains and the best economic growth in a few years. These aren't the kind of conditions that generally lead to increases in the uninsured rate.

But as the New York Times' report on the data added, the Republican White House's policies have had an impact: "The administration ... cut back on advertising and enrollment assistance, programs that helped low income people learn about the new insurance programs, among other changes that may have depressed Obamacare enrollments."

To be sure, the uninsured rate is still much better now than it was before Democrats passed and implemented the Affordable Care Act, but the trajectory has shifted from an encouraging to a discouraging direction.

And the evidence suggests the change wasn't accidental; it was the result of deliberate changes intended to make the system worse.

The Census Bureau isn't the only source for tracking the uninsured rate; the Congressional Budget Office and Gallup release related reports of their own. Earlier this year, both also found increases to the uninsured rate since Trump took office.

If the president thinks he can avoid blame for the shift, I suspect he's mistaken.