The growingnumber of uninsureds in non-expansion states shows a vulnerabilityto market and policy changes in the marketplace and privatenon-group coverage in the wake of the Affordable Care Act.

A strong economy during 2017 and 2018 didn't do anything to stemthe decrease in Americans aged 64 and younger from obtaining healthinsurance, according to researchers from the UrbanInstitute.

The Washington D.C.-based think tank's report, funded by theRobert Wood Johnson Foundation, found that policies that reducedmarketing, access, and affordability of private insurance hamperedenrollment among the non-elderly.

The report noted that the increase was especially acute inMedicare non-expansion states.

Related: 10 states predicted to see the highest increase innumber of uninsured

"The increasing uninsurance rate between 2017 and 2018 wasdriven by losses of private non-group coverage, such as thatpurchased in the health insurance marketplaces, and decreases inMedicaid and the Children's Health Insurance Program (CHIP)coverage," the report said. "These trends are expected to reversein 2020 during the COVID-19 recession."

The report also noted recent estimates thatsuggest 25 to 43 million nonelderly will lose theiremployer-sponsored coverage in 2020. Of those, some 12 to 21million will switch to Medicaid coverage, 6 to 10 millionwill buy an individual market plan, and 7 to 12 million will becomeuninsured.

While the uninsured rate increased, sodid employer-sponsored coverage, according to thereport.

The growing number of uninsureds in non-expansion states shows avulnerability to market and policy changes in the marketplace andprivate nongroup coverage in the wake of the Affordable Care Act,the report said. In those same states, itadded, employer-sponsored coverage was less common priorto the enactment of the ACA, the nonelderly with incomes atslightly above the poverty level are eligible for marketplacesubsidies to purchase private nongroup coverage, rather thanMedicaid and CHIP coverage.

"Taken together, this means coverage gains in non-expansionstates between 2013 and 2016 relied more on the availability,affordability, and marketing of private nongroup coverage thancoverage gains in Medicaid expansion states," the report said. "Forthe 2018 plan year, the Department of Health and Human Serviceslimited marketplace open enrollment to 45 days, half as long as the2017 open enrollment period of 92 days, and cut outreach andenrollment funds."

Additionally, the report said, in late 2017 the federalgovernment stopped paying health insurers to provide cost-sharingsubsidies to their low-income enrollees, making insurance moreinaccessible.

Researches predicted that the situation in non-expansion stateswill worsen as a result of the COVID-19 pandemic because " thoseleaving Employer-sponsored plans have fewer coverage options thanin Medicaid expansion states."

Read more: 

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• California's penalty for uninsured drives surge inenrollment
• ACA exchange warns of 40% or more premium increasein 2021 due to COVID-19