Despite the fact that Obamacare’s major provisions went into effect at the beginning of 2014, about 30 million people remain uninsured in the United States. That’s partly because some people are ineligible for coverage because of their immigration status. But, according to a new issue brief from the Kaiser Family Foundation, it’s also because a lot of Americans are going without insurance even though they’re supposed to be eligible under the health law.
According to Kaiser researchers, who surveyed a representative sample of more than 10,000 adults, most of the uninsured people in the country have incomes that qualify them to receive financial assistance under Obamacare. They could either get subsidies to help them purchase private plans on the new state-level marketplaces, or they could enroll in public plans in their state’s expanded Medicaid program.
For instance, about 54 percent of the people who are currently uninsured have family incomes below the threshold — up to 138 percent of the federal poverty line — that’s intended to be covered by Obamacare’s Medicaid expansion:
Some of the people who remain uninsured are simply unaware of their coverage options, and may perceive health insurance as too expensive because they don’t realize how they might benefit from its provisions aimed at low-income Americans. Previous research confirms this has been a particularly big problem in red states, where anti-Obamacare lawmakers haven’t dedicated as many resources to trying to promote the law. There, patients are less likely to get information about how health reform could affect them.
But some of them are locked out of affordable coverage altogether. Since the Supreme Court ruled the law’s Medicaid expansion to be optional, that’s left an opening for GOP-controlled states to resist it — and some conservative lawmakers are still stubbornly refusing to expand the program. Kaiser estimates that about 18 percent of the adults who are currently uninsured fall into this Medicaid coverage gap:
The uninsured people who aren’t currently benefiting from Obamacare don’t have a lot of other options open to them. According to Kaiser, more than three-fourths of them have no access to insurance through an employer. About one in four uninsured people are working at a job that doesn’t offer them health care — the so-called “working poor” population that the Medicaid expansion was specifically intended to help:
Kaiser’s new research aligns with previous reports estimating that millions of low-income people of color are being locked out of Obamacare altogether because of their lawmakers’ resistance to Medicaid expansion. Last fall, the New York Times analyzed the data about the coverage gap and confirmed that the Americans being denied Medicaid are cashiers, cooks, nurses’ aides, waiters and waitresses, and janitors. If every state accepted the Medicaid expansion, the national uninsurance rate would be an estimated two percentage points lower.
The policy does appear to be gaining momentum in some GOP-controlled states that have forged ahead with public-private compromises to traditional Medicaid expansion. However, some of those proposals have gotten some criticism for requiring low-income people to pay premiums in order to use their Medicaid coverage. Iowa, Michigan, Arkansas, Indiana, and Pennsylvania currently require Medicaid beneficiaries to finance part of their public insurance plans.
That could become an issue particularly in light of Kaiser’s new findings about uninsured Americans’ cost barriers to getting covered. “Additional work is needed to understand whether affordability provisions in the ACA are sufficient to enable lower-income people to take up coverage,” the researchers conclude.