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How to Cover the Last...Millions - 2015 Policy Prescriptions® Symposium
- 1. The Post-Affordable Care Act Uninsured: How to Cover the Last … Million Uninsured Elizabeth Wiley, MD, JD, MPH @elizabeth_wiley 2015 Policy Prescriptions Health Policy Symposium 13 June 2015
- 2. DISCLOSURE I serve as an independent contractor developing course content for ELM Exchange.
- 3. LEARNING OBJECTIVES • Identify key characteristics of the uninsured in the U.S. • Describe strategies and policy approaches to reduce the number of uninsured Americans and/or achieve universal health coverage in the U.S.
- 4. HOW MANY AMERICANS ARE CURRENTLY UNINSURED?
- 5. The ACA & the Uninsured The ACA expanded health coverage by: • Subsidies for purchase of private insurance through exchanges (up to 400% FPL) • Coverage for young adults on parent/guardian’s plan • Medicaid expansion (up to 138% FPL) • Employer-sponsored insurance Image: Kaiser 2015
- 7. The ACA & the Uninsured So far… • At least 9.5 million previously uninsured Americans are now covered (Rand, Commonwealth 2014) • At least 3 million young adults (under 26) have obtained coverage under parent/guardian plan • An estimated 16 million Americans have been covered as a result of the ACA (HHS 2015) However…the CBO (2012) estimated that the ACA would result in coverage of 30-33 million Americans, leaving only 26-27 million uninsured by 2016…
- 8. ACA Coverage: Status of Medicaid Expansion (May 26, 2015) WY WI* WV WA VA VT UT TX TN SD SC RI PA* OR OK OH ND NC NY NM NJ NH* NV NE MT** MO MS MN MI* MA MD ME LA KYKS IA* IN*IL ID HI GA FL DC DE CT CO CA AR*AZ AK AL Adopted (30 States including DC) Adoption under discussion (3 States) Not Adopting At This Time (18 States) Image/Data: Kaiser 2015
- 9. What Opting Out of Medicaid Expansion Means…The Coverage Gap Image: Kaiser 2015
- 10. Coverage Gap: Geography TX 26% FL 18% NC 10% GA 8% Other States Not Moving Forward 39% South 89% Midwest 7% Northeast 1% West 4% Distribution By State: Distribution By Geographic Region: Data/Image: Kaiser 2015
- 11. The Coverage Gap: Race/Ethnicity & Health Status White 43% Black 27% Hispanic 24% Other 5% Excellent or Very Good 47% Good 35% Fair or Poor 18% Distribution By Race/Ethnicity: Distribution By Health Status: Data/Image: Kaiser 2015
- 12. The Coverage Gap: If all states expanded Medicaid…. 41% 41% 57% 34% 37% 41% Total Whites Blacks Hispanics Other All People of Color 10.8 M 2.9 M 18.7 M SOURCE: Kaiser Family Foundation analysis based on 2014 Medicaid eligibility levels, updated to reflect state Medicaid expansion decisions as of March 2015, and 2014 Current Population Survey data. Share of Uninsured Adults Who Would be Eligible if All States Expanded Medicaid, by Race/Ethnicity: 35.4 M 16.6 M 5.1 M
- 13. Beyond The Coverage Gap: The Post-ACA Uninsured • Business owners: 1 in 5 uninsured • Veterans: 1 in 14 uninsured • Undocumented immigrants: 1 in 7 uninsured • Neonates: 1 in 20 uninsured (at hospital discharge) Data/Image: Kaiser 2015
- 15. The Post-ACA Uninsured: Toward Universal Health Coverage? • Medicaid expansion • Private insurance exchanges • Employer-sponsored coverage • Medicare expansion • ???
- 16. REFERENCES Caman K & Eibner C. Changes in Health Insurance Enrollment Since 2013. Rand Corporation, 2014. Collins S, Rasmussen P & Doty M. Gaining Ground: Americans’ Health Insurance Coverage and Access to Care After the Affordable Care Act’s First Open Enrollment Period, The Commonwealth Fund, July 2014. Dark C & Eswaran V. Policy Prescriptions STAT*Sheets: Who Are the Uninsured? May 2014. Kaiser Commission on Medicaid and the Uninsured. Who is Impacted by the Coverage Gap in States that Have Not Adopted the Medicaid Expansion? June 2015. Majerol M et al. The Uninsured: A Primer – Key Facts About Health Insurance and the Uninsured in America. Kaiser Family Foundation 2015; Jan 13. Nardin R et al. The Uninsured After Implementation of the Affordable Care Act: A Demogrpahic And Geographic Analysis. Health Affairs Blog 2013; June 6. Sommers B et al. Health Reform and Changes in Health Insurance Coverage in 2014. N Engl J Med 2014;371:867-874.
Editor's Notes
- These provisions are supplemented by the employer-mandate and indivual mandate Large employers must either offer insurance or pay a penalty
- First quarter of 2015 11.9 among nonelderly US adults
- Coverage gap estimated to be 3.7 million – overwhelmingly in the South States were permitted to opt out of Medicaid after the Supreme Court held in 2012 that Congress exceeeded its constitutional authority by threatening existing Medicaid payments to coerce states into expansion National Federation of Independent Business et al. v. Sebelius
- In states that have not adopted the Medicaid expansion, poor adults fall into a coverage gap, earning too much to qualify for Medicaid but too little for subsidies for Marketplace coverage.
- Coverage gap estimated to be 3.7 million – overwhelmingly in the South
- 2/3rds of adults in the coverage gaps are in a family with at least one worker (whether full or part time) Adults in the coverage gap are also relatively evenly distributed among age groups
- 6 out of 10 African American uninsured adults would be covered if all states expanded Medicaid…
- 42% of uninsured children in the US live in an immigrant family – 2/3rds are citizens 14% of children w/ immigrant parents lack health insurance Total = 41.3 Million Nonelderly Uninsured
- Commonwealth data show that 60% of individuals with new coverage received care – either visited a doctor or other provider, went to a hospital or paid for a prescription since receiving coverage – 6/10 of those individual would not have been able to access or afford this care previously
- Current system does not seem to be sustainable - > 17% of the GDP still spent on health care and that percentage continues to rise (CMS 2015) Not politically feasible – more than 50 attempts by Congress to repeal the ACA