Gallup reports that the uninsured rate is increasing:
The percentage of U.S. adults without health insurance was essentially unchanged in the fourth quarter of 2017, at 12.2%, but it is up 1.3 percentage points from the record low of 10.9% found in the last quarter of 2016.
I think that number will continue to increase over the next couple of years. Here are the factors that will lead to more people uncovered:
- Higher premiums for off-Exchange/non-subsidized enrollment
- Less marketing and outreach for on-Exchange/subsidized enrollment
- No individual mandate
- Messaging environment that deprioritizes coverage
- Medicaid work requirements and hassle barriers
There are some factors that could lead to more people covered
- Continued aging into Medicare
- Cherry picking of healthy individual market folks into short term plans at very low premiums.
- Continued Silverloading due to the non-funding of CSR.
- 1332 waivers that prioritize reinsurance using the CSR windfall to lower premiums for off-Exchange individuals.
- Insurer/state level marketing increases to compensate for negative federal messaging environment
I think that as long as the fundamental structure of the ACA is in place and even if it acts as a high cost high risk pool, there is an upper limit on the number of people who are uninsured. I am not quite sure where that limit is but I strongly believe it is significantly less than 18%.