The Future of Health Reform - IV - Patients

From a coverage standpoint, patients (in select states) have been the big winner of the PPACA. Let's look at how.

First, and most importantly, the PPACA has delivered on its promise to get more people covered through health insurance.

This graph from Obamacarefacts (a pro-Obamacare website) shows the percentage of uninsured in the US by quarter from 2008 to 2015. The uninsured rate dropped from an average of ~16% before the PPACA went fully into action to ~11% with the insurance provisions in full effect.

The graph below shows the uninsured rate on a longer timescale, going back to 1963 when Medicare and Medicaid were introduced. Medicare and Medicaid brought the uninsured rate from 25% to ~15%, which has of course dropped down to 11% after PPACA.

Now, over the course of a middle class person's life, his insurance coverage will be as follows:

• As a student and up until age 26, he will be covered under his parent's insurance
• In his working years, he will be covered through insurance provided through work. If he is in a small company (less that 50 full-time employees), he will get insurance through an exchange.
• In his retirement years, he will receive Medicare after age 65. 

For a lower class person who has trouble gaining and keeping employment, he will be covered by Medicaid. Medicaid has expanded eligibility going up to 133% of the Federal Poverty Line.

According to a Forbes article, the newly insured come from various sources:

• 9.6 million from employer sponsored plans (42%)
• 6.5 million from an expansion in Medicaid  (28%)
• 4.1 million from individual plans on state exchanges (18%)
• 1.2 million from individual plans not on state exchanges (5%)
• 1.5 million from other insurance sources (7%)

The article suggests that the gains in the employer sponsored plans could simply be due to a recovering economy. In addition, the articles suggests that the individual mandate is haven't the desired effect.

With the state exchanges making health care insurance more affordable, the expansion of Medicaid eligibility, combined with the penalties imposed on businesses and individuals for not having insurance, I wonder why the insured rate hasn't dropped down further than 11%. I would expect that only those people who pay the penalty for not having insurance would not be covered. Let's examine the uninsured population in an Obamacare world.

According to a Kaiser Family Foundation article, the main reasons for lack of insurance are:

• High cost of insurance
• No job and therefore no insurance through work
• Poor adults in states that didn't expand Medicaid
• People who didn't know about the subsidies available to them 
• Undocumented immigrants aren't eligible for insurance

In a later article, we'll discuss the implementation of Obamacare, in particular which states expanded Medicaid and which set up their own health care exchanges.

Sources:

Obamacarefacts - Uninsured Rates

Forbes - has Obamacare reduced the insured by 16 million?

Kaiser Family Foundation - Who are the Uninsured?