After years of progress, uninsured rate climbs under Trump

For much of the last decade, the uninsured rate was getting better. Then Donald Trump took office.
Image: Pedro Rojas holds a sign directing people to an insurance company where they can sign up for the Affordable Care Act, also known as Obamacare
A sign directs people to an insurance company where they can sign up for the Affordable Care Act, also known as Obamacare, in Miami in 2015.Joe Raedle / Getty Images file

When health care reform advocates pushed for the Affordable Care Act a decade ago, they had several goals, there was one principal priority: the United States had one of the highest uninsured rates in the industrialized world, and reformers believed the ACA would make it better.

As regular readers know, 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.

Then Donald Trump took office. The Washington Post took note yesterday of the latest federal data.

Nearly 30 million people in the country lacked coverage at some point during 2019, 1 million more than in the previous year. Last year marked the third year in a row that the ranks of the uninsured swelled, according to a U.S. Census Bureau report regarded as the most solid depiction of the nation’s health insurance landscape.

Note, the uninsured rate in the United States got worse before the coronavirus pandemic struck and made matters vastly worse.

Putting politics aside, these results weren't altogether predictable. As a rule, as the unemployment rate drops and the economy is healthy, we'd expect to see more Americans having health insurance, not fewer.

And yet, the uninsured rate got worse in the first year of Trump's presidency, then a little worse in his second year in office, and then a little worse still in 2019.

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.

What's caused the shift? It's a point of contention among health care experts, but the Center on Budget and Policy Priorities noted in a report yesterday, "This is likely due in substantial part to Trump Administration policies that depressed enrollment in Medicaid and marketplace coverage."

In other words, it's not a coincidence that conditions were improving before the president took office, and got worse after he and his Republican team got to work.