(This is a re-publish of an opinion piece that appeared in the North State Journal 4/17/19 that was co-written by a good friend of mine, Jim Capretta.
I thought it was important enough and so full of factual information that I would just forward it to you instead of trying to use his basic information and write a new piece.
I recommend you read this piece and memorize every fact in it and then forward the article to everyone you know so they can memorize these same facts. They are important in any debate on health care reform)
Talk of universal coverage is in
the air. To a person, the Democratic candidates jockeying to take on Donald
Trump are pledging allegiance to this seemingly elusive goal.
As Yogi Berra might have put it,
“It’s déjà vu all over again.” It was only ten years ago that the country went
through a raucous and exhausting national debate over enactment of the
Affordable Care Act (ACA). Like today’s would-be Democratic candidates, Barack
Obama ran on a platform of universal coverage, and he sold the Affordable Care
Act (ACA) as making good on his campaign commitment.
After the law passed, Democrats
lost control of the House in the 2010 mid-term election. Most Democrats at the
time said the political price was worth it because the ACA was the culmination
of a decades-long quest.
But that was then. The Census
Bureau reports that, in 2017, there were 28 million people in the United States
who were not enrolled in health insurance, down from 42 million in 2013. When
Democrats say they want universal coverage, they apparently mean that official
statistics need to show 100 percent enrollment in some form of health
insurance.
It’s certainly within their
rights to say the goal must be zero uninsured, but the reasons the ACA couldn’t
hit that mark are likely to hinder a new effort too.
According to the Kaiser Family
Foundation, today’s uninsured fall into five categories.
First, 15 million people without
coverage — or half of the total — are already eligible for publicly-subsidized
insurance, in the form of Medicaid, the children’s health insurance program, or
a private plan that would be financed in part with federally-provided premium
credits. These “eligible but unenrolled” individuals remain uninsured either
because they are unaware of what is available to them, or because they haven’t
taken the steps necessary to sign up. It is common and expected for a public
program to fall short of 100 percent participation.
Second, 3.8 million people are
uninsured because they fail to enroll in the employer-sponsored plan that is
offered to them, or their spouses, at work.
Third, 1.9 million people are
ineligible for employer coverage and for premium credits under the ACA because
their incomes exceed 400 percent of the federal poverty line (FPL), or $103,000
for a family of four in 2019.
Fourth, 4.1 million people are
uninsured because they are immigrants residing in the U.S. without proper
documentation. The ACA explicitly excluded this population from subsidized
coverage.
Finally, 2.5 million people
reside in states that have not expanded Medicaid and have incomes that are too
high to qualify for that program. They also have incomes below 100 percent of
FPL (federal poverty line), which makes them ineligible for premium assistance
for private coverage under the ACA.
In summary, about 90 percent of
the 323 million people in the U.S. in 2017 had health insurance. Of the 28
million people without coverage, more than 90 percent were eligible to enroll
in some kind of plan or had incomes that would seem sufficient to purchase
insurance protection.
Only 2.5 million people — or less
than 1 percent of the total population — were in the U.S. legally, had low
incomes, and did not have ready access to an insurance plan.
There’s also reason to believe
the Census survey overstates the problem altogether. Some respondents have
coverage under Medicaid but mistakenly identify themselves as uninsured.
Improving how the uninsured rate is measured would likely reduce the reported
number by a few million people.
Further, many of those deemed
uninsured will get coverage automatically if they need extensive medical
attention and present themselves at a hospital. States are required to allow
hospitals to conduct presumptive eligibility determinations for Medicaid.
Expanding insurance enrollment
does not require upending today’s system.
Congress could entice the 14
states that have not expanded Medicaid to do so by allowing them to go to 100
percent of FPL instead of 138 percent, as called for in the ACA. Closing this
coverage gap would provide insurance to the 2.5 million low-income people who
do not have a good coverage option today.
Congress could also make
insurance enrollment as automatic as possible for the people who are already
eligible for coverage. Automatic enrollment has worked to boost participation
in retirement plans, and it could help increase health insurance enrollment
too.
Many Democrats would like the
U.S. to have a completely different system of insurance. Perhaps there are good arguments for that
point of view. But that would require disrupting coverage for the hundreds of
millions of people who are in stable insurance today.
A safer bet is to leave those who
have insurance alone and develop a plan focused on expanding coverage to the
remaining uninsured. The result would not be as dramatic as Medicare for All,
but such a proposal would be far likelier to get the approval of most
Americans.
Joseph Antos is the Wilson H.
Taylor scholar in retirement and health policy at the American Enterprise
Institute. James C. Capretta is a RealClearPolicy Contributor and Resident
Fellow at AEI.
(A version of the article was first published by
RealClearPolicy)
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