Health Law's Big Tent Still Leaves Some People Out : Shots - Health News About 10 million more people in the U.S. now have health insurance than did this time last year. But some immigrants, low-income adults and others are still falling through the gaps.
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Health Law's Big Tent Still Leaves Some People Out

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Health Law's Big Tent Still Leaves Some People Out

Health Law's Big Tent Still Leaves Some People Out

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  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
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We are also, this morning, following up on a story about Obamacare. We heard this week on the program about people who are stuck. They make too much money to qualify for insurance subsidies but not enough to buy insurance for their families. Suzanne Shugart's (ph) husband can afford insurance for himself through his job but...

SUZANNE SHUGART: If you were to increase it to a family plan, which would include me, it goes up to about $380 a month, which is nearly our mortgage payment.

INSKEEP: More than they can afford. So let's run some numbers. Obamacare was supposed to address a problem - tens of millions of people with no health insurance. And let's ask how it's doing with the Julie Rovner now at Kaiser Health News. Hi, Julie.


INSKEEP: So how many more people are covered in America since the start of this year when the law took full effect?

ROVNER: Well, it seems to be about 10 million or so adults - nonelderly adults. We don't know all the specific numbers, but generally there have been a lot of surveys over the course of the year, and they all seem to pretty much agree on that number, and also that that's about 5 percentage points lower in the percentage of the population that doesn't have insurance.

INSKEEP: OK. Ten million more people have insurance than had it at the beginning of the year. Generally speaking, who are they?

ROVNER: Well, they're people who went to the health exchanges and bought insurance who didn't have coverage before.

INSKEEP: Oh, those websites we've heard so much about, sure.

ROVNER: That's right. They're people who got expanded Medicaid. Medicaid's been expanded in a little more than half the states. And there are people who just got jobs with health insurance. Remember the economy is getting better so some of those people actually may have bought insurance on the exchange and left the exchange because they got a job and health insurance.

INSKEEP: Oh, now that's really interesting. So you're saying that there're 10 million more people with health insurance this year, but that's not just about Obamacare. Part of it is the improving economy?

ROVNER: Indeed. We don't know exactly what - how the numbers relate to each other, but yes.

INSKEEP: So 10 million extra nonelderly adults are insured along with a - some number of children. It's not clear exactly how many. But, Julie Rovner, we used to hear about more than 40 million people in this country who are uninsured. There must be tens of millions of people who are still not insured.

ROVNER: Well, there are several sort of discrete groups of people who still lack insurance. And remember this is a work in progress. But some of those groups will probably continue to lack insurance. The biggest one are people - are undocumented immigrants. They are not eligible to purchase insurance in the exchanges with or without a subsidy. And for the most part, they're also not eligible for Medicaid.

INSKEEP: Undocumented immigrants. Who else?

ROVNER: Well, the next big group are adults with low incomes who are in the states that did not expand Medicaid. So almost half the states that didn't expand Medicaid to what they call able-bodied adults, adults with disabilities, do get Medicaid.

INSKEEP: Are there other big groups who are not insured here?

ROVNER: Yeah, as we heard earlier this week, there's people in what's called this family glitch where the individual who has the job can afford his or her insurance, but if you add the cost of family coverage to that, it becomes unaffordable. But because the individual has an offer of coverage from the employer, the family is not eligible for subsidies on the exchange, and so therefore, insurance is too expensive on the job, too expensive in the exchanges. And those people can't afford insurance.

INSKEEP: So will all of these people - and it may be tens of millions of people uninsured at this point - will all of them be subject to fines under Obamacare?

ROVNER: Actually, most of them won't. There are a lot of exceptions to the rules for who's going to have to pay those tax penalties for not having insurance. People who are undocumented are exempt, also are people who don't earn enough money to have to file federal taxes. You're also exempt if the least expensive insurance would cost more than 8 percent of your income, and there other case-by-case exemptions for people who can claim financial hardships.

INSKEEP: OK, so what does it say about Obamacare that 10 million adults and some number of children are insured additional people here, but tens of millions still are not?

ROVNER: Well, a couple of things. First of all, this was just the first year - was expected always to take four, five years for it to fully cover the people that it was expected to, but this law was never expected to cover everyone. I think it was anticipated that when everything is fully implemented, about 90 percent of the population would have health insurance. But there was always going to be some number of people who weren't.

INSKEEP: Julie, thanks very much.

ROVNER: Thank you.

INSKEEP: That's Julie Rovner of Kaiser Health News.

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