Income Disparities Impact Healthcare Availability

There are limited affordable choices for Americans who do not have health insurance through their jobs, especially for those with low and moderate incomes.  Few are Medicaid-eligible, and locating a plan on the individual market equals paying high premiums.  According to the Commonwealth Fund Health Insurance Tracking Survey of U.S. Adults, 2011, nearly 57 percent of adults aged 19 to 64 in families earning less than 133 percent of the federal poverty level ($29,726 for a family of four) were uninsured for a time in 2011 and 41 percent) were uninsured for a year or longer.  In contrast, only 12 percent of adults earning 400 percent of poverty or more ($89,400 for a family of four) were uninsured during the year, with four percent having no healthcare insurance for one year or longer.

The lack of health insurance significantly makes it difficult to get needed healthcare.  Low- and moderate-income adults who were uninsured in 2011 were much less likely to have a regular source of healthcare than those who did have insurance.  Additionally, uninsured low- and moderate-income adults were more likely to cite factors other than medical emergencies as reasons for going to the emergency room.  These included needing a prescription drug or lacking a regular primary-care physician.

The survey also demonstrates how vital Medicaid and the Children’s Health Insurance Program (CHIP) are in providing health insurance to children in low- and moderate-income families.  More than 63 percent of adults with children under 133 percent of the poverty level and nearly 38 percent with incomes between 133 percent and 249 percent of poverty said that some or all of their children were covered by either program.  The Patient Protection and Affordable Care Act (ACA) will expand the ability of Medicaid and CHIP to cover children and families by targeting adults in low- and moderate-income families who are at the greatest risk of lacking health benefits through a job.

When it becomes fully effective in 2014, the ACA will provide near-universal health insurance through a broad expansion of Medicaid, premium tax credits that cap premium contributions as a share of income for people purchasing private health plans through new state insurance exchanges.  Another benefit is new insurance market rules that prevent health insurers from denying coverage or charging people with pre-existing medical conditions higher premiums.

Or, as the Washington Post’s Sarah Kliff puts it, “While the private insurance expansion could get thrown into limbo by the Supreme Court, there’s pretty widespread agreement that, absent full repeal of the bill, health reform’s Medicaid expansion is here to stay.  And that means a wide-reaching expansion of the entitlement program about two years from now.”

According to the Commonwealth Fund’s analysis, as a result of the Affordable Care Act, the majority of the 52 million adults who did not have health insurance in 2010 will gain coverage beginning in 2014.  Millions more will benefit as their ability to afford the price of premiums and out-of-pocket costs improves.

Karen Davis, President of the Commonwealth Fund, said that “The silver lining is that the Patient Protection and Affordable Care Act has already begun to bring relief to families.  Once the new law is fully implemented, we can be confident that no future recession will have the power to strip so many Americans of their health security.”

Amanda Peterson Beadle, writing on the thinkprogress.org website, notes that “The Affordable Care Act has already expanded health insurance to 2.5 million 19-to-25 year-olds, banned lifetime limits on health insurance coverage, created pre-existing condition insurance plans providing health insurance options to those who were often uninsurable, and required insurers to cover preventive care without requiring co-payments.  But the major provisions of the law to be implemented in 2014 will have the biggest effect on narrowing the income divide.”

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