While the proportion of Americans without health insurance has grown for the first time this decade, Nebraska and Iowa bucked the trend in showing stable rates, according to new figures from the U.S. Census Bureau.

Iowa’s 4.7% rate of people without health insurance in 2018 remained among the lowest in the country, ranking seventh best among the states, according to data compiled by the University of Nebraska at Omaha’s Center for Public Affairs Research.

Nebraska’s 8.3% uninsured rate also remained unchanged. It also continued to rank in the bottom half of the country, slipping from 28th best to 30th best among the states between 2017 and 2018. Nebraska’s uninsured rate exceeds most states’ in part because it’s among a minority of states that have not expanded Medicaid to cover more low-income people who lack insurance.

Nationwide, the rate of people without insurance increased for the first time since 2009, before President Barack Obama’s health care law reduced the ranks of the uninsured. The national rate by one measure increased from 7.9% to 8.5%, as the ranks of people without insurance increased by almost 2 million to 27.5 million.

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The change was driven primarily by a decrease in public insurance for the poor, with enrollment in Medicaid dropping by 0.7%, the data show. The uninsured rate spiked especially among adults who are Hispanic and foreign-born, with the increase in uninsured among both groups three times the national average. Coverage also dwindled among children who are Hispanic and naturalized citizens.

Health policy experts interpreted those patterns as evidence of a chilling effect from the Trump administration's efforts to restrict several forms of public assistance, including Medicaid, for immigrants seeking to remain in the United States. In addition, some states have been clamping down on eligibility rules for Medicaid.

Nebraska voters in November 2018 approved an expansion measure that would provide insurance coverage to an estimated 94,000 additional Nebraskans. But rather than simply expand the current program, the administration of Gov. Pete Ricketts is instead seeking to create a new two-tiered system that will require those being added to the program to work or look for work, care for a family member, volunteer or attend college to get full coverage.

Nebraska will need to get federal approval for the two-tier system and has estimated it would not be able to start the program until late next year, about two years after the vote.

The plan faces a court challenge that’s seeking to get the newly eligible added to the program yet this year.

This story includes material from the Washington Post.

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Reporter - Metro News

Henry is a general assignment reporter, but his specialty is deep dives into state issues and public policy. He's also into the numbers behind a story, yet to meet a spreadsheet he didn't like. Follow him on Twitter @HenryCordes. Phone: 402-444-1130.

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