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Amid roiling health care debate, the share of uninsured Americans is growing

Health care is a top 2020 political issue. Democratic candidates are debating whether to build upon the Affordable Care Act, or 'Obamacare,' or replace it with Medicare for All. Meanwhile, President Trump wants to dismantle the ACA entirely. As millions of Americans enter the time of year when they choose their health plans, Amna Nawaz gets the latest from Margot Sanger-Katz of The New York Times.

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  • Judy Woodruff:

    One of the biggest issues in the 2020 presidential campaign is about expanding health coverage or not.

    Millions of Americans are at that time of year when they have to decide whether to get their coverage through the marketplaces created during the Obama years.

    Amna Nawaz looks at this moment.

  • Amna Nawaz:

    Judy, several reports find the percentage of uninsured Americans is rising for the first time since the Affordable Care Act took effect.

    That increase is backed up by Census Bureau data. But experts are asking, why are those numbers rising? We're going to look at that question and this enrollment season.

    But, bear in mind, as this plays out, President Trump says he remains committed to killing the Affordable Care Act and has backed a state lawsuit to do so. At the same time, it's the law of the land. The president also says he wants to cover people with an alternative that would offer some of the same consumer protections and lower health care premiums. But he has not offered any new plan yet.

    For more on this, Margot Sanger-Katz joins me here now. She reports on all of this for The New York Times.

    Welcome back to the "NewsHour."

  • Margot Sanger-Katz:

    Thanks for having me.

  • Amna Nawaz:

    So, let's just start with where we are.

    We're a couple of days into the enrollment season. How are things looking so far?

  • Margot Sanger-Katz:

    So, despite everything you said, the Trump administration is no fan of Obamacare, but this year looks pretty good.

    Compared to last year, there are more choices in a lot of parts of the country, and premiums actually have come down a little bit. And it's been this interesting sort of boomerang.

    When the Trump administration came in, they did a whole bunch of things that made those markets really bumpy and problematic. Prices went way up. A lot of insurers left the market. There was a lot of concern and policy uncertainty.

    And then, over time, things have kind of stabilized, and so we're kind of correcting back to a more normal, stable place.

  • Amna Nawaz:

    Let me ask about this number that's catching everyone's attention now, the overall number of Americans who are uninsured.

    Take a look at this number and the increase. From 2017, it was 7.9 percent of the American public who were uninsured. That went up in 2018 to 8.5 percent. That's about 27.5 million people.

    The economy is doing well. You wouldn't expect to see these numbers. What's happening there?

  • Margot Sanger-Katz:

    Yes, I mean, I think this is a pretty troubling development. It's been about a decade since we have really seen the uninsured rate go up. So it's not just Obamacare, but even before then.

    And, generally, as you say, when the economy is doing better, more people have jobs that give them coverage. And I think there are a couple of different things that are going on here.

    One has to do with things that states are doing in their Medicaid programs, where they're making a little bit harder for people to get enrolled and stay enrolled. And that's something that is not an explicit federal policy, but the Trump administration has made it a little bit easier for states to do those sorts of things.

    I think another major possible source of these coverage losses are concerns about immigration policy, where a lot of families where there might be children who are U.S. citizens and parents who are either undocumented immigrants or even legal immigrants who are in the process of getting their green card or their citizenship, they may be more reluctant to sign up for public coverage because they're worried that it may affect their immigration status.

    And then I think there's this third category that's linked to the Obamacare markets that we talked about earlier. The premiums for Obamacare plans are really high. They have risen a lot over the course of the program.

    And there are people who do not qualify for any financial assistance buying those plans. And we can see that more than a million people have basically left that market because they have decided that it's too expensive.

  • Amna Nawaz:

    There's another subgroup you have looked at in your reporting that caught my attention because of another alarming number.

    You looked at the number of children who no longer have health insurance. And this is, as you reported, the number of children without Medicaid or health insurance. That number increased by more than a million between 2016 and 2018.

    What is happening there? Why children?

  • Margot Sanger-Katz:

    So, again, I think this is a little bit of a complicated portrait, but it is a really, really worrisome sign, more so even then insurance coverage for adults.

    We know that there are huge public health and economic benefits for children having health insurance. So kids that have Medicaid are more likely to be healthy when they're older. They're more likely to finish high school and college. They're less likely to have children themselves as teenagers.

    And there's even some evidence that they earn more income as adults. So I think it's a combination of various factors. As I said, I think some states are taking action that is making it harder for families to enroll their children in Medicaid or to keep them enrolled.

    And I do think that there's a lot of concern among immigrant families. My colleague Abby Goodnough went to Houston, Texas, and talked to some immigrant families where they had kept their kids in Medicaid for many years, and then were starting to disenroll them because they were worried it could affect their legal status.

  • Amna Nawaz:

    So the question everyone has after all of this — this is the question everyone's asking right now in this political climate — is, what plan and what kind of health care system should we have?

    You and your colleagues at The New York Times partnered with the Commonwealth Fund and with Harvard, and you asked that question of a number of Americans. You surveyed a number of people and said, what is the kind of plan that you think you would like?

    What you found was basically a three-way split between a Medicare-for-all-type plan and Obamacare-plus, right, Affordable Care Act-enhanced, and then a Republican plan, which would be less federal government involvement, more money and more resources to states.

    And that — I should say, those numbers all fall within the margin of error. So it's basically a three-way split. What does that tell you?

  • Margot Sanger-Katz:

    I think, first of all, it tells us there about two-thirds of Americans or at least 60 percent of Americans that favor sort of Democratic solutions. And that's consistent with other polling, where we see that people tend to trust the Democratic Party a little bit more on health care.

    There's only a third that are really enthusiastic about the plan that President Trump is talking about. But among people favoring those more Democratic options, there is a real divide.

    And I think we see that in the Democratic primary contest, where some candidates really want to do Medicare for all, a sort of single-payer system where everyone gets their insurance from the government. And then there are some candidates that want to try to figure out, how do we work within the existing system to fill in holes and to cover some of these people that are falling through the cracks?

    And I think we're going to continue to see that debate going on through this primary and probably into the general election as well.

  • Amna Nawaz:

    It remains a top issue for American voters out there.

    Margot Sanger-Katz of The New York Times, thanks so much for being here.

  • Margot Sanger-Katz:

    Thank you so much for having me.

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