More than one million Americans lost health insurance in 2018

By Alex González

14 May 2019

Estimates from a Centers for Disease Control (CDC) survey reveal that 1.1 million people lost their health insurance coverage in 2018. Last year, over 30 million people did not have health insurance at the time of the study, including 13.3 percent of adults aged 18 to 64 and 5.2 percent of children aged 0 to 17.

After decreasing or leveling off in past years, the number of uninsured is on the rise. The National Health Interview Survey, a nationally representative study, asked participants about both their current health insurance status and whether they have had health insurance in the past year. The report’s results are presented by income status, demographics, and by states that opted or refrained to expand Medicaid under Obamacare.

As with other basic necessities, the ability to afford healthcare is deeply connected to income. In 2018, among adults aged 18 to 64, more than 27 percent of those who were “poor” (with family incomes at or below the poverty line) and about 25 percent of those who were “near-poor” (with family incomes between 100 and 200 percent of the poverty line) did not have health insurance.

Meanwhile, only about 8 percent of those who were “not poor” (with family incomes over 200 percent the poverty line or higher) were uninsured. This means that poor or near-poor were more than three times as likely to be uninsured than the non-poor.

For all age groups, the percentage uninsured at the time of the interview and the percentage uninsured for at least part of the year increased from 2017 to 2018. Some 9.4 percent of individuals lacked health insurance coverage at the time of their interview in 2018, compared to 9.1 percent in 2017.

More than one in ten individuals reported being uninsured for at least part of the year, with this group also increasing from 2017 to 2018. Some 12.9 percent of individuals of all ages reported being uninsured in 2018, while this figure was 12.4 percent in 2017. This means that over 40 million people were uninsured for at least part of the year in 2018.

In 2018, 6 million children aged 0 to 17 did not have healthcare coverage for at least part of the year, and 3.8 million were not insured at the time of the interview. Children who are poor or near-poor were more than 50 percent as likely as children who were not poor to be uninsured. In 2018, 6.4 percent of poor children did not have health insurance at the time of the interview, compared to 6.3 percent for near-poor children and 4.2 percent for non-poor children.

The number of uninsured people has fallen particularly in the 37 states that opted to expand Medicaid coverage under Obamacare. In these states, the percentage of uninsured adults decreased from 18.4 percent in 2013 to 9.9 percent in 2018. In other words, the percentage of uninsured adults aged 18 to 65 in these states decreased roughly by half.

Meanwhile, there are more uninsured adults in states that did not expand Medicaid. Between 2013 and 2015 the percentage of uninsured adults in these states decreased from 22.7 to 17.5 percent, but it increased between 2015 and 2017 from 17.5 to 19.0 percent. In 2018, the percentage of uninsured adults aged 18 to 64 in non-expansion states was 18.7 percent, or more than twice the rate as in the states that chose to expand Medicaid.

While the released report does not detail why individuals lost their health insurance, media reports have pointed to the repeal of the Affordable Care Act’s (ACA) so-called “individual mandate” by the Trump administration’s tax bill in 2017. No longer able to enforce the financial penalty of being uninsured, many individuals may have chosen to drop their healthcare coverage.

Legal challenges to the ACA are currently being decided by appeals courts after a federal district judge in Texas ruled that Obamacare was unconstitutional in December of last year. Between 20 and 25 million people would lose their healthcare coverage if the law that established Obamacare is struck down.

While many people became insured under ACA, the healthcare plans awarded under Obamacare’s insurance marketplaces or state-based exchanges were known for their high deductibles, large out-of-pocket expenses, and limited choice of insurers. In practice, this meant that while families and individuals were forced to buy health insurance, many were still unable to afford decent medical care.

Rising healthcare costs and an attack on benefits has prominently featured in a series of major struggles over the past two years, including strikes by teachers in the US and the ongoing strike by 2,000 nurses in Toledo, Ohio. However, workers that are entering into struggle must be warned: the fight to establish a high-quality and free healthcare system will not be granted by “Medicare-for-All” or proposed “fixes” to Obamacare by Congressional Democrats.

As long as the giant insurance companies and the tiny oligarchy that controls every aspect of social life remain in place, healthcare will remain a privilege for the few, rather than a social right for all. What is needed is a socialist policy for universal healthcare, through nationalizing the healthcare industry into a publicly owned and democratically controlled utility run to meet the needs of the population, not maximize the profits of the corporations.

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