A new analysis from Harvard researchers shows that more than two million people lost health insurance during the first three years of Trump’s presidency. They also estimate that coverage losses led to up to 25,000 excess deaths among adults below the age of 65. These figures do not include insurance lost during the pandemic.
“It speaks to what an utter disaster this administration has been from the perspective of health policy,” says lead researcher Adam Gaffney.
Gaffney and two other researchers analyzed data from the Census Bureau’s American Community Survey and Annual Social and Economic Supplement as well as the Centers for Disease Control and Prevention’s National Health Interview Survey. All three of these data sources document uninsurance rates, though the figures range across the three datasets. For example, the ASEC survey found that in 2019 there were 26.1 million uninsured, while the NHIS reported a much higher figure: 33 million uninsured for the same time frame. Both of those data sets underwent a change in design and therefore, the researchers say, the data cannot be reliably compared year over year. However, the ACS has not changed how it collects or analyzes survey data. That set showed that 29.1 million Americans were uninsured in 2019, an uptick of 2.3 million since 2016.
“I think the Trump administration has taken a number of steps that undercut coverage,” says Gaffney. This includes adding complexity to the Medicaid sign-up process and reducing community outreach. Trump has also introduced short-term insurance plans and low-cost, low-coverage options in the name of giving Americans more choice. “These coverage losses occurred despite an improving economy—you’d expect the opposite.”
To understand the impacts of the insurance coverage decline, the researchers looked at a number of studies, both randomized and quasi-experimental, that focus on the effect of gaining health coverage on mortality. In addition, the researchers analyzed previous studies that showed how growth in insurance coverage can save lives.
“Basically these previous studies show the amount of coverage you need to save one life,” says Gaffney. “We used that to come up with an estimate of lives lost.”
Using these calculations on the ACS data set, they found that between 3,399 and 10,147 adults under 65 may have died as a result of lost insurance between 2017 and 2019. Under the NHIS figures, the estimated fatalities among the same age group were higher: between 8,434 and 25,180. But Gaffney notes that death is far from the only consequence of lost insurance. Those without insurance are more likely to have their hospitals bills sent to collection, notes Gaffney, and more likely to suffer from depression.
These figures don’t take the pandemic into account, and 2020’s numbers of lost insurance could be even worse. In August, the Urban Institute published an estimate that 10.1 million people will lose employer-sponsored health insurance as a result of job loss during the last three quarters of 2020. The institute suggests that a large portion of those people will be able to find insurance coverage through other means, such as COBRA, Medicaid, or through joining another family member’s health plan. However, 3.5 million people are likely to lose insurance coverage altogether.
While more people are becoming uninsured, healthcare is not getting cheaper. President Trump has talked a lot about lowering drug prices but has failed to actually bring them down. More recently, the Department of Health and Human Services passed a rule that will require hospitals to publish the prices insurers pay them for medical services, starting in January. But as Gaffney says, less opaque pricing won’t help people who cannot afford the medical costs in the first place.
Furthermore, the number of uninsured individuals is poised to go up if Trump is reelected. The president and the Republican Party have repeatedly tried to repeal the Affordable Care Act. Already the administration has removed the mandate that requires Americans to have health insurance coverage, which has led to a rise in coverage loss. If the ACA is repealed, it could leave 19.9 million Americans without insurance, according to a report from the Urban Institute.
“When Trump came into office things weren’t perfect either,” says Gaffney, noting that 30 million people didn’t have health insurance before Trump took office. “But it’s not enough to roll back what Trump has done. We need a system that actually covers everyone.”