Health Care: Who's Not Covered?
Late Sunday night, House Democrats approved a health care bill that will extend medical coverage to millions of Americans. The bill will reach as many as 32 million people — but it won't cover everyone. Host Melissa Block talks to Linda Blumberg of the Urban Institute to find out who's not covered and what will happen to them.
ROBERT SIEGEL, host:
From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel.
MELISSA BLOCK, host:
And I'm Melissa Block.
Democrats say the health care bill, passed last night by the House, will ensure 32 million uninsured Americans by the year 2019. That's out of a total of about 55 million people who the Congressional Budget Office estimates would be uninsured by that date.
So who are those 23 million people who still won't be insured? For some answers, we turn to Linda Blumberg, economist with the Urban Institute.
Welcome to the program.
Dr. LINDA BLUMBERG (Economist and Senior Fellow, Health Policy Center, Urban Institute): Thank you very much.
BLOCK: And, Linda, who are these 23 million people who still won't get covered?
Dr. BLUMBERG: The biggest part of that group is going to be unauthorized immigrants who are excluded from the reforms. They won't be eligible for financial assistance or for coverage through the Medicaid program. And they'll make up about a third of that uninsured group.
BLOCK: So that's about eight million people. That leaves us with, what, another 15 million still uninsured. And who would they be?
Dr. BLUMBERG: They're going to be a mix of people who are not able to purchase coverage still even under the reforms because it won't be affordable to them, that the premiums they would have to pay would be very high relative to their incomes.
There'd also be some people who would be eligible for Medicaid but who will choose not to enroll until they need medical care. Once they do go to a physician or a hospital, they're very likely to be enrolled at little or no cost. But they won't have to pay any penalties because they're very low income.
And then there's going to be another group, which we believe will be relatively small but still mixed in there, who will choose to pay the financial penalties that are imposed instead of obtaining coverage - that they just don't want to buy the insurance, they'd rather pay the financial penalties.
BLOCK: Uh-uh. And would we assume in that last group that a number of them would be the healthy young?
Dr. BLUMBERG: Well, there will be some like that. But the interesting thing, contrary to a lot of the conversation that's been going on through the debate, the young people also have a tendency to be low income. They haven't built up a work history to be making a lot of money.
And so because they also tend to be low income, they'll be eligible for a great deal of financial assistance if they're purchasing coverage through the insurance exchanges. So we actually think that the affordability issues are going to be much more significant for people who are older, and as a consequence of their age will have to pay higher premiums still under reform.
BLOCK: So, Linda, if you look percentage-wise at the percentage of legal non-elderly residents who will theoretically have health insurance by 2019, we'd be moving from what percentage now to what percentage then?
Dr. BLUMBERG: Today there's about 83 percent of the population covered, and under the reforms we'd have 95 percent.
BLOCK: Okay. Now, a lot of these numbers we've been talking about are in dispute, including that number of 55 million uninsured people by 2019 that we've mentioned. What are the variables involved here?
Dr. BLUMBERG: The variables are really how fast health insurance premiums are going to continue to grow in excess of incomes, and the trends in health insurance coverage by employers we see dropping - especially among the small firms in considerable amounts in recent years. And we're guessing, based on past experience, what's going to happen in the future.
BLOCK: Linda Blumberg is senior fellow in the Health Policy Center of the Urban Institute.
Linda, thank you very much.
Dr. BLUMBERG: Thank you.
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