NCPA - National Center for Policy Analysis

The Crisis of the Uninsured Is Far from Over

September 25, 2012

The number of people who lack health coverage fell to 48.6 million in 2011 -- down slightly from 49.9 million the year before, according to the U.S. Census Bureau. A bright spot in the new report is that about 407,000 fewer adults between the ages of 35 and 44 were uninsured in 2011, says Devon Herrick, a senior fellow with the National Center for Policy Analysis.

However, the crisis of the uninsured is far from over. Moreover, it is unlikely to be resolved by the Patient Protection and Affordable Care Act (ACA) -- the federal health reform law.  The Congressional Budget Office (CBO) estimates that 30 million people will remain uninsured a decade from now when the ACA is fully implemented. One of the stated goals for passing the ACA was to boost access to health coverage.  Yet, a significant number of people will remain uninsured even after the law is fully implemented.

  • Consider, when they go into effect in 2016, penalties for going without health coverage will be far less than the cost of coverage -- if the penalties are enforced at all.
  • A further concern is that up to 30 percent of businesses will likely find it to their advantage to drop their employee health plan when their workers have access to subsidized coverage in the state health insurance exchanges, beginning in 2014.
  • Up to half of the uninsured were expected to gain coverage after states expand Medicaid eligibility to all legal residents earning up to 138 percent of the federal poverty level ($15,415 for one person, or $31,809 for a family of four). But this is unlikely to occur now that the Supreme Court has ruled that states are not required to expand state Medicaid programs.

Moreover, about 13 million foreign-born residents are uninsured -- accounting for one-quarter (27 percent) of those who lack health coverage. Nearly half (44 percent) of foreign-born noncitizen residents currently lack health coverage. Only immigrants who have been legal residents for more than five years qualify for public coverage, and most will not qualify for health insurance subsidies in the new health insurance exchanges.

The uninsured include diverse groups, each uninsured for a different reason. These groups include:

  • Low-income families (19.2 million individuals).
  • Middle-income families (nearly 14.7 million individuals).
  • The young and healthy (about 19.2 million 18-to-34 year olds).
  • Middle-aged adults (about 13.4 million 45-to-64 year olds).

Source: Devon Herrick, "The Crisis of the Uninsured Is Far from Over," National Center for Policy Analysis, September 25, 2012.


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