Here comes the Republicans' worst nightmare about ObamaCare: it works! Every single provision of the Affordable Care Act that has gone into effect thus far has worked. First, it lowered premiums of "Medicare Advantage" plans by 1% despite having the government stop subsidizing it to the tune of 14% extra over traditional Medicare. Medicare changes were one of the first to go into effect. As insurance regulations, like beginning this plan year, insurers have to spend 80-85% of premiums on actually providing care, started to kick in, heads exploded and in some market, private insurance premiums headed south. President Obama massively expanded coverage for children through SCHIP before the big health care reform, and since then by stopping health insurer discrimination based on pre-existign conditions against children first.
And? And, beginning September 23 of last year, insurance companies have been required to insure adult children under 26 under their parents' insurance plans. So? So, in a survey just released by HHS, there was only one age group that increased their health insurance coverage. Wanna take a guess which one?
18-24 year olds were the only age group to experience a significant increase in the percentage with health insurance over the past year, from 70.7% in 2009 to 72.8% in 2010. This is a two percentage point increase in the share of adults 18-24 with coverage and represents 500,000 more young adults with health insurance.Now, remember that this is from a survey conducted for 2010, and the requirement to cover adult children was only added for the last few months of last year. The actual impact right now is likely to be much larger. And this increase alone may have been the lion's share of the reason for the fact that from 2009 to 2010, the proportion of the population uninsured remained essentially unchanged (at about 16%) despite having a significant decline in overall employer coverage from 56.1% to 55.3%.
I know stories in my personal sphere of people who got insurance coverage because of this provision in the new law. I am sure that many many of you do as well. It frees young adults up to take the jobs they want to take rather than having to take one just because it offers health insurance, so they can take a job in their community (maybe even work as a community organizer [gasp!]) or even start their own business.
In some ways, this is a microcosm of one of the effects of health care reform that will be seen on a larger scale after 2014: independence of health insurance from one's job. That is not necessarily decoupling, as the ACA is expected to expand employer-based coverage as well; it's independence. The end of the fear that if you leave a dissatisfying job, you and your family will be one accident, one disease, one health care emergency away from being destitute thanks to medical costs.
While the numbers for young adults are good, however, the census numbers released yesterday also tell us where we have our work cut out for us in terms of access to health insurance, which by definition, are also the populations that are being/will be helped the most with the implementation of the ACA.
People of color are more likely to be uninsured (no surprise there), with Hispanics at a large disadvantage:
Race/Ethnicity: In 2010, three in ten individuals of Hispanic origin (30.7%) were uninsured. Blacks were also more likely to be uninsured, with 20.8% lacking insurance, and 18.1% of Asians were uninsured, compared to 11.7% for non-Hispanic whites.Part-time work is no better guarantee of insurance than no work at all:
Employment: Working full-time increases the likelihood of having insurance, though one in seven full-time workers (15.0%) was still uninsured. Uninsured rates were higher among those with a marginal attachment to the labor force. Over a quarter (28.5%) of part-time workers were uninsured, the same percentage as among those who were unemployed.This should tell us why it's so important that small businesses get a 35% tax credit now to provide coverage, and why the expansion of coverage through Medicaid is so important. Expanding Medicaid to 133% of poverty will cover many, if not most, of those who work part time. The same will also disproportionately help people of color, given the embarrassing racial and ethnic skew in income and wealth distribution in America. Of course, subsidies in the exchanges will help them too.
Let's look at the income distribution of the Americans and how it stacks up to people with and without insurance:
I'll give you two guesses to which populations have median household incomes below $50,000 a year.
Health reform, in those respects, is more than just about expanding coverage. It is about equalizing, to the degree possible, health care and outcomes for the most economically and thus health-economically disadvantaged populations: communities of color, low income populations (lots of overlap there), and young people. This is why health reform is the most significant expansion of the social safety net in several generations. It's a socially conscious, publicly funded. paradigm shift: from health care being the privilege of those who could afford it to when health reform is fully implemented, a social responsibility distributed equitably. This is a concept liberal at its core, given shape by a president who wouldn't stop despite the political headwinds telling him to stand down.