Earlier this week the Commonwealth Fund released its annualĀ Affordable Care Act Tracking Survey[1], and the news isn't good for consumers struggling to afford individual health insurance coverage.

The number of uninsured Americans has increased since 2016, according to the report, reversing years of decline since the ACA was passed in 2010. The number of uninsured adults between the ages of 19 and 64 rose to 15.5 percent in March 2018, up from 12.7 percent in 2016. An estimated 4 million people lost individual coverage during that period, while the number of people with employer-sponsored coverage stayed steady.

Adults with lower incomes -- about $30,000 for an individual and $61,000 for a family of four -- saw a much higher increase: 25.7 percent in March 2018 compared to 20.9 percent in 2016.

The reasons for the increase are varied and still a bit speculative, said Sara Collins, Commonwealth vice president for health care coverage and access. She and her colleagues at Commonwealth point to the Trump administration's drastic cutbacks on advertising and outreach during open enrollment for the Obamacare health care exchanges. Many exchanges saw robust signups despite the cutbacks, but overall the number of people who declined to buy insurance increased.

Another factor may be related to the so-called coverage gap. When the ACA was passed, it mandated that all states expand their Medicaid coverage, including increasing qualifying income limits. At the same time, the ACA ruled that people whose income fell below 100 percent of the poverty level would not qualify for the ACA's government subsidies to help pay health insurance premiums. The assumption was these people would be covered by expanded Medicaid coverage, Collins explained.

That plan went haywire when the Supreme Court later ruled that...

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