Ballooning Ranks of Uninsured Endanger GOP Health-Care Message

  • Republican senators tout coverage for preexisting conditions
  • Almost 30 million lacked insurance last year, Census says

The number of Americans without health insurance has grown steadily under the Trump administration and it’s creating headaches for Republicans who once championed efforts to roll back Obamacare.

Republican leaders Tuesday unveiled a policy platform centered around defeating the coronavirus and improving the economy, with no mention of their long-time pledge to roll back the Affordable Care Act. Democrats, in contrast, are sticking with the message that won them a House majority in 2018: a promise to extend health-insurance coverage to more Americans through the ACA.

Health-care politics this year is almost a polar opposite of 2016, when the U.S. hit an all-time low in the number of people without insurance coverage. Democrats are hoping this shift will win over voters uneasy about being able to afford health care.

“Fewer people insured means a lot more anxious voters,” said Leslie Dach, chair of Protect Our Care, a group aligned with Democrats that advocates for Obamacare. “The loss of coverage and the fear of loss of coverage is a big deal in a Covid world.”

Almost 30 million Americans lacked health insurance at some point in 2019, an increase of 1 million people from 2018, according to Census data released Tuesday. The number of insured people declined in 19 states, most of which have congressional delegations largely made up of Republicans, such as Texas, Oklahoma, and Wyoming.

Rise in Uninsured

As many as 6 million Americans may have lost their insurance as the coronavirus shuttered businesses and swelled the jobless ranks this year, the Economic Policy Institute estimated.

During the 2016 election, Republicans aired 47,000 political ads mentioning the ACA or Obamacare compared with Democrats who aired just 5,000 such ads, according to the ad-tracking firm Advertising Analytics. In 2020, Republicans aired 7,000 spots mentioning the health-care law while Democrats aired 153,000 such ads.

President Donald Trump’s administration, supported by Republicans in Congress, has contributed to eroding the number of people who have insurance by spending less on promoting the ACA’s annual open enrollment season, by supporting restrictions on Medicaid coverage, and by ending the penalty for failing to have coverage, Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation, said.

Repealing Obamacare was an early goal of the Trump administration in 2017 and a main party pledge for Republicans at the time. However, after an unsuccessful push to overturn the health law by Congress, the ACA remained popular. Democrats capitalized on that popularity in the 2018 midterm elections, when they won control of the House after campaigning on health-care issues.

Preexisting Conditions

Some Republicans seeking re-election are trying to walk a delicate line, as their party has more Senate seats to defend in November. Sen. Cory Gardner (R-Colo.) in August introduced a bill (S. 4506) that promises to maintain the ACA’s protections for people with preexisting health conditions.

In an ad unveiled this week, Gardner says his bill would keep the protections “no matter what happens to Obamacare.”

Sen. David Perdue (R-Ga.) similarly launched an ad in August that said he supports preexisting condition protections. Perdue and Gardner both backed efforts to roll back Obamacare and its preexisting condition protections, which are stronger than those offered under the Gardner bill.

These ads are meant to tell voters they can keep the parts of Obamacare they like and also get something less expensive under Republican policies, Ford O’Connell, a GOP strategist who served as an adviser on the late Sen. John McCain’s 2008 presidential bid, said.

“Most voters don’t know what Obamacare entails but they know its most-popular provision, which is preexisting conditions,” O’Connell said.

Republican leaders this week said they’re focused on the economy and combating the coronavirus pandemic by accelerating development of a vaccine. They’re aiming to showcase gains in household income under the Trump administration as a sign people are better off voting Republican.

“Republicans will restore our way of life,” Kevin McCarthy (R-Calif.), the House Republican leader, told reporters Tuesday. “We will defeat the coronavirus.”

To contact the reporter on this story: Alex Ruoff in Washington at

To contact the editors responsible for this story: Robin Meszoly at; Sarah Babbage at