October 14, 2015 by Tony Novak
Freedom Benefits is working on a small research project where I expect to eventually collaborate on an article. The focus is to look more closely at who is not being served by the Affordable Care Act. The premises behind this project are:
- Expansion of health coverage to uninsured Americans is not moving in a smooth positive upward direction as predicted by the Executive branch and the Congressional Budget Office.
- The number of uninsured Americans is somewhere around 50 million people and has not significantly changed as a result of the Affordable Care Act despite the massive public effort and spending.
- The number of people with inadequate or non-compliant insurance is much higher; probably bring the total affected by lack of insurance to 90 million Americans. (PBS highlighted that the problem issues between “uninsured” vs. “underinsured” in its series “Healthcare crisis: Who’s at risk?” are not substantially different from a social policy perspective).
- The number of uninsured has not decreased much since we first started covering this topic for Freedom Benefits more than a decade ago. (See this 2004 press release). In fact, the number of uninsured has remained relatively stable and increased slightly over the long-term.
- While somewhere around 10 million now enjoy government-subsidized health coverage through Obamacare, that has not reduced the number of uninsured by a similar amount. In other words, Obamacare is pumping a large amount of money into the health care system but we not getting the results we expected in expansion of coverage because Obamacare benefits are focused on a smaller less healthy segment of the population.
- Some portion of Americans simply refuse to participate in the coverage plans required by the Affordable Care Act. (See “I will not have any health insurance…I do not want nor need it”).
- The number of health coverage “dropouts” is now increasing at a faster rate. (See this editorial in today’s Wall Street Journal).
- The amount of unpaid consumer medical debt is shockingly high and is growing larger. (See my blog post on this finding by the federal Consumer Financial Protection Bureau titled “Startling news about consumer medical debt“).
- The number of failed or withdrawn health plans is increasing and further failures and withdrawals are expected in 2016. Alternatives are likely to be more expensive and less attractive to consumers.
- A growing number of Working class Americans are being squeezed by the crisis and do not have a workable plan of action.
All of this adds up to the fact that we still have a national crisis with the number of people without health insurance. This high percentage of people without coverage was widely called an unacceptable social position before implementation of the Affordable Care Act and we presume that America will recognize it as unacceptable in the future after it becomes publicly accepted that the Affordable Care Act will not fix this national problem.
What we don’t know is what makes up this growing number without health coverage. who are they and why don’t they have health coverage? Where do they live? What caused them to lose coverage or did they not ever have it? Do they see their situation as temporary or a long term problem? Do they consider it to be not a problem at all? Do they have alternate coverage not approved by the Affordable Care Act? If they never had any coverage, why? What type of health coverage do they want? What can they afford? How do they plan to handle the tax penalties for not having required coverage?
These issues are of particular importance to firms like Freedom Benefits that have a history of serving those on the fringes of health care. We serve working class Americans who are not covered by an employer-provided plan or who feel that this coverage is inadequate. We typically help people who are between jobs, travelling, immigrating to the U.S., need to supplement a weak primary health plan, or who – for whatever reason – are not covered by any health plan.
I last looked at the uninsured issue about a year ago in a blog post titled “A closer look at the number of uninsured in the U.S.“. The results were surprisingly similar to what we saw more than a decade ago in 2004. But the landscape of the uninsured population has changed and we need to take a fresh look at what’s going on right now. We look forward to sharing the results of this research in the near future.