A strong economy during 2017 and 2018 didn't do anything to stem the decrease in Americans aged 64 and younger from obtaining health insurance, according to researchers from the Urban Institute.

The Washington D.C.-based think tank's report, funded by the Robert Wood Johnson Foundation, found that policies that reduced marketing, access, and affordability of private insurance hampered enrollment among the non-elderly.

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

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

The report also noted recent estimates that suggest 25 to 43 million nonelderly will lose their employer-sponsored coverage in 2020. Of those, some 12 to 21 million will switch to Medicaid coverage, 6 to 10 million will buy an individual market plan, and 7 to 12 million will become uninsured.

While the uninsured rate increased, so did employer-sponsored coverage, according to the report.

The growing number of uninsureds in non-expansion states shows a vulnerability to market and policy changes in the marketplace and private nongroup coverage in the wake of the Affordable Care Act, the report said. In those same states, it added, employer-sponsored coverage was less common prior to the enactment of the ACA, the nonelderly with incomes at slightly above the poverty level are eligible for marketplace subsidies to purchase private nongroup coverage, rather than Medicaid and CHIP coverage.

"Taken together, this means coverage gains in non-expansion states between 2013 and 2016 relied more on the availability, affordability, and marketing of private nongroup coverage than coverage gains in Medicaid expansion states," the report said. "For the 2018 plan year, the Department of Health and Human Services limited marketplace open enrollment to 45 days, half as long as the 2017 open enrollment period of 92 days, and cut outreach and enrollment funds."

Additionally, the report said, in late 2017 the federal government stopped paying health insurers to provide cost-sharing subsidies to their low-income enrollees, making insurance more inaccessible.

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

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Despite strong economy, uninsured rate spiked in 2017 and 2018

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