Monday, August 10, 2015

qotd: Can we celebrate the decline in the numbers of uninsured?

August 10, 2015
In U.S., Uninsured Rates Continue to Drop in Most States
By Dan Witters

The marketplace exchanges opened on Oct. 1, 2013, with new insurance
plans purchased during the last quarter of that year typically starting
on Jan. 1, 2014. Medicaid expansion among initially participating states
also began with the onset of 2014. As such, 2013 serves as a benchmark
year for uninsured rates as they existed prior to the enactment of the
two major mechanisms of the healthcare law.

Nationwide, the uninsured rate fell from 17.3% in full-year 2013 to
11.7% in the first half of 2015.

Collectively, the uninsured rate in states that have chosen to expand
Medicaid and set up their own state exchanges or partnerships in the
health insurance marketplace has declined significantly more since 2013
than the rate in states that did not take these steps. The uninsured
rate declined 7.1 points in the 22 states that implemented both of these
measures by Dec. 31, 2014, compared with a 5.3-point drop across the 28
states that had implemented only one or neither of these actions.

Although the 22 states that implemented both mechanisms before Jan. 1,
2015, had a lower uninsured rate to begin with, the 7.1-point drop is
larger than what is reported among the other 28 states, and represents a
44% decline since 2013 in the uninsured rate among adults residing
there. The 5.3-point drop in the 28 states that have implemented one or
neither of the mechanisms represents a 28% decline in uninsured rates.
Still, the difference in the rate of decline in uninsured rates between
the two groups of states has now leveled off, and is unchanged relative
to the same 1.8-point gap in the rate of decline measured in midyear 2014.


Comment by Don McCanne

Although supporters of the Affordable Care Act (ACA) celebrate the
reductions in the numbers of uninsured into the second year of plan
enrollment, those of us who believe that everyone should be covered
certainly do not have cause to celebrate.

Nationally, the rate of uninsured fell from 17.3% before ACA expansions
were implemented to 11.7% after the second annual enrollment period.
That is a decline in the uninsured of only 32%. Two-thirds of the
numbers previously uninsured still remain uninsured.

Even in those states that cooperated with ACA by both expanding Medicaid
and by establishing exchanges themselves or partnering with the federal
government to establish exchanges still saw reductions in the uninsured
of only 44% - less than half (a decline from 16.0% to 8.9%). Thus even
the optimal results are disappointing. States that failed to cooperate
saw even less of a decline in the uninsured - 28% (from 18.7% to 13.4%).

With two seasons of ACA implementation, the low fruit has been picked.
With increasing penalties for remaining uninsured, a few more enrollees
should trickle into the exchanges. Also some states missing in action
will likely reluctantly expand their Medicaid programs. But even with
optimistic estimates of the increases in participation, it is quite
clear that far too many will remain uninsured.

The defect is in the design of the Affordable Care Act - an
administratively complex, fragmented system that could never result in
truly universal coverage, not to mention all of the inequities that it
perpetuates. In contrast, a single payer system automatically enrolls
everyone, while reducing inequities. That's the design that we need.

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