Galen Senior Fellow Doug Badger and Heritage Research Fellow Jamie Bryan Hall shed new light on the core problem that health policy experts have focused on for decades�covering the uninsured.
Badger and Hall find, based upon their analysis of Census Bureau data, that �More than 99 percent of Americans have access to health coverage, regardless of their income or medical condition.�
Policymakers would do well to focus on solving the problem for this one percent�the uninsured�rather than turning our whole health sector over to the federal government, as many are advocating.
The recent Census Bureau report on the uninsured overlooked an important point: More than 99 percent of Americans have access to health coverage, regardless of their income or medical condition.
The overwhelming majority of those lacking insurance could have obtained coverage but did not enroll.
Many of those with lower incomes may not sign up for subsidized coverage because they know they can receive care at little or no cost to themselves even if they remain uninsured until they arrive at a clinic.
Those in the top two income quintiles may remain uninsured because government intervention in health insurance markets has created a menu of unattractive products at unattractive prices.
Either way, Americans across the income spectrum deserve a better approach to health care.
Understanding the challenge
It�s critical that policymakers understand the distinction between lack of coverage and lack of access to coverage.
A Kaiser Family Foundation analysis of last year�s Census Bureau report found that of the estimated
27.4 million non-elderly people who were uninsured in 2017:
6.8 million (25 percent) were eligible for Medicaid or CHIP but not enrolled.
8.2 million (30 percent) were eligible for Obamacare subsidies but did not enroll.
3.8 million (14 percent) declined an offer of employer-sponsored coverage.
1.9 million (7 percent) were not eligible for subsidies because they had income more than four times the federal poverty threshold, which put them in the top two income quintiles.
4.1 million (15 percent) were ineligible for subsidies because they were not lawful U.S. residents. Their situation is a matter to be settled by immigration policy, not health care policy.
2.5 million (9 percent) were under the poverty line but ineligible for federal assistance. They represented just 0.7 percent of the population.
These 2.5 million lawful U.S. residents ineligible for federal assistance lived in states that had not expanded Medicaid eligibility to non-elderly, non-disabled adults with incomes up to 138 percent of the federal poverty level.
Here, it is important to draw a second crucial distinction: between access to coverage and access to care.
These 2.5 million individuals are eligible for free care at 3,000 federally-funded health centers in the non-expansion states and 11,000 nationwide. In addition, all public and non-profit hospitals are required to have programs to provide free or low-cost care to low-income patients. These hospitals can enroll low-income people in Medicaid when they show up for care, which is another reason some Medicaid-eligible people wait until they need to see a doctor sign up for their free coverage.