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KFF brief reviews characteristics of uninsured adult population

Posted on August 29, 2012 | No Comments

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Key Developments

Effective January 2014, the Affordable Care Act (ACA) establishes a new minimum Medicaid eligibility level of 138 percent of poverty for non-disabled adults who were not previously eligible for the program. As with current Medicaid, legal immigrants who have been in the country for five years or fewer are not eligible for this coverage. Nationally, 21.5 million currently uninsured nonelderly adults may meet the income and citizenship criteria to be eligible for Medicaid after the expansion.

A brief recently released by the Kaiser Family Foundation uses the American Community Survey to describe the low-income uninsured adult population — the target group for the Medicaid expansion under the Affordable Care Act — by state. Many people in this target population have substantial health needs and face barriers to health care, and nearly half have incomes of 50 percent of poverty or less.

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A new study by the Urban Institute funded by the Robert Wood Johnson Foundation finds that two-thirds of the nation’s remaining uninsured adults have incomes at or below 138 percent of the federal poverty level (FPL). While this is the target population of the Affordable Care Act’s (ACA) Medicaid expansion, 40 percent of the uninsured live in states that chose not to expand Medicaid. The study found that affordability was the main reason people did not get health insurance, yet many uninsured individuals had limited awareness of potential financial help available to them.
A new interactive feature released by the Kaiser Family Foundation indicates how the Affordable Care Act (ACA) may impact Medicaid enrollment and the uninsured demographic at the local community level. The interactive tool is accompanied by a report, as well as other interactive features, that describes how the Medicaid population will change after the ACA is implemented and how the uninsured population will decrease both in and amongst states post-ACA.
A recent post from Health Affairs estimates that 30 million Americans will still not have insurance coverage by 2016, well beyond the implementation of the Affordable Care Act's (ACA) key provisions. The Uninsured After Implementation Of The Affordable Care Act: A Demographic And Geographic Analysis characterized states based upon their proclivity for expanding Medicaid: completely undeclared, leaning toward expansion, or leaning away from expansion. Using data from the Census Bureau's 2012 Current Population Survey, the researchers found that 29.8 million people would remain uninsured if all undeclared states opt-in to expansion, while 31 million would remain uninsured if all undeclared states chose to opt-out of expansion. Additionally, researchers found that 80% of those remaining uninsured would be US citizens in either scenario.
The Census Bureau report published yesterday found that the number of uninsured Americans fell to 48.6 million in 2011, or 15.7 percent of the population. This is the first drop in uninsured Americans since 2007. In 2010, 49.9 million people, or 16.3 percent of the population, were uninsured. Census Bureau officials attribute the drop in large part to provisions under the Affordable Care Act (ACA). The drop in the number of uninsured Americans was fueled by a significant drop in uninsured young Americans aged 19 to 25, from 29.8 percent in 2010 to 27.7 percent in 2011, the Census Bureau said. The rate also decreased among seniors. The Bureau also found that the percentage of Americans covered by private insurance remained flat at 63.9 percent. The percentage of Americans covered by government programs increased for the fifth consecutive year to 32.2 percent in 2011.
The Supreme Court's ruling on the Affordable Care Act (ACA) upheld the individual mandate and made the expansion of Medicaid coverage to nonelderly adults with incomes below 138 percent of the federal poverty level optional for states. In a new brief, authors from the Urban Institute estimate the number of uninsured Americans in each state who could be eligible for Medicaid if every state takes advantage of the option of expanding Medicaid coverage. According to the report, almost half of the nation's uninsured could qualify for Medicaid under the ACA. Of 22.3 million low-income uninsured Americans who could be potentially eligible for Medicaid under the ACA, 67 percent (15.1 million) are adults not currently eligible for Medicaid. Of this group, 11.5 million have incomes below poverty and would not qualify for any other subsidized coverage.
In a new issue brief entitled "The Income Divide in Health Care: How the Affordable Care Act Will Help Restore Fairness to the U.S. Health System," The Commonwealth Fund Health Insurance Tracking Survey of U.S. adults finds nearly three of five adults in families earning less than 133 percent of the federal poverty level were uninsured for a time in 2011. Two of five were uninsured for one or more years. Low- and moderate-income adults who were uninsured during the year were much less likely to have a regular source of health care than people in the same income range who were insured all year. In addition, uninsured lower-income adults were more likely than insured adults in the same income group to cite factors other than medical emergencies as reasons for going to the emergency room. These included needing a prescription drug, not having a regular doctor, or saying that other places cost too much. The report suggests that the Affordable Care Act (ACA) will substantially narrow these inequities through a set of affordable coverage options.
Based on the experience of ten states that currently run programs covering low-income childless adults, the Center for Health Care Strategies has released a report with lessons for the health reform law's Medicaid expansion. It highlights the fact that much of the expansion population is likely to have complex health needs—including mental illness and substance abuse—and have higher average costs than adults currently enrolled in Medicaid.
Enrolling the uninsured population into the health insurance marketplaces is a key component of the Affordable Care Act (ACA). To aid in this effort, the US Centers for Medicare and Medicaid Services (CMS) recently released a brief describing various characteristics of the uninsured population in America. The uninsured population can be divided into three main segments:
  • Healthy and Young
  • Sick, Active and Worried
  • Passive and Unengaged
Designed as a guidance tool for those poised to enroll individuals into the health insurance marketplace (insurers, consumer advocates and state officials), this brief outlines potential barriers and concerns to enrollment, as well as key messages to share with each segment about the importance of being insured.