By Rachel Garfield, Kendal Orgera, and Anthony Damico
Kaiser Family Foundation, January 25, 2019
By 2013, the year before the major coverage provisions of the Affordable Care Act (ACA) went into effect, more than 44 million nonelderly individuals lacked coverage.
Despite large gains in health coverage, some people continued to lack coverage, and the ACA remained the subject of political debate. Attempts to repeal and replace the ACA stalled in summer 2017, but there have been several changes to implementation of the ACA under the Trump Administration that affect coverage. In 2017, the number of uninsured rose for the first time since implementation of the ACA to 27.4 million. Those most at risk of being uninsured include low-income individuals, adults, and people of color. The cost of coverage continues to be the most commonly cited barrier to coverage.
Under current law, nearly half (45%) of the remaining uninsured are outside the reach of the ACA either because their state did not expand Medicaid, they are subject to immigrant eligibility restrictions, or their income makes them ineligible for financial assistance. The remainder are eligible for assistance under the law but may still struggle with affordability and knowledge of options. Ongoing efforts to further alter the ACA or to make receipt of Medicaid more restrictive may further erode coverage gains seen under the ACA. On the other hand, state action to take up the ACA Medicaid expansion could make more people eligible for affordable coverage. The outcome of current debate over health coverage policy in the nation and the states has substantial implications for people’s coverage, access, and overall health and well-being.
By Don McCanne, M.D.
Just before the Affordable Care Act was enacted, more than 44 million individuals were uninsured. Now about 27 million are uninsured. Thus we have reduced the uninsured population by less than two-fifths. What a crummy result considering that we could have insured everyone through a Single Payer Medicare for All system.
Many of the politicians want to continue to work with ACA to try to increase the number covered. However, under the current law, almost half of the uninsured are outside of the reach of ACA and would remain uninsured even if outreach programs brought most of the rest of those eligible under the ACA umbrella. Perhaps new laws expanding ACA might tweak these numbers, but they would still leave many millions without coverage and tens of millions with inadequate coverage. Besides, such tweaks would never be approved by President Trump nor the Republican-controlled Senate.
What about 2020? Many politicians who campaigned in support of Medicare for All are now signaling that they would prefer to build on ACA instead. Yet the policies supported by their consultants would leave in place our outrageously expensive system with all of its profound administrative excesses, not to mention that it would leave tens of millions exposed to financial hardship.
We have to hold the politicians to their promises of Medicare for All. That means supporting the real thing – the genuine single payer model that would include absolutely everyone, not some cheesy Medicare for Some model. But we also have to bring many more politicians on board. That means being sure that their constituents understand the difference, which. of course, also means that we still have a lot of work to do.
Addendum: An interesting finding in this report is that three-fourths of the uninsured are citizens. According to DHS, two-thirds of the noncitizens are legal residents. That means that only about one-twelfth of the uninsured are undocumented immigrants. That is hardly a reason to continue with policies that keep the other eleven-twelfths uninsured, though most of us in the movement believe that anyone who needs health care should have it, regardless.
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