The share of Americans without health insurance has gone up for the first time since the Affordable Care Act (ACA) was passed almost a decade ago, with 535,000 more Americans uninsured in 2018 than in 2017. Though Kentucky’s year-over-year uptick in those without coverage was not statistically significant, the trend emerging mirrors the national picture, forewarning of deeper coverage losses that will occur in Kentucky as federal and state policy choices erect barriers to coverage.
The new American Community Survey data shows that after Kentucky’s uninsured rate went down from 14.3% in 2013 to a low of 5.1% in 2016 – one of the strongest success stories in the nation thanks to the Medicaid expansion and other parts of the Affordable Care Act – we’ve begun to backslide. Between 2017 and 2018, the uninsured rate rose by a statistically insignificant 0.3% after a similar increase between 2016 and 2017. However, between the historical low point in 2016 (5.1%) and in 2018 (5.6%, the data released today), there was a statistically significant increase in the share of Kentuckians without insurance.
“Being able to see the doctor, receive preventive care and be treated for medical conditions are foundational to Kentuckians’ well-being and economic security – to our ability to work and contribute to our families and communities,” Kentucky Center for Economic Policy Communications Director Anna Baumann said. “While we’ve made huge strides in recent years thanks to the Affordable Care Act, and while that has started to show up in indicators like increased access to drug treatment, reduced racial disparities among those who lack insurance coverage, reduced colon cancer deaths and healthier babies, those gains are being undermined by new barriers to health coverage.”
Federal policy changes that have begun to undermine coverage include:
- The repeal of the individual mandate as a part of the 2017 federal tax law.
- Federal cuts to marketing, outreach and enrollment assistance in the ACA marketplace.
- A yet-to-be implemented “public charge” rule change, the fear of which is already discouraging immigrants who are legally eligible for Medicaid from participating.
In addition to dismantling the successful Kynect state exchange in 2016, Kentucky is also in the process of making changes that will further limit coverage. The biggest current threat is the state’s continued pursuit of a waiver that would require some Medicaid participants to adhere to strict work reporting requirements – costly red tape that will leave even many working Kentuckians without health insurance (Arkansas, which implemented less extensive requirements in 2018, saw coverage losses as a result). Furthermore, state-level changes to Kentucky’s enrollment processes may be the cause for a larger decrease in Medicaid enrollment in 2018 than can be explained by an improving economy (according to a recent presentation from the Department of Medicaid Services, there was a decrease of 69,000 people enrolled in Medicaid between March 2018 and 2019). Nationwide, similar state-level changes may be partially responsible for an increase in the uninsured rate.
“A federal judge has struck down the state’s proposed barriers to Medicaid twice based on the grounds that they go against the purpose of the program, which is to furnish people with health insurance,” said Baumann. “We’ve got to stop walking back the health coverage gains we’ve made, and start building on them.”