According to a new Gallup report, 13.7% of U.S. adults were uninsured in the last quarter of 2018. This represents a 2.8% increase since 2016 when, following implementation of the Affordable Care Act (ACA) and expansion of Medicaid eligibility, the percentage of uninsured adults stood at its lowest-10.9%. (An increase of 2.8% represents about seven million adults.)

The greatest rates of increase were among women, people living in households with an annual income below $48,000, and people younger than 35 years. In this group of young people, the un-insured rate reached 21%-an upsurge of 4.8% from 2016. The upward trend nationally has pronounced regional differences. The eastern United States, which has the lowest uninsured rate (7.1%), didn't see a rise, but the West, the Midwest, and the South all reported increases above 3%. In the South, a 3.8% increase resulted in 19.6% of adults without insurance.

Reasons for the increase vary. Among possible influences are higher insurance premiums, along with decisions by multiple insurers to withdraw from state ACA exchanges altogether; the end of cost-sharing payments from the federal government to insurers; and adverse policy decisions such as reducing public messaging, shortening the enrollment period to less than seven weeks (about half of that in previous years), and slashing funding for ACA "navigators" who help consumers sign up for a plan (from $63 million in 2016 to $10 million in 2018). Possible political factors include the Trump administration's disparaging comments about the ACA and attempts by congressional Republicans to repeal it. While these efforts weren't successful, the 2017 Republican tax reform law eliminated the ACA's individual mandate penalty, which may have reduced participation in the marketplace. To read the Gallup report, go to https://news.gallup.com/poll/246134/uninsured-rate-rises-four-year-high.aspx.-Dalia Sofer