We're not done yet.
This
new study from the Urban Institute is both maddening and instructive. Maddening because millions of people are needlessly missing out on getting affordable health insurance and instructive because it shows how the complexity of Obamacare makes it hard for a big chunk of the population to navigate.
More than two-thirds of uninsured adults (70.8 percent) are potentially eligible for financial assistance for coverage under the ACA (figure 1). About a quarter (27.7 percent) of uninsured adults are potentially eligible for the ACA’s Medicaid expansion to adults, meaning they have family income at or below 138 percent of FPL and live in a Medicaid expansion state. In addition, about four in ten uninsured adults (43.1 percent) have family income in the range targeted by Marketplace subsidies, including 15.5 percent of uninsured adults in Medicaid expansion states with family income between 139 and 399 percent of FPL and 27.6 percent of uninsured adults in Medicaid nonexpansion states with family income between 101 and 399 percent of FPL. Marketplace subsidies begin at 100 percent of FPL but were structured to layer over the Medicaid expansion, so adults with family income between 100 and 138 percent of FPL in expansion states would be potentially eligible for Medicaid rather than Marketplace subsidies. […]
Nationwide, 22.6 percent of uninsured adults have incomes at or below FPL and live in states that have not expanded Medicaid. […] In March 2015, one in five uninsured adults (22.6 percent) had family income at or below 100 percent of FPL and lived in a Medicaid nonexpansion state, and so these adults may fall into the “coverage gap” between their states’ existing Medicaid eligibility requirements and subsidized coverage available through the Marketplace.
The main reason the uninsured give for not having coverage is that it's too expensive—60 percent say that's the barrier, even those who are eligible. More than half of them, 52.5 percent "had not heard about subsidies and had not looked for information on health plans in the Marketplace." Another sizable chunk though, roughly a quarter, knew about the health insurance exchanges and checked them out, finding that insurance was still too expensive. This is a group that is on the margins financially. Half of them report having a hard time paying for either housing or food—or both—in the past year.
What all this suggests is that more work has to be done to inform the still uninsured population of their options under Obamacare. The study doesn't go into the politics of the law—whether Republican efforts at the state level to stymie enrollments by limiting outreach efforts by the administration were a factor, but it's a real possibility in at least some states. And Medicaid expansion refusal is a really significant barrier.
But it also suggests that Obamacare—as much as it's helped millions of people, and it has—is a really complex system that's hard to maneuver for a good chunk of the population, the chunk of the population that needs it the most. Is there a simpler way? Of course, there is. Medicare for everyone. Ultimately, it's the solution that makes the most sense if universal coverage—and universal care—is the goal.
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