31 Million Uninsured Under the PPACA . . .
Over at “Economists View,” Anne and Muses are having a discussion over why some 30-something million will be uninsured under the PPACA Paul Krugman: The Obamacare Shock. The conversation goes back and forth citing references without giving any real explanation of what the 31 million is composed of and why they will not be covered. For some reason today, I can not log-in and add to the conversation with an explanation of the 31 million.
Perhaps it is a little known fact; but states today can, if they so choose to do so, qualify Medicaid coverage for everyone. States can also cover beyond 100% of FPL which some states do. The majority of states do not cover certain single adults as determined by each state’s rules for Medicaid coverage.
“Currently, few states cover non-disabled, non-pregnant parents up to 138 percent of FPL in Medicaid, and even fewer states cover such adults without dependent children. At present, only 18 states provide comprehensive Medicaid coverage to parents at or above 100 percent of FPL ($18,530 for a family of three in 2011), and the median state covers working and non-working parents up to only 63 and 37 percent of FPL, respectively. The majority of states do not cover non-disabled, non-pregnant adults without dependent children at any income level, and many low-income women only qualify for Medicaid coverage when they are pregnant. As has been noted, ‘it’s a very common misconception that Medicaid covers all poor people, but that’s far from the truth.'”
“Nationally, just over half (53 percent) of the uninsured who would be newly eligible for Medicaid are male. This is not surprising, since, as indicated above, Medicaid has historically had much broader eligibility for parents than for adults without dependent children, and a high proportion of these parents have been single mothers. ‘Overall, 47 percent of the uninsured who would be made newly eligible for Medicaid under the ACA are women.” Opting into the Medicaid Expansion under the ACA: Who Are the Uninsured Adults Who Could Gain Health Insurance Coverage?.
The expansion of Medicaid to 138% of FPL under the PPACA would have mandated state coverage for single adults not qualifying for the PPACA and its subsidies. The SCOTUS decision to allow states to back out of the expanded Medicaid coverage up to 138% FPL was previously mandatory under the PPACA with the threat of the removal of Medicaid subsidies. States not expanding Medicaid coverage will maintain the status quo and many who would have been covered under Medicaid may now go uninsured as they will not qualify for the PPACA. The state exclusions for which many blogs, politicians, and conservative think tanks such as Cato blame the PPACA as causing is the result of states not expanding Medicaid and accounts for 15.1 million uninsured of the potential 31 million. Another estimated 11.2 million are considered to be illegal residents of the US who will not be covered by the PPACA. Treatment of Non-Citizens under the PPACA and do not have healthcare insurance. The balance of the uninsured is made up of those exempt from being insured, those opting out and paying the penalty, those who may not understand how to apply for Medicaid, etc.
Without a doubt, Republicans hope the constituency will not understand the issues and blame the PPACA for the lack of coverage of single adults by using the 31 million as a political numeric. It is also doubtful whether there is a real concern by politicians for the coverage of illegal residents. I also believe it to be ironic when Republican-lead states are concerned a Republican-controlled House may pull the carpet out from under them by negating funding for the expansion of Medicaid in the future.
Anybody who is not covered by Medicaid will be able to sign up for an exchange plan.
Your point is?
where are you reading this?
Sarris I believe anybody can sign-up for insurance from the exchange, but it will cost money that a poor person probably doesn’t have. As I understand it, ACA, as written(before SCOTUS’s decision, naturally assumed that states would cover more people with Medicaid. But now a poor person living in the wrong state can be ineligible for Medicaid AND ineligible for a tax rebate to cover some or all of the costs of buying insurance on the exchange. Faced with buying on the exchange, and having no money, I suppose this person will violate the “mandate.” Congress could fix this, but that would require our do-nothing Congress to do something, and the GOP doesn’t want to fix Obamacare to make it consistent with Scalia’s subsequent ruling.
PJR:
If a state does not implement the Medicaid expansion, some adults could instead receive federal tax credits and other subsidies when purchasing coverage through the newly created exchanges, but these credits and subsidies would not be available for citizens with incomes below 100 percent of FPL. Of these approximately 15.1 million newly Medicaid-eligible uninsured adults, 11.5 million have incomes below 100 percent of FPL and, therefore, would not receive any additional help obtaining health insurance coverage under the ACA if their state does not expand its Medicaid program.
Since Sarris did not make his post clear enough, I thought he was referring to the content of mine. The question still stands, “where is Sarris getting this information from to assert his comment.” The PPACA subsidies stop below 100% of FPL and many states do not cover 100% of FPL. Furthermore, there is still the issue of single, nonelderly adults, who do not qualify for Medicaid presently in a majority of states, and would not qualify for subsidies either. The Republican-led states have this pretty well thought out. Even if it wanted to, Congress can not force the states to expand Medicare. It would have to become a 100% Federal program. http://www.urban.org/UploadedPDF/412630-opting-in-medicaid.pdf Opting in to the Medicaid Expansion under the ACA: Who Are the Uninsured Adults Who Could Gain Health Insurance Coverage? Also here: http://www.urban.org/UploadedPDF/412607-Opting-Out-of-the-Medicaid-Expansion-Under-the-ACA.pdf “Opting Out of the Medicaid Expansion under the ACA: How Many Uninsured Adults Would not Be Eligible for Medicaid?” Washington, DC: The Urban Institute, 2012
While an argument (Sarris’s) could be made on the less than 100% still being able to apply for unsubsidized healthcare insurance; it is a pretty weak one at that as many of the people at or below FPL have problems putting food on the table. It is not much of a credible argument. It still remains the potential for ~15 million being uninsured due to a lack of the expansion of Medicaid.
Sorry, I meant SCOTUS’s ruling at the end of that comment.
Run that’s my understanding, too. I was responding to the Sarris comment exactly as written–it is correct that poor folks without Medicaid can (in principle) sign-up on the exchange, BUT they cannot (in practice) because these poor folks can’t afford it–they get no tax rebate or, at some income levels, not a full tax rebate. Sarris seems to think that his claim “will be able to” should be read purely as a legal ability, not a financial ability. Sarris has no basis to question your depiction of the real world.
In the real world, close to 400,000 poor people in my state will continue not to have health insurance unless the GOP legislature decides to expand Medicaid coverage (at almost no cost to the state). All of them will be legally “able to” sign-up on the exchange. None of them will be financially “able to” sign-up on the exchange.
PJR:
Went back and tempered my response to you. 🙂