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The Trump administration’s decision to ask a federal court to declare the entire Affordable Care Act unconstitutional has fired up Democrats. By one estimate, about 20 million people rely on the law for their health care.
Presidential candidate Julian Castro, who served as Housing and Urban Development secretary in the Obama administration, said President Donald Trump’s latest move comes on top of his broader policy to undermine the signature health care program of President Barack Obama.
"Donald Trump is doubling down on a health care agenda that has left millions more Americans uninsured since he took office," Castro tweeted March 26. "As President, I will expand access to quality health care, and make universal coverage my first legislative priority."
In this fact-check, we focused on whether millions more people are uninsured since Trump took office.
Castro’s staff pointed to the results in the January 2019 Gallup National Health and Well-Being Index. It said 13.7 percent of Americans were uninsured in the last quarter of 2018.
"Today's level is the highest in more than four years, and well above the low point of 10.9 percent reached in 2016," the report said. "The 2.8-percentage-point increase since that low represents a net increase of about seven million adults without health insurance."
So that squares with Castro’s "millions," but we’ve found before that Gallup is an outlier, largely because its estimate for the uninsured was lower than anyone’s in 2016. From that low point, any increase appears larger. So we kept looking for more sources.
According to the latest figures from the Centers for Disease Control and Prevention, between 2016 and the first nine months of 2018, the number of uninsured rose 1.3 million. That number comes from the National Health Interview Survey, a long-standing research program that drew responses from a pool of more than 61,000 people.
"The National Health Interview Survey is the gold standard in terms of measuring health insurance enrollment at the national level," RAND health policy analyst Christine Eibner said. "My only caveat is that the most recent data do not incorporate the elimination of the individual mandate penalty, which took effect on Jan. 1, 2019. So, it’s possible that we will see further erosion."
Republicans lifted the requirement for everyone to have insurance as part of the 2017 Tax Cut and Jobs Act.
Chris Condeluci, a former Republican Senate committee staffer on health care benefits, also trusts the CDC data.
"There’s a slight uptick in the number of uninsured," Condeluci said. "A slight uptick isn’t millions, but you can't shy away from the fact that there are now some people who are uninsured who had insurance in 2016."
The government’s survey found that the uninsured rate rose from 12.4 percent in 2016 to 13 percent in September 2018. The CDC analysts have not said the increase is statistically significant. On the other hand, the latest results are preliminary, and the CDC authors noted that "preliminary estimates of persons without health insurance coverage are generally 0.1 to 0.3 percentage points lower than the final estimates."
In short, the best available survey shows a rise in the number of uninsured, and it’s possible the uninsurance rate will be higher when the final numbers come out.
The New York-based Commonwealth Fund, a private health policy group, also measures insurance coverage. Based on its work, about 2 million people lost health coverage under Trump.
A large research effort by the Urban Institute has found small but statistically significant signs that progress toward wider coverage has stalled and might be reversing.
The Census Bureau’s "Health Insurance Coverage in the United States: 2017" analysis showed an increase of the uninsured of 492,000 people between 2017 and 2016. That’s only for one year, but the trend is upward.
Whatever the rise in the number of uninsured, Castro broadly ties the trend to Republican policies.
There’s no question that Trump and congressional Republicans worked hard and nearly repealed Obamacare. Trump canceled about $10 billion in reimbursements to insurance companies, a move that drove up premiums, although since then, they’ve moderated. The administration tightened the screws on enrollment, by shortening the sign-up period and cutting the marketing budget by 90 percent. However, enrollment for Obamacare plans fell only 2.6 percent between 2018 and 2019. Total sign-ups were over 11.4 million.
"Trump and Congress took many actions that could have an upward effect on the uninsured rate," said Cynthia Cox with the Kaiser Family Foundation. "But the actual effect of Trump Administration policies on the uninsured rate is still an open question."
Castro said that millions more people are uninsured as a result of Trump’s policies. One poll did estimate a jump of 7 million people without health insurance. But the most trusted government survey found a smaller increase of 1.3 million.
Whatever the role of Republican policies, there’s broad agreement that the number has gone up.
Castro said it was millions. The best data says it’s closer to 1.3 million.
Castro has the trend right, but the numbers don’t quite back him up on the specifics. We rate this claim Half True.
Julián Castro, tweet, March 26, 2019
Gallup, U.S. Uninsured Rate Rises to Four-Year High, Jan. 23, 2019
Centers for Disease Control and Prevention, Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January–September 2018, February 2019
Commonwealth Fund, "First Look at Health Insurance Coverage in 2018 Finds ACA Gains Beginning to Reverse," May 1, 2018
Vox, Under Trump, the number of uninsured Americans has gone up by 7 million, Jan. 23. 2019
PolitiFact, Have 7 million Americans become uninsured since 2016?, Jan. 25, 2019
PolitiFact, Did Republican sabotage cost 3.2 million their health coverage?, June 1, 2018
Email interview, Sawyer Hackett, deputy national press secretary, Julian Castro for President, March 26, 2019
Email interview, Michael Karpman, research associate, Health Policy Center, Urban Institute, March 27, 2019
Interview, Chris Condeluci, principal, CC Law and Policy, March 27, 2019
Email interview, Cynthia Cox, director, Program for the Study of Health Reform and Private Insurance, Kaiser Family Foundation, March 27, 2019
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