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Trump's Obamacare Sabotage Has Resulted In...No Change to the Uninsured Rate

New Census data shows little change from 2016.

Polaris/SIPA/NewscomPolaris/SIPA/NewscomFor the past year and a half, Democrats have repeatedly warned that President Donald Trump is trying to sabotage Obamacare.

The administration has made a number of changes to the administration of the health law, including slashing most of its advertising and promotions budget, cutting funds for enrollment assistance, and stopping the payment of subsidies to insurance companies. (The law calls for the subsidies but they were not authorized by Congress and were ruled illegal by a court.) These changes, Obamacare's boosters charge, amount to a sustained effort to undermine the health law and its goal of providing insurance coverage to Americans.

This week, the Census Bureau released new data on changes to the uninsured rate under Trump. They represent the first official numbers for the full year of 2017, and they show the impact of Trump's changes to the program.

Trump's efforts to sabotage Obamacare resulted in...no change to the overall uninsured rate, which remained at 8.8 percent, the same as in 2016. In fact, there were 2.3 million more people insured in 2017 than in 2016. (The percentage of uninsured stayed the same because of population growth.)

The Census figures, of course, account for all types of insurance coverage, not just those covered through Obamacare's exchanges or Medicaid expansion. But enrollment through the exchanges dropped only slightly during the 2017 open enrollment period, even after a significant reduction in the advertising budget. ("It's not collapse. It's incredible stability," the head of California's state-run insurance exchange said earlier this year when those figures were released.)

The new numbers show minor changes to overall mix of insurance types: In 2017, a slightly larger percentage of Americans were insured through their employers than in 2016, and a slightly smaller percentage were insured through Medicaid, probably as a result of increased employment and the general strength of the economy. The percentage of individuals covered by Medicare, meanwhile, has increased.

It is possible, of course, that had the Trump administration not altered the operation of the health law, the uninsured rate would be even lower. And the rate could still rise over time. Trump could take further actions in the future that would affect Obamacare enrollment, or overall health coverage numbers.

But while health policy conterfactuals may be interesting to entertain, they do not change the reality that Trump's supposed sabotage appears to have led to several million more people with insurance, and no statistically significant change to the overall percentage of Americans with coverage.

At the same time, after years of substantial increases, premium hikes in Obamacare's exchanges for the coming year appear, on average, to be relatively modest (although some individual plans may still see big hikes).

President Trump and the Republican party have certainly demonstrated a hostility toward Obamacare, and a general indifference to the particulars of health policy. There is little question that Trump has not managed the program the way a Democratic president would, or the way the health law's supporters would like. One can reasonably take issue with some of the specific choices his administration has made.

But the primary goal of the law was to facilitate health insurance coverage for Americans, and the best evidence we have is that Trump's actions, whether or not they were intended to undermine the law, have had remarkably little effect on the overall rate of insurance coverage. If this is sabotage, it does not appear to be working very well.

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  • NoVaNick||

    Has anyone ever successfully sabotaged any government program? That should be pretty easy to answer.

  • Just Say'n||

    What does enrollment have to do with the program? This seems like a profoundly weird metric for a libertarian to use to judge its effectiveness.

  • NoVaNick||

    Right, the programs are all run through private insurers-there was never a public option.

  • JesseAz||

    With heavy government subsidies... Not really libertarian.

  • Sebastian Cremmington||

    Exactly, essentially giving people free health care has been a success! Who would have thunk?? The reality is the Exchanges have been a disaster but unfortunately Kushner's brother is heavily invested in them so I doubt we can ever get rid of them.

    The obvious thing to do is look at what is cheaper—Medicaid or the Exchanges? Go with whatever is cheaper up to 300% FPL and just let the individual market go back to what it was like in 2013. Taking the sick people out of the individual market will make it great for healthy people under 45. The only other thing I would do is go up to 500% FPL for maternity. Everything I have read says Medicaid costs less per capita than the Exchanges so just go with Medicaid and call it a day.

  • loveconstitution1789||

    Free market medical is the only way.

    Pay cash for minor medical care.

  • ||

    What does enrollment have to do with the program?

    It's the metric the left has always used to justify it?

  • Just Say'n||

    Oh yeah. I can't even keep track of the twist and turns of Obamacare stories that have been going since its enactment

  • JesseAz||

    At one point they pointed to the cost curve bending down as a success... Then reality of tens of billions in losses proved them wrong.

  • Paloma||

    Why is the number of insured a measure of success? Especially if being forced to by insurance in the first place is part of Obamacare.

    How many people have health care and how many people can actually afford it? Health care hasn't gotten cheaper and health insurance has gotten more expensive.

  • Paloma||

    BUY insurance. But you know what I mean, dammit.

  • loveconstitution1789||

    There is no mandate under ObamaCare anymore.

    You dont have to buy health insurance.

  • Toranth||

    For the most recent year (which is what is being spoken about here) there was a mandate. You would have seen it when filling out your taxes this spring.

  • loveconstitution1789||

    I ignore anything not dealing with taxes.

    I send a check every year, so I dont give the gov an interest free loan.

  • ||

    How many people have health care and how many people can actually afford it?

    This is exactly the question that has always been avoided by the ACA's supporters. They have always measured its effectiveness as "number of people possessing some form of insurance coverage."

    Hence, it's hard to then turn around and argue that the ACA has been "sabotaged" when the only metric that has ever mattered hasn't changed.

  • An Non||

    I'd say they're avoiding it precisely because the answer won't be in their favor--I've had to go without health insurance because my options are to pay for it or be able to afford health care. (My health insurance options are functionally catastrophic policies--which I'd be okay with, IF they weren't being sold me with the price tags of full coverage...especially as they don't cover my major health care costs.)

  • Jerryskids||

    Somebody should explain to these people that elections have consequences. No matter how hard they stamp their feet and scream about it, Trump is not in fact under any sort of obligation to maintain and expand on the policies of the Obama Administration.

  • loveconstitution1789||

    Especially not unconstitutional ObamaCare.

  • loveconstitution1789||

    I am still 'uninsured' and have been for decades. I have catastrophic health insurance and pay cash for medical visits.

    I wrote over the ObamaCare question on my tax form 'fuck you' to the IRS.

  • Eddy||

    Did someone say Sabotage?

  • Just Say'n||

    I thought that was a Beastie Boys clip, but then I remembered who posted it

  • Eddy||

    Did someone say Hot Legs?

  • Just Say'n||

    That's hilarious.

    Now hit us with a Hilaire Belloc quote

  • Eddy||

    "I wish I were as famous as Abraham Lincoln, so I could have lots of good if spurious quotes attributed to me."

  • dpbisme||

    The individual mandate was my problem with the law... I was in the Army, I never have claimed Unemployment insurance, I have always paid my taxes and all of a sudden I was being punished because I did not buy healthcare Insurance.

    Then the government STOLE my money to give to other people who have not been as productive as I have.

    ANYONE that votes for a Democrat has some serious
    mental issues as far as I can tell, I mean did you hear that they think Republicans are racists?

  • Just Say'n||

    "I mean did you hear that they think Republicans are racists"

    Some are. Just like other political persuasions.

  • CDRSchafer||

    Racism is the most ill defined, overrated issue this country faces currently.

  • ||

    Indeed.

  • Sebastian Cremmington||

    Actually Obama and liberals always opposed the individual mandate and it was only included at the behest of moderate Democrats in red states that thought it would appeal to Republicans. I think another factor was Gruber convincing Obama that it was necessary to make the insured rate look better and so it would help him in 2012. The reality is the individual mandate has always been innocuous but Republicans irresponsibly used it to win elections even though there 2012 candidate included it in his signature political achievement: Romneycare.

  • loveconstitution1789||

    Lefties want socialized medicine like single payer.

    They pushed obamacare thru and it has failed. That should keep single payer from being discussed seriously for a generation.

  • Sevo||

    "Trump's Obamacare Sabotage Has Resulted In...No Change to the Uninsured Rate."

    Oh, OK.
    Anybody know which college ball games are cancelled because of the hurricane?

  • JesseAz||

    CBS, SI, ESPN, FOX sports....

  • Don't look at me.||

    Why waste money advertising something that was mandated? Obviously unnecessary. Kudos to Trump.

  • wreckinball||

    So the libertarian website employs someone who thinks that attempts to "sabotage" government health care is a problem.

    Heck just blow the whole damn thin up..

    WTF Nick?

  • CDRSchafer||

    How do you sabotage a dumpster fire?

  • JesseAz||

    Put water in it.

  • Fairbanks||

    And he says that Trump and Republicans have shown a general indifference to the particulars of health policy. So "sabotaging" the government's micro-management of the economy is showing indifference?

  • XM||

    Since medicaid coverage counts as insurance (it shouldn't) I think the real question is, how many people dropped their existing plans or decided against buying health insurance after the individual mandate went dead.

    I keep hearing that most people get insurance from their work. As the economy rebounded some people probably quit their insurance and got covered through their new jobs. Some previously cancelled plans came back, if I'm not mistaken.

  • phaeretic||

    "They represent the first official numbers for the full year of 2017, and they show the impact of Trump's changes to the program."

    Do you know when the open enrollment period for Obamacare was for 2017? It was November 1 through December 15, 2016. Do you know what day Trump was inaugurated?

  • NotAnotherSkippy||

    Yes, Peter, but you were telling us breathlessly that repealing the illegal reimbursements were going to cost the country BILLIONS! Oh, it was going to result in MILLIONS losing coverage because the CBO said so. Did Suderman the computerman get it wrong?! UNPOSSIBLE!

    One can reasonably take issue with some of the specific choices his administration has made.

    No, one reasonably can't. Stopping the illegal reimbursements and expanding the term of short-term "thin" plans is precisely the direction that we should be heading. All of those are more than reasonable "specific choices" unless you're a welfare supporter like Petey. Just make the jump to Vox already. If I want good analysis, I'll stick with the better half of the Suderman household.

  • Sebastian Cremmington||

    I agree you have to have the short term junk policies in light of the Exchange policies being so expensive. But the reality is Republicans should have used the "savings" from the individual mandate to extend the premium subsidies to 500% FPL. Ryancare was a great plan but I think Ryan found out it spent more than Obamacare so he scrapped it. I will never forgive Schumer for not quickly agreeing to a vote and passing Ryancare because he had to know it spent more than Obamacare. Instead Republicans used the individual mandate to get $300 billion more in tax cuts when it should have gone to premium subsidies.

  • loveconstitution1789||

    More tax cuts coming!

  • magellannh||

    Actually, stopping the "illegal" reimbursements was definitely sabotage. This latest sabotage mainly hurt people like me who are healthy, self employed, and paying full freight.

    Insurers responded to the loss of the cost sharing subsidy reimbursements by baking those costs back into premiums. For lower income subsidized folks, that meant the sabotage had zero impact.

    Unfortunately, people like me who aren't subsidized were left holding the bag. Even though I have no preexisting conditions and am in good health, I'm paying $13K this year for a high deductible plan. That's compared to around $8k the year before. Ouch! It was bad before but Republicans have made it much worse.

    What REPUBLICANS have done with Obamacare is unconscionable. All I ask for is an individual insurance market that's roughly stable and workable. At this point, I could take or leave Obamacare. I'm an independent not a partisan. Between this, Trump's crazy, and his unchecked crony capitalism, I'm at maximum frustration with Republicans. I'm a fiscal conservative and usually vote a mixed ticket based on who I think will spend more responsibly. But this year I'm going with a straight Dem ticket.

    Repubs should have either maintained the status quo or fixed the problem. Their active sabotage is unforgivable.

  • Number 2||

    "If this is sabotage, it does not appear to be working very well."

    Damn Trump. He can't do anything right.

  • NashTiger||

    Iknorite?

    His Tax Cuts produced record high tax revenues

  • Sebastian Cremmington||

    Obamacare is essentially free health care for Democrats and ignorant racists in West Virginia that believe they are on Byrdcare...why would anyone eligible for it not sign up for it?!? The only people that don't like it call Obama "Hussein" and believe he is a Kenyan Muslim that set up death panels at FEMA camps! I am fine with those Deplorables paying for expensive junk policies while Democrats get free health care paid for by taxpayers, i.e., Republicans!!

  • loveconstitution1789||

    Free market medical care is the only good method.

    Pay cash for minor medical care.

  • jdgalt1||

    The main change Trump has made to ObamaCare was to eliminate the individual mandate, effective 1/1/2019. It's kind of pointless to look for changes in the number of insured people before that date.

    What would be more helpful is if Reason were to nudge states to re-legalize health insurance that does not meet the law's ridiculous definition of "minimum essential coverage" -- because MEC has become unaffordable and I doubt very many of us will go on buying it after December, even if the alternative is to go without insurance.

  • magellannh||

    IMO, there's some distortion about the impact of the minimum essential benefits on premiums. There's no doubt they increase premiums, but the difference between a bare minimum Obamacare policy and the policy I'd craft on my own isn't as great as some claim.

    If I could design my own plan, here's what I'd knock off the minimum essential benefits, with a best guess at premium savings in parens. I couldn't find an quick link with these percents, but I believe both KFF and Health Affairs have published estimates in the ballpark of these.
    1) Maternity coverage (6%)
    2) Mental Health coverage (2%)
    3) Preventative coverage (3%)

    So that's around 11% of premium savings if everything was cut out. To put this in context, the loss of the cost-sharing subsidy reimbursements from the Republican lawsuit increased my premiums by around 15-20%. Dropping the individual mandate without any counterbalancing protective measures will probably increase my premiums by another 15-20%.

    So that's 30-40% of extra premium cost caused by Republicans in the past year.

  • magellannh||

    As an unsubsidized off-exchange insurance buyer without pre-existing conditions, I'd benefit more from Republicans tackling the free-rider problem they caused by eliminating the mandate than I would from any loosening of the minimum essential benefit rules.

    There are some simple changes that could offset the premium increase from eliminating the mandate (eg continuous coverage requirements, waiting periods, etc).

    We spend about $8000 per year on health care for each American under the age of 65 in the US. That's an average premium of $400 per month for a 40 year old, assuming premiums cover 60% of costs (typical Obamacare bronze plan w/$5k deductible). The true age cost curve ranges from 1x for a 20 y.o. to 5x for a 64 year old. So that means that same bronze equivalent premium would be $160 for a 20 year old and $800 for a 64 year, old if Obamacare's restrictions on age rating were eliminated.

    You can move those numbers around by 20-40% in either direction with tweaks, but no matter what policymakers do, even in a completely free market, you're not going to be able to buy a "real" health insurance policy for a ton less than this.

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