Monday, September 16, 2019

US uninusred risies in 2018, and both Wisconsin and America is in danger of much more soon

The Census Bureau released their annual figures this week on the number of Americans that have (and do not have health insurance). And it featured this disturbing statistic.
In 2018, 8.5 percent of people, or 27.5 million, did not have health insurance at any point during the year. The uninsured rate and number of uninsured increased from 2017 (7.9 percent or 25.6 million) (Figure 1 and Table 1)
That’s the first increase in the uninisured rate since 2009, and it comes in a year where the economy was still growing. Sounds a lot like what we saw in the 2000s during the Bush “expansion”, doesn’t it?

In fairness, economic growth might explain some of these changes, as nearly 2 million fewer people got their health insurance through Medicaid, so they could have conceivably gone over the income limits in 2018. But instead of those individuals getting insured through the private sector, slightly fewer people got health insurance through that method as well, and it more than offset the increased enrollment in Medicare for 2018.
The percentage of people covered by any type of health insurance in 2018 was lower than the percentage in 2017. This decline appears to be driven by a 0.4 percentage-point decrease in public health insurance (Table 1). Medicaid coverage decreased by 0.7 percentage points between 2017 and 2018. The rate of Medicare coverage moved in the opposite direction, increasing by 0.4 percentage points. This increase was partly due to growth in the number of people aged 65 and over and not a change in Medicare coverage for adults in this age range.

The percentage of people covered by private health insurance, or any of its three subtypes (employment-based, direct-purchase, and TRICARE), did not statistically change between 2017 and 2018…

Employer-based insurance was the most common subtype of health insurance (55.1 percent), followed by Medicaid (17.9 percent), Medicare (17.8 percent), direct-purchase insurance (10.8 percent), TRICARE (2.6 percent), and VA or CHAMPVA health care (1.0 percent) (Table 1).

Direct-purchase insurance includes coverage obtained through a state or federal [Obamacare] marketplace. In 2018, 3.3 percent of people, or 30.8 percent of people with direct-purchase insurance, obtained their coverage through a state or federal marketplace.

Also interesting is the breakdown the Census Bureau gave on the income levels of the uninsured. Not surprisingly, poorer people are more likely to be uninsured than richer ones, but it were more well-off individuals who were more likely to lose their health care in 2018.
Health insurance coverage is generally higher for people in higher income-to-poverty ratio groups. In 2018, people in poverty (the population living below 100 percent of poverty) were least likely to have health insurance coverage (83.7 percent), while people living at or above 400 percent of poverty were most likely to have coverage (96.6 percent) (Table 4). Between 2017 and 2018, overall health insurance coverage decreased 1.0 percentage point for people in families with income from 300 to 399 percent of poverty and 0.8 percentage points for people in families with income at or above 400 percent of poverty. During this time, the overall health insurance coverage rate did not statistically change for any other income-to-poverty group.

Public coverage continued to be most prevalent for the population in poverty (66.8 percent) and least prevalent for the population with income-to-poverty ratios at or above 400 percent of poverty (18.5 percent) in 2018.
In fact, while people from households that make 300% or more of poverty are 5/9 of the country, they accounted for more than 85% of the 1.86 million Americans that lost health insurance last year. To me, this points to people who are likely to use the Obamacare exchanges, and/or might be “gig economy” contractors who weren’t already getting health insurance through their jobs.

Narrowing it down further, the Census report looks at a group of individuals just above the poverty line that can be covered under the expanded Medicaid provisions under the Affordable Care Act....or might not be covered by Medicaid in states that don't expand it.

Health insurance sources, 100-138% of poverty, 2018
Private sector 24.8%
Public sector 63.8%
Uninsured 14.7%
(totals over 100% as some people may have insurance for only part of the year).

In Wisconsin, we also had an increase in the amount of people uninsured. Not by much mind you (from 5.4% to 5.5%), and we are still a decent 11th among the US states and DC. And it certainly seems that Wisconsin has had quite a few individuals get enough income to become less eligible for public health care coverage, mirroring a trend in the US.

In particular, a sizable number of Wisconsin (and especially children) have gone off of regular BadgerCare in Wisconsin over the last year, and have ended up on what are known as “income extensions.”

These extensions are in place for either 4 or 12 months, depending on why the person’s income got above the poverty line, and are intended to prevent people from being cut off of BadgerCare if their income bumps up for a short period of time (like with seasonal/occasional work).
A BadgerCare Plus extension is a period of eligibility given to a person when the assistance group's income increases above 100 percent FPL either due to an increase in earned income and/or spousal support and otherwise meets the BadgerCare Plus eligibility criteria for people with incomes below 100 percent FPL.

A parent/caretaker relative or pregnant woman can enter an extension due to an increase above 100 percent FPL in the assistance group’s earned income, spousal support, or both. The children, stepchildren, and NLRR children of the parent/caretaker will also enter the extension at this time, provided they are under age 19, living with the parent/caretakers, and meet the income requirements outlined in Section 18.1.3 Children.

BadgerCare Plus members eligible as childless adults are not eligible for an extension.
Side note - the Walker Administration wanted to have people getting extensions have to pay a premium, but the Centers for Medicaid and Medicare Services disallowed that in late 2018.

What this shows is that tens of thousands of Wisconsinites may be in danger of losing their BadgerCare benefits in the coming months as those extensions run out. If those individuals aren’t getting insurance from their jobs/income sources, those individuals will likely have to get it from the Obamacare exchanges…if they get it at all.

You don’t think many of those Wisconsinites just above the poverty line would benefit from having Medicaid, and being able keep the same benefits and providers? And let’s not forget, that by refusing to expand Medicaid, we are paying an extra 31% for all of the current Medicaid expenses of people in poverty, while leaving people just above the poverty line in a tenuous situation.

In addition, the high number of middle-income people losing health insurance in 2018 shows that Trump/GOP attempts to mess with the ACA is having success, as insurance companies on the exchanges aren’t offering policies that people want for the price they’d have to pay. At 300%+ FPL, they are getting little to none of their Obamacare policy paid back through tax credits, it indicates a flaw that needs to be fixed (cough – public option and/or Medicare for All – cough).

And if we're starting to see more people become uninsured in America under a "growing" economy in 2018, what happens when an economic downturn hits sooner than later, and corporations decide offloading the costs of health care benefits are a good source of cost savings? And combine that with the fact that the ACA's individual mandate penalty was removed on January 1, 2019 due to the GOP Tax Scam. Ruh roh.

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