Drew Altman, Kaiser Family Foundation June
19, 2019
Data: Kaiser Family Foundation;
Chart: Axios Visuals
The
House Ways and Means Committee recently held a hearing about universal
coverage, examining incremental and more sweeping Medicare for All style
strategies for getting to universal coverage. That means one way or another
everyone would be covered, right?
The
catch: In practice, universal coverage will not mean 100 percent
coverage, because making everyone eligible for some form of coverage or
financial assistance does not mean everyone will actually get covered. Even
under Medicare for All, some populations could be left out.
- That
reality does not make it a less worthy goal to work to expand coverage as
much as possible.
By the
numbers: Thanks to progress made under the Affordable Care Act, we are at
90% coverage now. As the chart shows:
- More
than half of the remaining 27 million uninsured are eligible for coverage
now, or for subsidies to help them get coverage, but remain uninsured —
mostly because insurance is not affordable for them.
- A
separate significant share, 4.1 million, are ineligible because of
immigration status. Only one state, California, seems interested in
covering some of this population.
The big
picture: Making people eligible for coverage or financial help does not
assure they all get covered, and that that would remain the case whether we
expanded eligibility for subsidies, expanded Medicaid in more states, put in
place reinsurance mechanisms, or revitalized outreach and enrollment efforts,
to pick several of the incremental policies that have been proposed.
- A
pragmatic definition of universal coverage through incremental measures
might take us to something like 95% coverage of the non-elderly
population. That’s a guesstimate; it could just as easily be 96% or 94%.
We
could cover everyone from birth through a Medicare for All style plan. But for
that to happen, progressive Democrats would have to have substantial control of
the White House, the House and Senate — and overcome fierce interest group
opposition.
- And
to win passage, it’s possible that a political compromise would be
necessary that would exclude coverage for the millions who are ineligible
for coverage now due to their immigration status.
The
bottom line: Universal coverage is a powerful rallying cry for Democrats and
an important goal for progressive voters in the primary elections. But to
appeal to as many voters as possible, making health insurance affordable for
everyone — including by covering as many of the remaining uninsured as
possible — might be a more effective rallying cry for the general election.
No comments:
Post a Comment