This is the second in a series of articles on the rollout of Obamacare and how the law will change our health care system. Each week, we will publish two articles: one on the changes in medicine and medical care, and one on changes in the insurance industry. We hope this series of articles will help you make better decisions when it comes to your health care and how you buy insurance.
The Affordable Care Act (Obamacare) was passed in early 2010, but it will get its meaningful debut only in the next few months. The act was designed to make a significant dent in the number of Americans without health insurance. At the time the legislation was passed, the estimate of the number of uninsured Americans was 46.5 million, a number that had risen slightly after the financial crisis of 2008-2009.
The act anticipated providing coverage for approximately 30 million people, leaving close to 20 million uninsured by the middle of the decade. The bill assumed that the number of uninsured would rise without the legislation, to close to 50 million.
The number of uninsured is not a fixed number for a year — the same group of people are not uninsured for the full period of time. People lose their insurance, and others who were uninsured gain new insurance, sometimes through work. The total number of those uninsured for any time during a year is tens of millions higher than the 46.5 million number, and the number who are uninsured for the entire period during any 12-month cycle is tens of millions less than this number.
So, too, the composition of the uninsured population is quite varied. About a fifth earn $75,000 or more in annual income, a level well above the national median income for an individual or family unit. About 18 million, or near 40% of the uninsured, have incomes over $50,000, close to the median income level. Obamacare provides subsidies for those buying policies in the state exchanges with incomes between 138% of the poverty level and 400% of that level (now $94,000 for a family of four). The legislation also provides expanded coverage under the state Medicaid programs for those with incomes between 100% of the poverty level and 138% of that level, depending on family size.
At the time the legislation was passed, there were some estimates that over 10 million Americana qualified for Medicaid, Medicare, or some other government program even without the new legislation, but had never enrolled. It is, of course, possible that many newly eligible for Medicaid will not enroll despite the eligibility expansion under Obamacare.