"Examining age across childhood and young adulthood, uninsured rates in 2017 were generally lower for children than for young adults, from 3.5 percent for infants to 17.8 percent for 26-year-olds. Two sharp differences existed between single-year ages. The percentage of 19-year-olds without coverage (13.2 percent) was 4.6 percentage points higher than the percentage for people 1 year younger. Likewise, the uninsured rate for 26-year-olds, the highest among all single years of age in 2017, was distinctly higher than for 25-yearolds (17.8 percent and 14.9 percent, respectively)."From ages 26 to 64, the uninsured rate generally declined with age. Between the ages…
Children and Adults in the US Without Health Insurance Coverage
"In 2017, 5.4 percent of children under the age of 19 and 12.2 percent of adults aged 19 to 64 did not have health insurance coverage. For all selected characteristics, the percentage of adults without health insurance coverage was significantly higher than for children (under 19 years of age) (Figure 6). Additionally, differences in the uninsured rates between demographic and socioeconomic groups were generally larger among adults than among children.39 "For example, the difference in the uninsured rate by poverty status was larger among adults than among children. In 2017, 7.8 percent of children in poverty were uninsured, compared with…
Why is the US at a Health Disadvantage Relative to Other Countries?
"One explanation for the health disadvantage of the United States relative to other high-income countries might be deficiencies in health services. Although the United States is renowned for its leadership in biomedical research, its cutting-edge medical technology, and its hospitals and specialists, problems with ensuring Americans’ access to the system and providing quality care have been a long-standing concern of policy makers and the public (Berwick et al., 2008; Brook, 2011b; Fineberg, 2012). Higher mortality rates from diseases, and even from transportation-related injuries and homicides, may be traceable in part to failings in the health care system."The United States stands out from…
Major Provisions of the Affordable Care Act
• Established “health exchanges” or “marketplaces” on a statewide basis that sold community-rated individual and family insurance policies that were required to cover ten sets of “essential health benefits.” Policies could be sold in four “metal tiers”, Bronze, Silver, Gold, and Platinum, which cover 60%, 70%, 80%, and 90%, respectively, of typical health expenses. The tiers with the more comprehensive coverage generally have higher premiums.•Provided income-based subsidies to purchase insurance policies on the exchanges. Families earning up to four times the FPL were eligible for at least some financial assistance to pay for insurance. Various restrictions applied; for example, people…
Medicaid Expansion Under the ACA
"Since January 1, 2014, states have had the option to extend Medicaid coverage to most non-elderly, nonpregnant adults with income up to 133% of FPL. Twenty-four states and the District of Columbia implemented the ACA Medicaid expansion at that time. Since then, the following seven states have implemented the expansion: Michigan (April 1, 2014), New Hampshire (July 1, 2014), Pennsylvania (January 1, 2015), Indiana (February 1, 2015), Alaska (September 1, 2015), Montana (January 1, 2016), and Louisiana (July 1, 2016). (See Figure 1.)"Virginia is expected to begin coverage of the ACA Medicaid expansion on January 1, 2019. Maine adopted the…
Affordable Care Act and “Shared Responsibility”
"The Affordable Care Act (ACA), enacted in 2010, established “shared responsibility” between the government, employers, and individuals for ensuring that all Americans have access to affordable and good-quality health insurance. However, health coverage remains fragmented, with numerous private and public sources, as well as wide gaps in insured rates across the U.S. population. The Centers for Medicare and Medicaid Services (CMS) administers Medicare, a federal program for adults 65 and older and some people with disabilities, and works in partnership with state governments to administer both Medicaid and the Children’s Health Insurance Program (CHIP), a conglomeration of federal–state programs for…
Health Insurance Coverage In the US Before the ACA
"Until the major provisions of the ACA went into effect in January 2014, health insurance coverage was always voluntary. About 30% of the population was covered through the two major public programs enacted in 1965: Medicare for seniors (later extended to the disabled) and Medicaid for poorer Americans [2]. Most others received coverage through their employment, either as employees or dependents, but such coverage was always voluntary: employers did not have to provide it, and individuals were not required to buy it. Less than 10% purchased coverage on their own."As far back as the 1950s those with pre-existing illnesses generally found…
Problems That Hampered Implementation of ACA’s Coverage Provisions
"Several major problems have hampered the implementation of the coverage provisions of the ACA. First was the troubled debut of the federally run insurance marketplaces and a number of state-run programs. The federal marketplaces now seem to be functioning adequately, and most states with problems have either fixed them or imported solutions from other states or the federal government. Second, a number of insured Americans were upset and surprised when companies canceled policies that did not meet minimum standards under the ACA. The numbers of canceled policies have declined over time, and cancellations have become less troublesome as better-functioning marketplaces…
ACA Hampered By Financial Vulnerabilities From the Start
"The ACA is vulnerable to the availability of resources at many other levels. The United States has a large national deficit for which the federal government must account. The states find themselves with inadequate financial resources. Many states cannot legally run a deficit and this limits their ability to participate in many of the ACA programmes that require their funding (Weissert & Weissert, 2006)."The federal budget compromise enacted by Congress in March 2011 reduced funding for many programmes as part of a package of budget cuts required to ensure that the federal government could continue to function in the face…
ACA’s Medicaid Expansion and NFIB v Sebelius
"As enacted, the ACA Medicaid expansion was a mandatory expansion of Medicaid eligibility to non-elderly adults with incomes up to 133% of the federal poverty level (FPL). However, on June 28, 2012, in National Federation of Independent Business v. Sebelius, the U.S. Supreme Court found that the federal government could not withhold payment for a state’s entire Medicaid program for failure to implement the ACA Medicaid expansion. Instead, the federal government could withhold only funding for the ACA Medicaid expansion if a state did not implement the expansion, which effectively made the expansion optional."After the Supreme Court ruling, the Centers…