The Census Bureau’s annual snapshot out today shows there were 50.7 million, or 16.7 percent of the population, without health coverage in 2009. These numbers come as the nation experiences a growing shift from private health coverage to more expansive public health programs.
Given today’s high rates of unemployment and the fact that most Americans get health insurance through their employers, the increased number of uninsureds comes as no surprise. The exodus from job-based insurance will only escalate under Obamacare.
The CMS actuary estimates that, under the president’s system, approximately 14 million Americans will lose or be moved out of their existing job-based coverage, and be enrolled in government-based plans. The new Census data shows the percentage of people in private insurance (63.9 percent) at a record low, while those in government health programs (30.6 percent) are at a record high.
Other analysts expect this displacement to be much higher, with the continuing “crowd-out” of private coverage worsening and millions more Americans enrolled in the low-quality Medicaid program.
Familiar Pattern. The Census findings confirm a familiar pattern. The vast majority of uninsured Americans are disproportionately young, healthy people. They work in small firms, often as part-timers, or in industries that don’t typically offer health insurance. Many had coverage and lost it, usually due to a job change or third-party decisions they had little control over.
This makes the health insurance market notoriously unstable. Americans lose and gain coverage, transitioning in and out of state markets, which often are dominated by a few giant insurance companies. These consumer-unfriendly markets often are saturated with mandates and special rules foisted upon powerless consumers at the request of powerful special interests.
Meaningless Choice. Under Obamacare, distant federal officials will make our “choices” for us, and we will pay (mostly through higher taxation) for those choices. Plus, for the first time in American history, we will be assessed tax penalties for not making certain choices. Yet Obamacare still will not be able to deliver anything close to universal coverage.
An estimated 23 million Americans will still lack coverage, and more than half of those who do gain coverage will be pushed into Medicaid, the federal health program for low-income families. Medicaid, which pays doctors about 56 percent of what private insurers pay, has a history of offering patients less access to physicians, lower quality of care, and poorer outcomes when compared with private health plans.
Plus, patients enrolled in Medicaid and SCHIP are twice as likely as the uninsured to use hospital emergency rooms for non-urgent medical problems. Former CBO Director Douglas Holtz-Eakin projects $36 billion in additional health care costs from Medicaid’s expansion under Obamacare. Curiously, Obamacare supporters claimed there would be a reduction in emergency room usage. Fat chance.
Higher Uninsurance? Despite $1 trillion in additional spending—plus the law’s mandates and penalties—Congressmen cannot guarantee that Obamacare will relieve the nation’s rising uninsured rate. Much depends on the implementation of the law’s contradictory provisions and policy objectives.
For example, higher health costs make coverage less affordable and contribute to the rising uninsured population. Obamacare guarantees higher health costs. Record-breaking Medicare provider payment reductions and the massive Medicaid expansion guarantees even more cost-shifting to the private sector. Analysts already have forecasted higher premiums, between 1 percent and 9 percent, for major insurers. And the tens of billions of dollars in new taxes will be passed onto consumers.
Indirectly, the new law creates incentives for even more market instability. It outlaws pre-existing condition exclusions from coverage and requires guaranteed issue of coverage. While these are important issues, the requirements are set up in a way that are likely to encourage young and healthy consumers to forego health insurance until they become sick. Congress tried to solve this problem with unconstitutional mandates, but the penalties don’t make it worthwhile for consumers to take on high insurance premiums.
Need for a New Policy. Today’s uninsured numbers reflect the impact of a sluggish economy. If Congress and the White House were to implement serious policies to spur economic growth in the private sector, these rates would decline. But pro-growth economic policies cannot solve the fundamental problems in the nation’s health insurance markets. Only sound and carefully calibrated, market-based health care policy will accomplish that. Read about those policies here.
