The number of uninsured Americans reached 13.7% in the fourth quarter of last year, the highest rate since 2014. The rate also rose from 10.9% in 2016, and that increase represents about 7 million Americans.

The level reached 18.0% in 2012, according to a new research study by Gallup. The implementation of the Affordable Care Act’s individual health insurance mandate in 2014 drove that down to the 2016 level. But the effects of the legislation are no longer favorable.

The Gallup data are based on the question, “Do you have health insurance coverage?” Sample sizes of randomly selected adults in 2018 were around 28,000 per quarter.

Gallup’s specific analysis of the data show:

The ACA marketplace exchanges opened on Oct. 1, 2013, and most new insurance plans purchased during the last quarter of that year began their coverage on Jan. 1, 2014. Medicaid expansion among 24 states (and the District of Columbia) also began at the beginning of 2014, with 12 more states expanding Medicaid since that time. Expanded Medicaid coverage as a part of the ACA broadens the number of low-income Americans who qualify for it to those earning up to 138% of the federal poverty level. The onset of these two major mechanisms of the ACA at the beginning of 2014 makes the uninsured rate in the third quarter of 2013 the natural benchmark for comparison to measure the effects of that policy.

Throughout the two years from the fourth quarter of 2016 to the fourth quarter of 2018, the rate of the uninsured did not rise evenly. While the rate rose 2.0% across the entire population, it rose 4.8% for adults ages 18 to 34. It rose 3.9% among women compared to 1.6% for men. The rate rose 2.8% among people who made less than $24,000 and 3.0% among those who made $24,000 and $48,000. However, it rose only 1.2% among people with incomes over $120,000.

The change was also substantial by region. Among states in the eastern part of America, the rate actually dropped by 0.4%. Among states in the south, the rate was up 3.8%.

Gallup gave several possible reasons for the change. These included in specific:

• An increase in the rates of insurance premiums in many states for some of the more popular ACA insurance plans in 2018.
• Open enrollment periods since 2018 have been characterized by a significant reduction in public marketing and shortened enrollment periods of less than seven weeks, about half of previous periods.
• Political forces that may have increased uncertainty surrounding the ACA marketplace.
• The president’s decision in October 2017 to end cost-sharing reduction also potentially could have affected the uninsured rate.

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