After Years of Decline, Uninsured are Growing, Especially in Iowa

Americans without health insurance rose to 12.2 percent last year, up from 10.9 percent at the end of 2016, according to new data the polling firm Gallup and digital health company Sharecare . This comes after several years of dramatic declines in the percentage of Americans who lack health insurance ― a direct result of the Affordable Care Act’s (ACA) coverage provisions.

The uninsured rate rose by statistically significant margins in Iowa and 16 other states in 2017, marking the first time since the full implementation of the ACA in 2014 that any state had a rate increase. Notably, Iowa’s uninsured rate jumped from 3.9 percent in 2016 to 7.2 percent in 2017, Gallup said, one of the largest increases in the country. That’s just short of what it was in 2013, when 9.7 percent of Iowa’s population was uninsured.

Gallup highlighted a few factors that may have caused the uninsured rate to increase:

  • Increase in insurance premiums for the more popular ACA insurance plans
  • Less marketing and a shorter enrollment period
  • Insurers have withdrawn from the exchanges, leaving less competition
  • Political forces such as attempts to repeal and replace the ACA, the elimination of the individual mandate and the decision to end cost-sharing reduction payments

Many health plans have stopped selling health coverage through the exchanges created four years ago under the ACA. Attempts to overturn the health law last year caused premiums to surge, as insurers expected that undoing the law’s requirement that all Americans have health insurance would leave them with a smaller and sicker pool of clients.

The repeal effort ultimately failed, but the Trump administration overturned the penalty for going without insurance, opening the door for insurers to sell cheaper, skimpier plans.

Gallup’s findings come just a week after the Commonwealth Fund published its ACA Tracking Survey, which also highlighted the increasing rate of uninsured individuals. The survey tracked coverage rates through March 2018 and found that the uninsured rate increased among adults younger than age 65 from 12.7 percent in 2016 to 15.5 percent in 2018.