The Affordable Care Act Part II: The Current Healthcare System

[TexasTowelie]

By Dr. Brian Carr
President, Behavioral Health Associates, Lubbock, Texas, 1991-Present
Chairman, City of Lubbock Board of Health, 2013
Submitted on September 4, 2013 - 7:18am

In 2010 approximately 150 million Americans (representing 48% of the population) obtained their health insurance coverage from their employer. The employer contributed the majority (about 70%) of the employee’s premiums.

The second largest group of the remaining population (about 28%) also receive assistance in obtaining healthcare coverage. These are those Americans who are elderly, in poverty and disabled. They receive governmental assistance in the form of Medicare (15%) or Medicaid (13%).

Add these two groups together and you have about 78% of Americans covered in their healthcare insurance needs. It is the remaining 24% of the population that are uninsured or seek individual healthcare coverage on the open market that is identified. Within this approximate 50 million individuals are about 13 million undocumented aliens. This leaves about 37 million citizens without healthcare coverage. This group is at a distinct disadvantage compared to the other groups.

While the ACA will affect all Americans to some degree it is mainly targeted at the one in four Americans who today receive no financial help if they try to obtain health insurance. The two largest sub-groups in this population are

1. Those who are self-employed or otherwise unable to participate in group insurance plans. Making up about 9% of the population, these are people who are financially able to buy insurance on their own but typically have to pay significantly higher insurance premiums, co-pays and deductibles than everyone else. These people experience a tax penalty in that they have to use after-tax dollars to make their insurance purchase and also lack the bargaining power afforded large groups such as a large business.

2. The uninsured-as of 2010 the uninsured represent about 16% of the population (about 50 million people). A big chunk of this group are illegal aliens (about 13 million) leaving about 37 million Americans who are unable to obtain healthcare insurance coverage. This includes young adults who enjoy robust health, while others are low-income people under 65 whose work circumstances don’t give them easy access to employer-based healthcare and who simultaneously make too much money to qualify for Medicaid. A major portion of this group are those individuals (myself included) who are not able to obtain coverage due to significant illness histories or pre-existing conditions.

By 2019 the ACA is expected to reduce the number of uninsured Americans from 41 million to about 10 million-a 75 percent reduction in the number of uninsured.

As noted by Chris Lillis, M.D. the need of those who are uninsured is both a moral failure as well as costly mistake for our country. In describing his work at a free clinic in Virginia he points out that the failure of the state government of Virginia to expand Medicaid under the ACA has a human as well as financial cost. In a case study he describes the plight of one such uninsured American:

“He is one of the 400,000 Virginians who would benefit from the expansion of Medicaid, and gaining this coverage would allow him to access primary care services rather than rely on the charity of the free clinic. Having a primary care doctor would allow for the same coordination of care that my patients, and my family depend on during episodes of illness. Having Medicaid coverage, and primary care, would also save our local health systems countless dollars — rather than duplicating tests and procedures that may be performed just 5 miles down the road since a primary care doctor could keep track of his diagnostic work up”.

A set of maps are described in an article from The Washington Post. The top map shows the population that is likely to qualify for Medicaid coverage, if they live in a state that is expanding that program. The bottom map captures the Medicaid-eligible population and those who may qualify for subsidies to purchase health insurance in the new marketplaces.

Tomorrow Part III: Why the ACA was Needed

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http://lubbockonline.com/interact/blog-post/dr-brian-carr/2013-09-04/affordable-care-act-part-ii-current-healthcare-system

Cross-posted in Good Read forum.

[northoftheborder]

1. Thank you for excellent information.