August 2021
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After Reform, Millions Will Still Lack Affordable Health Insurance

A recent report from the Congressional Budget Office highlights the continual struggle of providing affordable health insurance to all Americans. Healthcare reform legislation recently passed by the Senate will cost over $800 billion while making significant regulatory and structural changes to the current health insurance system. While the goal of proponents is to extend coverage to the entire U.S. population, it appears that they will fall short in enacting universal health care.

Shockingly, only about 92% of people under 65% years of age will be insured by 2018. Many of the most drastic changes, such as a highly-regulated federal health insurance market with subsidies for low- and middle-income individuals, will not take effect for several years. Moreover, the nonpartisan office estimates that approximately 31 million currently uninsured Americans will have access to affordable health insurance due to the bill. Still, the estimates are sobering to Democrats; they are simultaneously providing ammunition to Republican politicians who claim that the costs are far too high to undertake a strategy that will not even work effectively. The White House points the finger at conservatives in Congress for blocking further expansions of coverage, while touting the Senate bill as a striking improvement from the status quo.

The primary question many have is this: how did so many uninsured individuals and families fall through the cracks? Despite the Senate’s bill clocking in at over 2,000 pages long, some groups are left out, either by accident or on purpose. The former group mainly consists of younger individuals–considered to be those under 30–in good health, a demographic which often chooses to forgo coverage even if affordable health insurance is available to them. Healthcare reform legislation includes a mandate that will soon make that choice more costly. As of 2014, individuals over a certain income level who refuse to buy health insurance will be fined. The goal is to have them become insured; not only is it necessary to avoid possible financial ruin in the event of a catastrophic medical emergency, but their inclusion is also needed in the health insurance pool to reduce medical costs.

Massachusetts has had a similar law for several years, which has reduced the percentage of uninsured in this population. There are about 13 million in this group nationwide, so just making a dent will be helpful. However, some individuals prefer to pay the annual fines (which range from several hundred to over one thousand dollars) in lieu of purchasing insurance. This accounts for some of these Americans who will remain uninsured after reform. It does not even include those people for whom health insurance would cost over eight percent of their annual income; they will be exempt from the health insurance mandate entirely.

Another group already has access to affordable health insurance, but is not taking advantage of it. Hundreds of thousands of Americans are eligible for Medicaid, the federal health insurance program for the poor. With the new Senate bill, individuals and families living in households making under $30,000 per year can qualify for the plan. For various reasons, they have not signed up. Explanations for this range from difficulty filling out forms to embarrassment and lack of publicity. More households will be covered under the existing program, which some experts predict will further decrease the population of the uninsured. Reform supporters claim that there are always a handful of stragglers–even European nations with free universal, socialized health care fall just short of the 100% mark.

On the other hand, illegal immigrants were purposely excluded from the legislation. Coverage for the millions of individuals in America without legal status has been a very controversial issue among both politicians and the public. The bill was expensive and complicated enough to pass with solely U.S. citizens and legal residents. While some liberal Democrats and activists fought the exclusion, it remained intact in the Senate, as well as the House of Representatives. Illegal immigrants are already forbidden from using Medicaid or any other type of public health insurance, but are commonly seen in hospital emergency rooms. They are often treated for conditions that could be handled far more cost-effectively in a doctor’s office, yet resort to the ER at a high cost to state and local governments.

Neither party is willing to offer affordable health insurance subsidies to illegal immigrants, or allow them on an existing program such as Medicaid. The Senate’s bill goes farther to keep them out, however: it will forbid them from using the discounted health insurance exchange markets the legislation will create. In contrast, the House version will allow illegal immigrants to buy coverage in those markets, as long as they only use their money. The future of this provision must be negotiated in committee, so it is unknown whether the ban will become law. There is another prominent concern; the Latino population, whether or not they have legal status, skews younger than the general American population–which puts many of them in the younger age groups shown to be less willing to buy insurance. Therefore, the amount of illegal immigrants who would actually take advantage of their increased access to affordable health insurance remains in doubt.

Yamileth Medina PhotoAbout Author
Yamileth Medina is an up and coming expert on Health Insurance and Healthcare Reform. She aims to help people realize that they can find affordable health insurance right now. Yamileth lives in Miami, FL.

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