4.6 Million More Americans Lost Health Insurance During Trump's First Term.

The increase in uninsured Americans didn't happen by accident. It was the documented result of specific policy choices that the Trump administration made deliberately: eliminating the ACA outreach budget by 90%, cutting the enrollment period in half, eliminating cost-sharing reduction payments that kept premiums affordable, promoting junk plans that drew healthy enrollees out of the ACA market, and removing the individual mandate penalty. The Gallup organization, which tracked insurance rates independently, documented the same trend: 2017 was the first year since the ACA's implementation that the uninsured rate rose. Every year of the Trump first term reversed the gains of the Obama years.

The children's numbers are particularly stark. The number of children under 19 without health insurance rose from 3.9 million in 2017 to 4.3 million in 2018 — an increase of 400,000 children — driven mainly by declines in public coverage as the administration made enrollment more difficult. These are children who didn't get preventive care, who had untreated dental and vision problems, who ended up in emergency rooms for conditions that could have been treated cheaply and early if they'd had insurance. The Washington Post cited research suggesting the mortality increase from lost coverage approximated one death per 800 uninsured people — putting the scale of preventable harm in concrete terms.