PDF There is a group of people that has not been engaged in this debate about health care reform.
Yet the debate is about this very group of people – the uninsured.
But when the dust settles, the shouting is over, the ink is dry, and the regulations are in translation, those disengaged uninsured will emerge from their shells. Like Punxsatawney Phil their heads will rise above their immediate struggles and they will check out the new climate for health care.
Will the sun shine and point the way for a brighter future for so many who have hidden in the burrows of our society?
Or will they see no discernible change and crawl back into an indefinite health insurance winter?
A recent report by the Robert Wood Johnson Foundation and the Urban Institute attempts to answer the question, how will the current reform proposals affect the number of uninsured.
It is full of impressive numbers, but offers insufficient concrete evidence that a “reformed” maze will be any easier to navigate than the current one.
One number is instructive. Almost 30% of the currently uninsured are eligible for some form of public health insurance programs? Half of those are children. Why aren’t they enrolled?
Can we expect expanded access to public programs to generate expanded enrollment, even with an individual mandate? What are the current obstacles to enrollment?
Who are the uninsured anyway?
Two-thirds are from families where at least one person works.
Only 20% of those have access to employer sponsored health insurance.
Of those with access to either employer sponsored health insurance or other private insurance, one third would pay between 10 and 49% of their income on premiums. One fourth would pay more than 50% of their income on health insurance. Another 7% are uninsurable due to their own or a family member’s health status.
One quarter are between the ages of 45 and 64.
Over two thirds (68 %) live in the South(44%) or West (24%).
So what are the reform proposals?
The proposals by the three key legislative committees, differ only in detail and share a common approach to expanding access to health care.
Expanded access to Medicaid up to some percentage of the federal poverty level.
Subsidies to purchase health insurance for individuals and families up to as high as 400% of the federal poverty level(FPL).
|
Full Coverage as a % of FPL |
Subsidy Eligible up to _% of FPL |
|
| Senate HELP |
150% |
500% |
| Senate Finance |
115% |
400% |
| House Tri-Committee |
133% |
400% |
Those with income above the limits would be favorably impacted by reforms to the health insurance markets that include a health insurance exchange
a individual mandate
requirements for guaranteed issue and renewability
Eliminating medical underwriting
A note. The analysis does not count undocumented immigrants who would not be eligible for expanded access to public programs or to subsidies.
According to the report authors, 39% of currently uninsured would be eligible for an expanded Medicaid program and 38% would be eligible for subsidies.
Almost 60% of those newly eligible for public programs would be childless adults who are particularly disadvantaged under the current system.
Only 19% of those currently uninsured have access to employer sponsored health insurance. For those eligible for subsidies under the reform proposals, 27% have access to employer sponsored health insurance, but for 45% of that group, the cost of insurance, including employer sponsored health insurance, is between 10 and 45% of family income.
|
Access to Health Insurance coverage under reform proposals |
|||
| Expanded Medicaid | Subsidy Eligible | Subsidy Ineligible | |
| Number (millions) |
17 |
36 |
4 |
| Percentage in a family with at least one FT worker |
41% |
89% |
94% |
| Access to Employer sponsored Insurance |
10% |
27% |
21% |
| Premium cost as % of family income |
|
|
|
| 10% – 49% |
37% |
45% |
9% |
| >50% |
50% |
1% |
0% |
The key passage in the report is describes the administrative processes.
“Understanding and removing the barriers to enrollment for families who are eligible for Medicaid will be critical to covering the eligible but uninsured. Eligibility determination processes remain burdensome in many states, especially for parents…Improved outreach strategies, application assistance, simplified eligibility determination processes would help enroll this population with or without reform.”
Imagine a hypothetical 45 year old worker with children who can no longer work at their $60,000 per year job because of an illness. He or she is already living pay check to paycheck. She is not eligible for unemployment compensation, because she can not work. She is concerned about making the next rent or mortgage payment. What hoops will she have to jump through to maintain coverage?
Will she see the sun shine? Or will she stay hidden in her health care burrow?
In the answer to that question rests the fate of the Democrats and their leader.
I’m speaking out loud and clear about not having ANY coverage for myself, my wife, or our 3 kids. LeftOfCenter44.com
For your sake, I hope you get away with it.
For my sake, and the sake of the rest of us who will ultimately pay,and for the sake of your wife and kids, I hope you don’t.
Unless, of course, you earn over say $1 million per year and could absorb any health catastrophe.