Another increase in non-insured rates


30.4 million Americans did not have health insurance in 2018, up from 29.3 million in 2017, according to the CDC's National Health Interview Survey.  

Efforts by the Trump administration and Congress to challenge and loosen requirements of the Affordable Care Act probably played a role in some Americans going without cover.

The Tax Cuts and Jobs Act of 2017 eliminated the health law's individual mandate that required people to get health insurance or pay a penalty. It formed the legal basis for a coalition of Republican-led states to argue in the federal court that the entire health law should be rejected, a court challenge that the Trump administration supports.

Even if, as Republicans claim, more low-income people moved from Medicaid cover to health insurance through a job, this does nothing to make health care more affordable for those whose health plans shift costs to them through higher deductibles and co-payments.

The CDC survey says the number of Americans in high-deductible plans reached an all-time high, covering 45.8% of people with private health insurance in 2018. In 2010, 25% of people with private cover had high-deductible plans.

A Gallup survey found that Americans borrowed US$88 billion to pay for health care in 2018, and one in four people skipped care because of cost.

High-deductible plans are popular among companies seeking to defray the rising cost of health care. A survey by Kaiser Family Foundation and the Los Angeles Times found that many employees in high-deductible plans postponed care or cut spending on household expenses such as food and clothing.

The uninsured rate among US working-age adults was 13.3% in 2018, up from 12.8% in 2017. Among all ages, the uninsured rate was 9.4%, but that figure includes seniors on Medicare and children with Children's Health Insurance Programme cover.

Texas had the highest uninsured rate among working-age adults, 25%, and Massachusetts the lowest, 4.9%.

Most uninsured Americans are not however international medical travel targets. They are mostly too poor to afford the treatment and travel and a substantial number of them have no passport.



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