Arizona is one of eight states that had “statistically significant” increases in the number of people without health insurance between 2017 and 2018, the U.S. Census Bureau says.

In Arizona, 750,000 people didn’t have any health insurance last year. That’s about 1 in 10 people or 10.6% of the population. The number of Arizonans without coverage jumped by 55,000 people over 2017, after several years of drops in the rate of uninsured.

A census report released Sept. 10 says roughly 27.5 million Americans were without health insurance at some point last year — that’s 1.9 million more people uninsured than in 2017, the report says.

The recent jump concerns some health-care experts, who fear efforts to chip away at the Affordable Care Act have left people without coverage. Some politicians, including U.S. House Speaker Nancy Pelosi, D-Calif., and Democratic presidential candidate and former vice president Joe Biden, have publicly blamed the Trump administration.

After President Trump took office, for example, he slashed marketing and enrollment assistance money allocated to help people sign up for so-called “Obamacare” on the insurance marketplaces.

But it’s unfair to blame Trump since problems with health care in the U.S. began long before he took office, said Naomi Lopez Bauman, director of health care policy for the  Goldwater Institute, a conservative think tank based in Phoenix.

Families who do have Affordable Care Act marketplace plans often have large deductibles — some as high as $7,000, she said.  She added that people who don’t qualify for federal subsidies are often opting to go without insurance because it’s too expensive. 

“This is not shocking news to people who have been following the ACA since the very beginning,” she said of the latest census numbers.

“The ACA fundamentally is one-size-fits-all and it is not targeted toward patient value. It is targeted towards coverage and that was determined by insurers and hospitals. This is not the kind of coverage that most people would choose if they were using their own money and shopping on their own.”

‘Larger societal cost’ of going uninsured

States other than Arizona that showed statistically significant increases in the number of uninsured people were Alabama, Idaho, Michigan, Ohio, Tennessee, Texas and Washington.

“What it translates to are the lives and health of real live people and their loved ones that depend on this insurance,” said Swapna Reddy, a clinical assistant professor in the College of Health Solutions at Arizona State University. “We know what happens to a population when it’s uninsured or underinsured. There’s the human cost at the individual level, but there’s also the larger, societal cost.”

When too many people don’t have health insurance, there’s a financial risk that people without insurance will have an unexpected illness or accident that they won’t be able to afford. 

Others will delay care, which accrues cost for the entire health system because it leads to preventable surgeries and hospitalizations. Untreated bronchitis can turn into severe pneumonia. Unaddressed diabetes can turn into an amputation. Hospitals’ uncompensated care money is depleted, and more people go into medical bankruptcy.

“It’s much better when people are insured and receiving preventive and regular care — not just for those people, but for all of us,” Reddy said. “The care is a whole lot cheaper than when they are going into the emergency room for care. That is not a supposition; it is a fact.”

Arizona’s uninsured rate is still far lower than it was before most provisions of the Affordable Care Act took effect in 2014. In 2013, Arizona’s rate of uninsured people was 18%, which worked out to 1.2 million people, data from the Kaiser Family Foundation says. The percentage had dropped to 10.1 by 2017.

Immigration climate a factor in Arizona?

One factor that could be affecting insurance coverage in Arizona is the Trump administration’s public charge rule changes, which take effect Oct. 15. The changes broaden the government’s ability to penalize immigrants who seek green cards if they use taxpayer-funded programs such as housing assistance, food stamps and Medicaid.

News about the public charge change has created fear and confusion among low-income immigrant families for more than a year even though the changes aren’t yet in effect, according to social service agencies.

As a result, even immigrant families who wouldn’t be affected by the public charge rule are avoiding government assistance of any kind, ranging from Medicaid to free and reduced-price meals at school.

The census data showed that nationally, Hispanics had the lowest rate of health insurance coverage. Nearly 18% did not have insurance in 2018. The rate of Hispanics with health insurance dropped by 1.6% from 2017.

“There’s a lot of misinformation about the public charge rule. And then there’s some very warranted fear about the public charge rule,” Reddy said. “It’s not just undocumented immigrants; it’s documented immigrants waiting for permanent residency, too.”

Immigrant families are fearful of connecting with the government in any way, she said.

Twenty-three children’s health and advocacy organizations, including the American Academy of Pediatrics, the American Medical Student Association and the March of Dimes issued a statement of opposition to the final public charge rule last month, saying it would have a detrimental affect on the health of millions of immigrant children, pregnant women and families.

“Children’s health will bear the burden of the public charge final rule, with families disenrolling from or avoiding services they are eligible for out of fear,” the statement says. “Children will miss out on the long-term health benefits of programs like Medicaid and expectant mothers will forgo prenatal care.”

Latino children among hardest-hit

The census data showed that overall, the number of uninsured children in the U.S. increased by 425,000 children between 2017 and 208, the Georgetown Center for Children and Families said in a news release. 

“Children hit hardest by coverage losses include Latino children, non-Hispanic White children and children under age 6,” center director Joan Alker said. “This is clear evidence that the (Trump) Administration’s rhetoric targeting immigrant families is harming children, but that’s not the only cause. More red tape, less outreach, and general neglect are contributing to this rise in uninsured children.”

Reddy said the U.S. needs to “course correct” or else more Americans will be going without health insurance.

Starting this year, there no longer will be an “individual mandate” that financially penalizes Americans for not having health insurance. Whether or not that results in more Americans, including Arizonans, going without health insurance is unclear, Reddy said. 

Something that could impact insurance rates is the Trump administration’s decision to expand short-term and association health plan coverage, Reddy said. That could end up siphoning young, healthy people out of the health insurance marketplaces and driving up costs for the people who remain, she said. 

“When there’s more people in the marketplace, that’s how premiums come down,” she said. “It’s all about adjusted risk pools.”

Lopez Bauman said no matter where anyone sits on the political spectrum, the aim is to have acceptable and affordable health care coverage. But trying to find it within the framework of the Affordable Care Act is not the right path, she said.

Measuring the condition of health care by the rate of people without insurance is not telling a complete picture, she said.

“It’s important to take a much broader look at what the uninsured rate means and doesn’t mean, and is there fertile ground for innovations in health care that allow people to get the care they need, when they need it, and at a good price,” she said. “We’ve really got to go back to the drawing board and allow more consumer choice and freedom.”

Reach the reporter at [email protected] or at 602-444-8369. Follow her on Twitter @stephanieinnes

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