CBO presents options for covering the uninsured
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@JamesCapretta 30mm Americans under 65 were uninsured in 2019, 20m eligible for subsidized coverage but unenrolled, 9.8mm ineligible for subsidies. Addressing gaps is crucial for near-universal coverage, as highlighted by the CBO’s analysis.
James Capretta, "CBO presents options for covering the uninsured," American Enterprise Institute, October 5, 2020, https://www.aei.org/articles/cbo-presents-options-for-covering-the-uninsured/
Allison Percy and Karen Stockley, “Who Went Without Health Insurance In 2019, and Why?” Congressional Budget Office, September 2020, https://www.cbo.gov/system/files/2020-09/56504-Health-Insurance.pdf
Jared Maeda and Karen Stockley, “Policies to Achieve Near-Universal Health Insurance Coverage,” Congressional Budget Office, October 2020, https://www.cbo.gov/system/files/2020-10/56620-near-universal-coverage.pdf
Capretta here makes no sense according to CBO“…0 million people are uninsured because they are residing in the U.S. without proper legal status; as such, they are ineligible for subsidized coverage.6 million people are ineligible for employer coverage but have incomes too high to qualify for subsidized premiums through the ACA exchanges; they could enroll in plans offered in the nongroup market but would be required to pay the full premiums themselves. Finally, there are 3.2 million people who have incomes below the federal poverty line and live in states that did not expand Medicaid as allowed by the ACA.This group falls into a “coverage gap” in current law; their incomes are too low to qualify for subsidized premiums in the ACA exchanges and yet too high to qualify for Medicaid. The first priority of any future effort to cover the uninsured should be to ensure this population can enroll in either Medicaid or another alternative that requires no premium payment….”
And only 1/3 of persons not insured not eligible for subsidized coverage“…In 2019, an estimated 30 million people under the age of 65, or 12 percent of that population, were uninsured. One reason for the lack of insurance coverage was a lack of subsidized options. About one-third of uninsured people under the age of 65 did not have access to coverage that was subsidized by the government or an employer: 13 percent were noncitizens who were not lawfully present in this country; 11 percent had income that was less than 100 percent of the FPL and lived in a state that did not expand Medicaid; and 9 percent had income that was too high to qualify for marketplace subsidies(see Figure 1)…”
“…About two-thirds of the 30 million uninsured people under the age of 65 had access to some form of subsidized coverage but were not enrolled, although those options were subsidized to different degrees: 17 percent were eligible for Medicaid or CHIP; 19 percent were eligible for subsidized coverage through the marketplaces established under the ACA; and 31 percent had access to coverage through an employer. Most of those people could have purchased health insurance that cost less than 10 percent of their income, but fewer people had an option that cost less than 5 percent of their income. Those people lacked health insurance coverage because they did not consider it to be worth the cost or because of the complexities of the enrollment process, among other reasons….”
But bottom line according toCBO only 9.8mm people who are currently uninsured are not eligible for subsidized coverage under the current systems, and 4mm are not lawfully present in the country, so only5.8mm peoplearen’t being captured by the current system. The other 20mm people don’t have health insurance because to quote CBO “…Those people lacked health insurance coverage because they did not consider it to be worth the cost or because of the complexities of the enrollment process, among other reasons…”





Ed Comment:The numbers in this article don't seem to add up. It says 30 mm are uninsured. Then it details 10 million and seems to call it 2/3s. Then it has a category zero million.
Ed Comment:Hard to see that 100mm people are at risk of losing coverage and/or can't get HC. 20 mm are subsidized and don't take it. 2.6 can afford it and don't take it. Half of the remainder are illegals. Many people won't be very sympathetic to them and we still give them some/essential HC so it looks like 3 of the 30 might want it but can't get it. The rest are all covered. That said, I still don't know how many people with pre existing conditions significant enough to truly prevent them from being covered are being "saved" by obamacare. (The ones with employer coverage would get it). So it looks like the true number is at risk is much smaller than 100mm Can you please take all your entries and sort everyone into buckets including the elderly. One bucket would be resting conditions covered by employers. It would be great to see those who were eligible for Medicaid and chips without Obama care and those who were added to it because of Obama care. A clear top down picture would be useful/enlightening.
Jim Capretta Comment:"Thank you for pointing this out (not sure why no one else did). Some numbers got lopped off in the translation from what I submitted to what got posted. Here are the correct numbers in order of the first bulleted points: 5.1 million people 5.5 million 9.4 million Then in the next bullets it should be: 4.0 million 2.6 million I hope this is clear enough.”
Ed you were right, 30mm persons < 65are currently uninsured, but I can’t line his numbers with the reports, according to theCBO(See Figure 1, 67% of uninsured persons are currently eligible for subsidized coverage) Before I sent you a note that it was wrong I wanted to confirm with him, he said it was a typo on AEI’s part.
Capretta, "...In 2019, 12 percent of the nonelderly population — or about 30 million people — went without health insurance..."
Kevin McNellis, Carolyn Ugolino and Emily Vreeland, “Federal Subsidies for Health Insurance Coverage For People Under 65: 2020 to 2030,” Congressional Budget Office, September 2020, https://www.cbo.gov/publication/56650
Steve Comment:I’m still working on thenumber of individuals with pre-existing conditions who currently get coverage through employment and the number who are buying it on the exchanges due to the ACA. This is proving a little hard.But I wanted to show you a topdown snapshot of the <65 population,90% are covered if you exclude illegal immigrants. (According to theKaiser Family Foundationanother67.7mm >65 individuals are enrolled in Medicare in 2020.)According to CBO 155mm (57%) of the 272mm individuals < 65are covered by employment based coverage this year. But in terms of the number of people < 65 “saved” by Obamacare in 2020 CBO estimates13mm(so 5% of <65) individualswere added to Medicaid due to the ACA.See table A-1. In total70mm (28%)individuals <65 are covered by Medicaid. Note one thing from footnotes as this caught me up “The components do not sum to the total population because some people report multiple sources of coverage. CBO and JCT estimate that in every year of the projection period, between 12 million and 14 million people (about 5 percent of the insured population) have multiple sources of coverage, such as employment-based coverage and Medicaid”
Ed Comment:Hard to see that 100mm people are at risk of losing coverage and/or can't get HC. 20 mm are subsidized and don't take it. 2.6 can afford it and don't take it. Half of the remainder are illegals. Many people won't be very sympathetic to them and we still give them some/essential HC so it looks like 3 of the 30 might want it but can't get it. The rest are all covered. That said, I still don't know how many people with pre existing conditions significant enough to truly prevent them from being covered are being "saved" by obamacare. (The ones with employer coverage would get it). So it looks like the true number is at risk is much smaller than 100mm Can you please take all your entries and sort everyone into buckets including the elderly. One bucket would be resting conditions covered by employers. It would be great to see those who were eligible for Medicaid and chips without Obama care and those who were added to it because of Obama care. A clear top down picture would be useful/enlightening.