WASHINGTON – The number of Arizonans without health insurance rose by about 55,000 people last year, according to new data from the Census Bureau, as a relatively strong economy was offset by hefty cost increases for coverage.
The change from 2017 to 2018 raised the total number of uninsured in the state last year to about 750,000, or 10.6% of Arizona’s population.
Similar increases were seen nationally, where an estimated 500,000 lost insurance over the year, bringing the uninsured population to more than 28.5 million, or about 8.9% of the U.S. population, the Census said.
State health officials said they have not analyzed the cause of the “concerning” rise in uninsured people in Arizona, adding that they have not noticed a decline in Medicaid enrollment from one year to the next.
But experts offered a number of possible reasons, from the state’s relatively high undocumented population to the Trump administration’s attempts to dismantle the Affordable Care Act, known as “Obamacare.”
One possible reason is fear: An official at the nonprofit Arizona Alliance for Community Health Centers said the Trump administration’s headline-grabbing actions against illegal immigrants have likely scared away undocumented people in need of health care.
That fear could extend to migrants who are here legally themselves, said Allen Gjersvig, director of navigator and enrollment services at the alliance.
“People that have perhaps mixed family-immigration status – somebody in the family is not fully documented, others are – they are afraid of being found out,” so they drop coverage, Gjersvig said.
David Hyman, a Georgetown University Law Center professor, agreed that this population can have an effect on a state’s number of uninsured.
“The states that adjoin our neighbor to the south have historically had much higher uninsurance rates than the Northeast United States and the Upper Midwest,” he said.
The Pew Research Center estimates about 275,000 people were undocumented in Arizona in 2016.
Some advocates found another reason to blame the Trump administration, pointing to steps it has taken to unravel the ACA, one of the signature achievements of President Barack Obama’s administration.
“The Trump administration has done whatever they can to try to sabotage health care for Americans,” said Morgan Tucker, Arizona director of Protect Our Care.
The percentage of Americans without insurance fell from 15% in 2012, the year Obamacare took effect, to 9% in 2017, the year Trump took office, according to data from the Kaiser Family Foundation.
ACA critics complained that costs for health insurance varied widely in the early years, and they challenged the constitutionality of the “individual mandate,” which required that people get coverage or pay a fine.
Jim Hammond, publisher of the Hertel Report, said that without penalties for passing on insurance, people are just less inclined to make an expensive purchase of a product he called a difficult sale under the best of circumstances.
“The return on your investment is oftentimes not felt,” Hammond said. “You don’t really get a good deal on your insurance unless you get sick.”
The disincentive to get a policy comes at a time, Hyman said, when costs are increasing. Hammond said the people most affected earn $65,000 to $70,000 annually because they have to pay their insurance premiums without any subsidies from the government.
“If you make that kind of money, most people think, ‘Oh, well, then you can afford health insurance,'” Hammond said. “But then, if you go out and try to buy it and it’s $800 a month, you might think it’s not worth it.”
Hyman said lower-income workers face the same struggle, as businesses in the agricultural and service sectors typically don’t offer health care coverage.
Tucker said other changes have not helped, such as shorter enrollment periods and diminished access to the healthcare marketplace. She said the advertising budget for the insurance marketplace has also been cut – and she’s not the only one to notice.
Gjersvig points to marketing cuts as the reason why more navigators, or health care guides, cannot be deployed. Navigators, who simplify the complex system for the community and pass along relevant information, are desperately needed, he said.
Hammond said the insurance industry needs to do a better job explaining to people why coverage is so crucial.
“Paying for an office visit or paying for an X-ray or lab work – people can find the money to do that,” he said. “But what if you got cancer? Or what if you were involved in a serious accident?”
“That’s what people are really protecting themselves from when they buy insurance and I don’t think that the insurance industry has really made that entirely clear.”
But Hyman said increased coverage will only do so much if costs keep going up.
“We tend to focus on: Do people have insurance or not?” he said. “But if the cost of health care keeps rising, you’re sort of fighting a losing battle.”