Dive Brief:

The number of Americans with health insurance surged in the years immediately after the implementation of the Affordable Care Act. That ended in the first year of the Trump administration, according to new data from the Urban Institute, underwritten by the Robert Wood Johnson Foundation.

From 2013 to 2016, 18.5 million Americans were added to the insurance rolls. In 2017, that dropped by 700,000, according to the Urban Institute — despite the fact that the strong economy should have cut the number of uninsured.

The hardest hits were in states that refused to expand income eligibility for Medicaid.

Dive Insight:

The Affordable Care Act was intended to increase the number of Americans with health insurance and, for several years after state health insurance exchanges launched and some states expanded Medicaid, that goal seemed to be in sight. However, following President Trump's inauguration in 2017, his administration has implemented numerous rules and executive orders whittling away at key tenets of the ACA.

The new study is further evidence that stripping the ACA of several insurer-stabilization mechanisms and expanding barebones coverage like short-term health plans as viable alternatives to the federal and state exchanges has led to a rise in premiums and in the rate of uninsured.

The research focused on the American Community Survey of more than 3 million residents nationwide. The percentage of Americans without insurance rose from 10% in 2016 to 10.2% in 2017. Its authors concluded that this occurred despite a strong economy and corresponding increases in income and employer-sponsored coverage.

The loss of insurance was particularly acute in the 19 states that decided not to expand Medicaid eligibility, concentrated heavily in the South and Midwest. While the combined population in those states grew by 800,000, about 700,000 of their residents lost coverage. The uninsured rates in those states was 14.3% in 2017 versus 7.6% in the expansion states.

In addition to drops in their Medicaid rolls, those states also experienced reductions in the number of individual residents who purchased coverage on their state exchanges. Nationwide, the number of those with private non-group insurance dropped by 1 million, or 0.4%.

The study’s authors expected more of the same in the near-term. "Further changes to private non-group coverage and marketplace policies in 2018 and 2019, including shorter open enrollment periods, availability of short-term, limited-duration policies, loss of federal funds to support cost-sharing subsidies, and repeal of the individual mandate to purchase coverage, may also disproportionately reduce coverage in non-expansion states in the coming years," they wrote.