Though former President Donald Trump criticized the Affordable Care Act during the most recent debate with Vice President Kamala Harris and said he would like to replace it, newly released Census data from the American Community Survey demonstrates the ACA’s progress in helping more Americans get health insurance. In 2023, the uninsured population declined for the third year in a row, reaching a record low.
JEREMY LINDENFELD; jlindenfeldphoto@gmail.com, @jeremotographs
Lindenfeld is a California-based reporter covering inequality, climate change and labor organizing for Capital & Main.
Lindenfeld told the Institute for Public Accuracy: “In the new Census data, we saw marginal decreases in the number of people who were uninsured. The number remained at a record low [from the year before]. The enhanced premium tax subsidies in particular continued to help people afford health insurance when they couldn’t afford it otherwise.
“One complicating factor is that the Medicaid unwinding,” which began in March 2023, “isn’t really taken into account in the new American Community Survey (ACS) data. The ACS does their survey on a rolling basis. They contact people throughout the year, so if someone loses their insurance in November due to the Medicaid unwinding in their state, but they were contacted [by the ACS] in September, they would still be considered insured. The unwinding is a state-by-state process. One expert says we won’t see the full impact of the Medicaid unwinding for another year or two––but we expect [the outcome of the unwinding] to be an increase in the uninsured rate.
““We don’t have the details on either candidate’s plan yet. Trump said during the debate that he has ‘concepts of a plan’ on healthcare. It’s hard to say what he’s going to do. If his previous administration is any sign, he’ll keep eating at the edges of the ACA. [The legislation] is so popular, and increasingly popular every year. Trump understands that it’s not politically salient to say ‘we’re going to take the ACA away.’
“Most of the things Kamala Harris is mentioning on healthcare don’t have to do with the uninsured rate. She talks about Medicare negotiations, price controls, forgiving medical debt. But she does want to make those temporary premium tax credits, which expire at the end of next year, permanent. On average, [the premiums] saved enrollees $700 in 2024, helping drive marketplace enrollment. The subsidies allowed people to maintain their insurance or sign up for it.
“Experts say that the most straightforward way to reduce the [uninsured] rate and the number of uninsured people is to get the 10 states that haven’t adopted Medicaid expansion to do so. Legislation has been passed to incentivize those states to adopt Medicaid expansion, and that got some of the states that were holding out to adopt it. But there are still 10 standouts that don’t seem close to doing so. There are still 27 million uninsured people in this country.”
