Health Letter, March 2016
The following excerpts are reprinted from an article with the above title published in the Physicians for a National Health Program (PNHP) Winter 2015/2016 Newsletter with permission from the editors.
UNINSURED AND UNDERINSURED
- 33.0 million Americans (10.4 percent) were uninsured during all of 2014, the first year the main coverage expansion provisions of the ACA [Affordable Care Act] were in effect, a drop of 8.8 million from 2013. Changes in survey methodology caused an additional artifactual drop of 5 million in 2013. The number of uninsured children fell by 1 million to 4.8 million (6.2 percent). States that expanded their Medicaid programs under the ACA have, on average, a lower proportion uninsured (9.8 percent) than states that did not implement the Medicaid expansion (13.5 percent). The poor continue to experience a high rate of uninsurance (19.3 percent), along with Hispanics (19.9 percent) and blacks (11.8 percent). Non-citizens are over three times more likely to be uninsured (31.2 percent) as citizens (8.7 percent). At the state level, Texas has the highest uninsurance rate (19.1 percent) followed by Florida (16.6 percent) (“Health Insurance Coverage in the United States: 2014,” U.S. Bureau of the Census, September 2015).
- Medicaid expansion alone would not cover all of the uninsured. The 33.0 million uninsured Americans are almost evenly divided between states that have expanded their Medicaid programs and those that have not, according to the Kaiser Family Foundation (Altman, “Covering the uninsured: not just a red state issue,” Wall Street Journal, 10/14/15).
- 28.5 million people (9.0 percent) were uninsured in the first six months of 2015, the second full year of ACA coverage expansions, a drop of 7.5 million from 2014, according to a preliminary analysis of data from the National Health Interview Survey (Martinez and Cohen, “Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January-June 2015,” National Center for Health Statistics).
- Over 423,000 immigrants lost health insurance in the first nine months of 2015 because of missing or incomplete paperwork related to their immigration status. This figure, which only accounts for people who lost coverage from the federal exchange, not the state exchanges, is up almost fourfold from all of last year, when 109,000 people lost coverage due to citizenship and immigration issues. A new 95-day time limit for resolving documentation questions contributed to the increase. The overwhelming majority of those losing coverage are legal immigrants, according to the National Immigration Law Center (“More than 400,000 immigrants losing health care after change in coverage procedure,” Fox News Latino/AP, 9/13/15).
- A new study by the Department of Health and Human Services (HHS) found that 80 percent of the uninsured have less than $1,000 in savings, half have less than $100 in savings, and half report difficulty affording basic necessities such as food and housing in the past year. In addition, many have other financial priorities, such as car or home repairs, or paying down debt, which takes precedence over buying health insurance (Finegold et al., “Uninsured populations eligible to enroll for 2016,” HHS, 10/15/15).
- The penalty for not having health insurance in 2016 is rising to $695 per adult, $347.50 per child, or 2.5 percent of household income, whichever is higher, up from $325 per adult, $162.50 per child, and 2 percent of income in 2015 (https://www.healthcare.gov/fees/fee-for-not-being-covered/).
- National health expenditures are projected to rise from $3.1 trillion in 2014 (17.4 percent of GDP) to $5.4 trillion (19.6 percent of GDP) in 2024, an average increase of 5.6 percent annually, according to projections by CMS (Keehan et al., “National Health Expenditure Projections, 2014-24: Spending Growth Faster than Recent Trends,” Health Affairs, August 2015).
- Over half of adults (52 percent) who visited the marketplaces did not sign up for coverage, according to a survey of adults under age 65 in mid-2015. Among those who didn’t enroll, 57 percent said they could not find an affordable plan and 43 percent said they were not eligible to enroll in Medicaid or financial assistance. Twenty-six percent had incomes below 100 percent of poverty but were not eligible for Medicaid in their states (Collins et al., “To Enroll or Not to Enroll? Why Many Americans Have Gained Insurance Under the Affordable Care Act While Others Have Not,” Commonwealth Fund, 9/25/2015).
- The cost of health plans sold on HealthCare.gov is rising faster than the cost of medical goods and services. Premiums are going up an average of 7.5 percent in 2016 for the benchmark plan in the 37 states using the HealthCare.gov marketplace, 5 percent faster than last year’s Consumer Price Index for medical care services (up 2.4 percent). The benchmark plan is the second-lowest-cost silver plan in a state; premium subsidies are pegged to the cost of the benchmark plan (“2016 Affordability Snapshot,” Centers for Medicare and Medicaid Services, 10/26/15)
- One-quarter of privately insured working-age adults who were continuously insured all year had unaffordable health care costs in 2015, according to a survey by the Commonwealth Fund. Among the privately insured with low-incomes (below 200 percent of poverty), 53 percent reported unaffordable health care costs. The Commonwealth Fund’s new Health Care Affordability Index defines “unaffordable” as being “underinsured” (out-of-pocket costs over 10 percent of income, or over 5 percent of income if low-income; or the deductible is 5 percent or more of income) or having unaffordable premiums. Premiums are considered unaffordable if they are 10 percent or more of income, or are 7 percent or more of income if low-income. According to the Index, 13 percent of people with private insurance had premiums that were unaffordable, 10 percent had unaffordable deductibles, and 11 percent had unaffordable out-of-pocket costs. Nearly all of the 1,687 adults in the survey were in employer-based plans.
Respondents were also asked their views on the affordability of health care, and many more perceived their premiums or deductibles as “unaffordable” than predicted by the Affordability Index. For example, 43 percent of adults who had private insurance all year said their deductible was difficult or impossible to afford compared with only 10 percent who had unaffordable deductibles as measured by the Index. One quarter of adults said their premiums were difficult or impossible to afford (Collins et al., “How High is America’s Health Care Cost Burden?” Commonwealth Fund, 11/20/15).
- Only 42 percent of nonprofit hospitals notify patients about their charity care policies before trying to collect unpaid bills, according to a new study. Under the ACA, hospitals are required to have a written policy on charity care, make those policies known to patients, and are prohibited from charging the uninsured more than they charge privately insured or Medicare patients. But most hospitals aren’t following the rules. Only 29 percent say they charge the uninsured the same rates as other patients. Twenty percent report patients to credit agencies, garnish wages, and put liens on property, practices that shouldn’t be needed if hospitals followed the rules (Sun, “How nonprofit hospitals overcharge the (under and) uninsured,” Washington Post, 11/13/15).