The steady increase in the number of working-age Americans who have gained health insurance as a result of the Affordable Care Act (ACA) has come to a halt. So say the findings of the most recent Commonwealth Fund ACA Tracking Survey, conducted in February and March of this year. A randomly selected, nationally representative sample of 2,043 working-age adults were interviewed by telephone in English or Spanish for the survey.

Physicians, nurses, health care workers, and patients who expect to lose access to health care or see costs rise voice their concerns at a rally at Harbor-UCLA Medical Center in Torrance, California. Photo (C) Associated Press.

Analysis of survey responses found that an estimated 4 million people between the ages of 19 and 64 have lost insurance coverage since 2016; the current uninsured rate in this group stands at 15.5%, up from 12.7% in 2016. More than one-quarter (25.7%) of lower-income adults are uninsured, an increase from 20.9% in 2016. ("Lower-income adults" are those who earn less than 2.5 times the federal poverty level, which is approximately $30,000 for an individual and $61,000 for a family of four.)

An online summary of the survey's findings (see http://www.commonwealthfund.org/blog/2018/first-look-health-insurance-coverage-2) identifies two factors responsible for the declines in coverage: first, a "lack of federal legislative actions to improve specific weaknesses in the ACA"; and second, "actions by the current administration that have exacerbated those weaknesses," including sharply reduced spending on advertising and outreach and shorter enrollment periods. Further losses in coverage are expected next year, when the repeal of the penalty for those who don't purchase insurance-part of the 2017 tax law-goes into effect.

The 2018 results are also in from the Commonwealth Fund's annual Scorecard on State Health System Performance, which ranks state health systems according to access to and quality of care and health outcomes and disparities. The five top-ranked states this year are Hawaii, Massachusetts, Minnesota, Vermont, and Utah; none changed places from the 2017 ranking. The five states at the bottom of the ranking are West Virginia, Florida, Louisiana, Oklahoma, and Mississippi. For other key trends, see https://interactives.commonwealthfund.org/2018/state-scorecard.-James M. Stubenrauch