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Who Benefits from Health Care Reform?

Though you may have heard the number 31 million used repeatedly last night during discussion of the legislation, the latest CBO estimate is that the legislation will extend health coverage to 32 million additional people. Who are those 32 million? And, since coverage is not universal, who are the 23 million that will remain uninsured?

The change in coverage of 32 million breaks down as follows (this is based upon the most recent CBO estimates of the impact of the legislation; since Medicare is available for the elderly, these numbers are for the non-elderly population only and the changes are cumulative through 2019):

1. 24 million people will purchase coverage through the new insurance exchanges.
2. 16 million people will enroll in either Medicaid or the Children's Health Insurance Program (CHIP)
Thus, so far we have gained 40 million enrollees. But there are 8 million in losses:
3. 5 million decline in the number of people purchasing insurance outside of exchanges.
4. 3 million decline in the number of people obtaining health insurance through their employers.
The 40 million new enrollees minus the 8 million that are lost gives the net 32 million figure cited above.

But who are these people? In general terms, the beneficiaries of the legislation will be (this is based upon a CBPP analysis, and is in general terms only, more exact numbers do not appear to be available):

  • Low- and moderate-income individuals and families who do not have employer-based insurance and who do not qualify for Medicaid or Medicare. This will be accomplished by expanding Medicaid, and through cost-sharing credits to help these households pay for insurance.
  • Individuals and families who have incomes that are too high to qualify for Medicaid, but below 400 percent of the poverty line will receive "premium credits" to lower the cost of health insurance in the new health insurance exchanges.
  • All individuals younger than 65 who are legal residents and not eligible for Medicare. The plan expands Medicaid up to 133 percent of the poverty line. As CBPP notes, " This would mean that millions of low-income parents, as well non-disabled low-income adults who do not have dependent children would become newly eligible for health coverage through Medicaid."
  • People at all income levels, as well as employers will benefit from "a number of important reforms to the health insurance market that would greatly improve access to affordable and comprehensive health insurance coverage."
  • Adult dependents younger than 26 can now be covered on their parent's policies. These insurance plans cannot exclude children due to pre-existing conditions, and they will be required to offer preventative measures at no additional cost.
  • People who have existing health problems. Beginning in 2014, insurance companies will be prevented from denying coverage or charging higher premiums to people who have health problems, and it limits insurers' ability to charge higher premiums to individuals as they age.
Who are the 23 million that will remain uninsured? Again, precise numbers are difficult to find, but they are mainly from the groups identified above. But an important group who will remain uncovered is unauthorized immigrants. This group makes up about one third of the 24 million who will remain uninsured.

The plan takes a large step toward providing expanded coverage, and the expansion to cover children and lower income individuals is laudable, but coverage is not yet universal. There are still some big holes in insurance coverage, and an important goal for the future is to find a way to bring the remaining uninsured into the system.

In addition, while this plan does more than any other plan to date to control health care costs, the projections for health care costs are still scary -- if nothing is done Medicare costs will swamp the federal budget -- and this too is something that must be addressed in the future.

Update: From Ezra Klein:

Who is left uninsured by the health-care reform bill?

The graph atop this post shows the predicted insurance situation (numbers come from this CBO report) for non-elderly Americans if health-care reform didn't pass. .... You're seeing 162 million people in the employer market, 54 million uninsured, 35 million people on Medicaid or the Children's Health Insurance Program, and 30 million people in the non-group/other market (this contains not just the individual market but small public plans). To put that slightly differently: No insurance is predicted to be the second-most common arrangement. Compare that to the post-reform prediction:

Here you're seeing 159 million Americans on the employer market, 44 million on Medicaid or the Children's Health Insurance Program, 25 million on the non-group/other market, 24 million in the exchanges, and 22 million left uninsured. The uninsured category has gone from the second largest to the absolute smallest. ... But all in all, only 40 million Americans are in a different insurance situation than would otherwise have been the case. Three-quarters of them would've been otherwise uninsured, and a few more would've been on the individual markets or getting insurance through a small business who's now using the exchange.
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