Here's what happened to people without health insurance since Obamacare

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Obamacare hasn't been a cure-all for America's uninsured population — but it sure has changed the numbers of people without health coverage, and what the remaining uninsured look like.

Two new surveys out Thursday shed new light on the effects of the Affordable Care Act.

One details a dramatic drop in uninsured population in California, the nation's most populous state, and one that has fully embraced Obamacare's tools for expanding health coverage.

The other survey details how people nationally who still lack health insurance after Obamacare's first two years are more likely to be Hispanic, be very poor, be under the age of 35 and work for a small business.

The first survey comes from the Kaiser Family Foundation, which has been tracking the effects of the ACA in California since 2013 in a series of interviews with the uninsured. That year was the last one before individual health insurance plans went on sale on government-run Obamacare marketplaces nationwide, and also the last year before the ACA rule mandating nearly every American to have some form of health coverage or pay a fine took effect.

Kaiser's survey in 2014 found that 58 percent of the uninsured population in California had gained health health coverage since the year before. In 2015, the survey found that 68 percent of the previously uninsured had obtained such coverage.

The first survey comes from the Kaiser Family Foundation, which has been tracking the effects of the ACA in California since 2013 in a series of interviews with the uninsured. That year was the last one before individual health insurance plans went on sale on government-run Obamacare marketplaces nationwide, and also the last year before the ACA rule mandating nearly every American to have some form of health coverage or pay a fine took effect.

Kaiser's survey in 2014 found that 58 percent of the uninsured population in California had gained health health coverage since the year before. In 2015, the survey found that 68 percent of the previously uninsured had obtained such coverage.

Kaiser's survey also found that recently insured Californians "are more likely to report that their health needs are being met today than when they were uninsured" — 77 percent this year, compared to 49 percent in 2013. Nearly 80 percent of the recently insured said their experiences with their current coverage has been positive.

The second report released Thursday comes from the Commonwealth Fund, with the title, "Who Are the Remaining Uninsured and Why Haven't They Signed Up for Coverage."

The group notes that about 20 million Americans have gained health coverage since 2010, when the ACA first began taking effect, with a provision that allowed people under the age of 26 to stay on their parents' health plans.

"Yet an estimated 24 million people still lack health insurance," the report said.

Of that 24 million, about 21 million of them — 88 percent — have incomes below about $16,243, were young adults, worked at small firms, and/or are Latino, according to the Commonwealth Fund.

In 2013, Latinos, who have the highest rates of uninsurance of any ethnic group, compromised 29 percent of the uninsured population.

Latinos now make up 40 percent of the uninsured, according to the report, which notes that is "more than twice their representation in the overall population.

At the same time, whites, who previously made up half of the uninsured, now comprise 41 percent of the uninsured.

The report noted that 34 percent of the remaining uninsured have incomes low enough to qualify them for Medicaid, but live in one of the 20 states that have not adopted Obamacare's provision that allows nearly all poor adults to be covered by that program, with significant federal financial assistance.

In states that did not expand Medicaid under Obamacare, 41 percent of adults with incomes below $16,243 were uninsured as of the summer of 2013. By 2016, the uninsured rate among that population had fallen just to 35 percent hits year — which is actually 1 percent more than in the past two years.

However, in the states that did expand Medicaid, the uninsured rate among poor adults fell from 30 percent in 2013, to only 17 percent this year.

The report found that almost two-thirds of uninsured adults who knew about Obamacare insurance marketplaces, which offers subsidized coverage to low- and middle-income people, had not visited those exchanges "because they did not think they would be able to afford coverage."

At the same time, the report said, more than half of the uninsured adults actually had incomes in range that made them eligible for federal subsidies that could reduce the coverage of their Obamacare exchange plan coverage.

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Type: Discussion • Score: 17 • Views: 4,918 • Replies: 137

I really do dislike starting discussions, but I was starting to feel rude to just put news articles anywhere. I figured since there is this deal going on Atena and Humana and Atena threatening Obamacare, perhaps more information on Obamacare needs to be out there and kind of like a status report.

From the above article, it says the states which expanded Medicare have more people insured and the people who do not sign up for the exchanges do not do so because they think they can't afford it when in fact there are subsides to help them to afford it. I suspect because they are young, they figure they can just skate by and hope they don't need any big expensive health care services.

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There is no doubt more people are covered, despite the fact some states do all they can to discourage involvement. Still, big pharma charges outrageous prices for their products and many Americans still cannot afford to go to the doctor. Single payer is the one workable answer.

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@edgarblythe,

Believe it or not, I agree, I just don't know how we will get there. Do you think conservative states resist participating in the Medicare expansion just because it is known by Obamacare and they can't stand Obama or is more of a resistant to government health care?

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I know that for the last 6 years I have had the worst insurance I have ever had in my life. I remember bitching about HMO's... how I'd love to have that back now.

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@McGentrix,

I have had mixed. My company now because of the high cost and/or because some insurances now do not qualify under the obamacare - has a more limited choice. My prior choice is not available so I am forced to enroll in the high deductible.

So what happens - my normally healthy kids who rarely are seen by doctor outside of annual physicals both get injured. One in January shortly after I get the high deductible. I was suggested to bring her to the hospital by her doctor after getting a suspected concussion. Before I would pay at the most $100 for the emergency room. Now because of a high deductible it was all out of pocket until I reached the $5k (assuming you use doctors/hospitals in the network) for a family so a couple of thousands of dollars out of pocket we are on our way. Follow up visits - many hundreds more (which would have been $25 for each 3 visits). Still not at the $5k quite yet.

Then a couple of weeks later the other kid goes down - a sprained ankle - I bring her to the doctor's office - xrays/crutches/air cast - more money - which again would have $25 and nothing extra for the supplies. So this is all within the first few months of the year - then a knee sprain - more xrays; a knee brace - more money - within the first three months of the year I am just a few dollars from the 5k which would have been less than $250 in my previous life.

So the orthopedic PA (can't see the doctor because she is only 13) - says nah she doesn't need PT so he doesn't recommend her for it. I call my insurance and find out I don't need a referral for PT - so I figure what the heck first visit and I am up to the $5k and now insurance kicks in to pay 90% - heck year I'm getting get my money's worth.

And guess what in July another what we thought sprained ankle in a national competition. Trainer there thought it was just a minor sprain so taped her up and she finished the next few games. Then went onto to play summer softball for another month - swollen didn't go down.

I didn't want to see a PA - I wanted a real doctor for her. So I called the insurance company and again - the only good thing - I don't need a referral from her primary care who kept giving me this PA. Found a kid's orthopedic doctor and found she actually fractured her growth plate - now with the 10% I only have to pay the boot and specialized and more PT are well worth.

Long story short - only benefit is that I now don't need referrals - just need to check with the insurance company for someone in the network. And once you spend all the high deductible, health care is cheap.

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@McGentrix,

I've been covered under MediCare for over 15 years now, and love it! My co-pay for doctor's visit is $35 which is very reasonable to me. My hospital stay at Kaiser Hospital was a bit over $100/day, and I found that to be very reasonable for the care I got. Doctors, nurses, and techs were all excellent. Many were trained at Stanford or UC San Francisco.

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I never could afford Kaiser. When I first worked in the med world I had heard some iffy stuff about Kaiser (that was a long time ago) but I came around to appreciate it from hearing from friends, and finally when an early excellent boyfriend was head of their Emergency room for some years, and I knew he was a sharp doc.

I ended up with Blue Cross. Always expensive to me, if less than Kaiser then, and with my later health difficulties and large payments to BC over years, I became and stayed insurance poor, the costs killing my savings. Finally I was eligible for medicare, almost happy to get older. Not perfect, but a big help. I had to apply early, as it was, no waiting until the best age.

I'm glad there is help out there now, however imperfect, and I can easily believe it's imperfect.

I still wish Atul Gawande would take over the med world, but he's busy.

https://en.wikipedia.org/wiki/Atul_Gawande

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I do know of folks who are covered for the first time in their adult lives because of the Affordable Care Act.

There is also, no doubt, a difference among the states which embraced the ACA versus the ones not taking the Medicaid expansion. But it's not as stark a difference as I had thought. See: http://www.ncsl.org/research/health/affordable-care-act-expansion.aspx

Looking at their map, here's what I found. The state with the smallest % of uninsured seems to be Massachusetts with 4%. That kinda makes sense as we had universal health care before the president took office. Highest percentage of uninsured seems to be Texas, with 17%. Mass took the expansion; Texas did not. In Mass, the % of people with Medicaid is 24%. In Texas, it's 18%. Keep in mind, of course, that the lower Texas percent on Medicaid probably still translates into more people than Mass's percent, due to population differences.

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@jespah,

I just reread about Gawande on Wiki, the link I gave, and learned more about him than I already knew. I remember pushing that New Yorker 2009 article here on a2k, no takers, gah.

Anyway, I remember him as quite sane about medical practice issues of many sorts, including good private practice, and he is still on the young side (50) and, by virtue of his background, in a position to help re advice for good changes.

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@McGentrix,

McGentrix wrote:

I know that for the last 6 years I have had the worst insurance I have ever had in my life. I remember bitching about HMO's... how I'd love to have that back now.

I'm sincerely interested, what specifically have your issues been?

I've had none.

I've spoke of this on other threads, but my situation is as follows.

My husband is on medicare, so has separare insurance from me.

Our taxable income puts us above the mediCAID (I emphasize since so many people confuse medicare and medicaid, and have already done so in this thread) .

For me, I have one of the Human Silver plans. My rates are reasonable. I do a small contract job, and twice this year things changed, and I had to go online to healthcare.gov to let them know first my income increased (yay), and just last month to let them know that it (unexpectedly) went down. I made sure I did this so there wouldn't be an issue with me overpaying premiums, and with other tax considerations I have, potentially have them keep money I wouldn't have had to pay. Honestly, yeah, some people would have been confused how to figure how much to tell them income dropped (I'd rather pay a little at the end of year than wonder if I got enough back), but I can't help that about other people tax knowledge and math skills.

Each year at zero cost I get a well woman exam, which includes a pap test, pelvic exam, referral for no cost mammagram, when needed referral for colonoscopy, flu shot.
If I go to my PCP for anything else, I think the office visiit cost is $35. I had to go to a specialist twice, and those office visits were $45.
I get my routine meds through mail order, and a 3 month supply varies, but ranges from $15 to $20-ish each for each. So like $5 to $7 for each drug a month.

I did have to initially change physicians, but I've developed a good doctor patient relationship with my new one. She's great.

In contrast, husband is on Medicare. He is on a metric sh!t tons of medications, which every year means we have to slog through the Medicare drug gap (AKA the donut hole), and even with a supplementary drug plan we have to pay a staggering $4850 dollars of our own money out of pocket before we fall back into the catastrophic care stage. To give an example of just one of his meds, while he was in the donut hole this year, one of his meds, for a ONE month supply, cost him close to $300. We just got out of the hole, and now the price for the same drug for one month is $20.
Each year when he gets out of the hole, we immediately start saving, buying discounted gift cards for our pharmacy to save 10% to 13% every month and stock piling them for next year.

If he was my age, (12 years younger) not yet on Medicare, none of this would be going on.

So what's your story McGentrix why you hate it so much?

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@chai2,

Quote:

If I go to my PCP for anything else, I think the office visiit cost is $35. I had to go to a specialist twice, and those office visits were $45.

Because I used to be able to have such a plan - but now it is not available to me because of the higher costs - the company no longer offers it. The costs were more reasonable before - otherwise why would the company drop this insurance? Either that or because of obamacare it is no longer offered so the only option is a high deductible which sucks if you need any care other than an annual physical which is totally at no cost.

For some people they benefited from what was offered via obamacare and for others it hurt. Simple fact - you have to get the money somewhere to pay for those who did not have insurance. Unfortunately it seems to have hurt those that work a normal type of job. At least that is what I have heard from others similar to myself that work where insurance is normally offered through their companies.

Those the benefits went down and the costs increased.

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@Linkat,

Agreeing linkat.

I just get frustrated when it goes to auto pilot on "Obamacare sucks!"

If there were no obamacare, I would have, when I decided to leave my well paying job which was literally making me sick, and had to have taken some job I also didn't want. I was at the top of my pay scale, and any other job I took would have been a huge step back moneywise (why hire me at higher pay when you can get a younger person for less) I would not have been able to pay for any health care unless I took a job for much less than I'd been making, and still be getting up at 5am. Which actually I did for maybe a year after leaving my job before my life situation changed.

As with everything, it's a balancing act. In a few more years, you won't have kids on your plan. I worked for years just to have insurance to cover my husband, regardless of how it was harming me.

For the first time in my life, I'm being selfish, recognizing I've paid my dues, and yeah, those in their prime working years can kick in for it, the same way someone is going to do it for them someday. I did it for years, not anymore. Think about me staying up until 2 or 3am and sleeping in when you're stuck in traffic, and realize that'll be you someday.

You're absolutley right, the money has to come from somewhere. No surpise there.

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Our experience has been very much like Linkat's. To keep our premium the same our co-pays have more than doubled (from $20 to $50) and we have a $10,000 deductible instead of a $2,000 deductible.

We've essentially stopped going to the doctor. We keep paying just in case something catastrophic happens.

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The present situation with Obamacare is no longer sustainable without massive government subsidies. This is illustrtated by the ongoing exit of major insurers from the Health Care exchanges. The system is collapsing as a result of its own internal contradictions.

In this ill-conceived legislation the government has attempted to significantly increase the demand for medical care through subsidized insurance for low income people, while at the same time requiring new (and often inapplicable) elements of coverage in all individual health care insurance policies, and - even more significantly, at the same time, effecively reducing the supply of medical praticioners and facilities, as a result of the side effects of its increasing control of the pricing of medical services and overt pressures to force the consolodation of hospitals, laboratories and indeed even the practices of individual doctors.

It also turns out that individual people are generally better at figuring out what is in their own self intertest, than are the self-appointed architects of their lives (like the ill-famed Dr Jonathan Gruber of MIT). Thus people delay signing up until they get sick, and in other ways defy the forecasts of those who designed this stupid maze.

Administrative costs for doctors and medical facilities are rising as the endless appetities of government bureaucracies for rules and paperwork are imposed on them. Fewer people are seeking careers as doctors, nurses and medical technicians; hospitals and laboratories are closing and being consolidated - and little investment is being made in replacement facilities, because no one can calculate the return on investment that will result in a market controlled by politicians. .

While governments can attempt to legislate changes to the laws of supply and demand (much as King Canute illustrated to his courtiers in ordering the Tide to stop coming in), the world simply ignores such futility.

Surely the spectacle of Maduro's Venezuela should be illustrative here. Just about every productive element of the Venezuelan economy has shut down under the socialist follies that have attended the "Bolivarian revolution". Price controls in a time of scarcity yield only black markets and less production of goods and services.

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@boomerang,

boomerang wrote:

Our experience has been very much like Linkat's. To keep our premium the same our co-pays have more than doubled (from $20 to $50) and we have a $10,000 deductible instead of a $2,000 deductible.

We've essentially stopped going to the doctor. We keep paying just in case something catastrophic happens.

Essentially stopped going to the doctor? Welcome to the world of thousands of people who before obamacare couldn't afford it either, and ended up at the emergency room when things got bad.

Couple of questions about the above, that isn't making sense to me.

This isn't so much directed at you boomer, but to those who are in the same situation, and having the same thoughts about it. Since you brought it up, I'll ask you.

If you've stopped going to the doctor, but keep the premiums in case of catastorophic, isn't there some sort of lower cost catastrophic policy you could get instead?

Also, if you're not going to the doctor as often, I assume you somehow take care of the injury or illness on your own with OTC drugs or other options? If that's the case, why were you bothering going to the doctor before? Do you consider that somehow you may have been overusing the system before?

I ask this because over the years, when I would have the occassional run of the mill cold, stomach bug, what I considered a small injury, there would often be someone who would say "You should go to the doctor" Why? I know what to do for the above, and it would be what the doctor would have told me to do. I go to the doctor (beyond preventive yearly things) to help me with things I can't handle at home.

If the difference in cost before/after is $30, do you find youself spending that much or more to fix what is wrong? If so, why not just go to the doctor?

You're a generous person I know, and give a lot. Do you ever consider your higher costs as a contribution to the welfare of others who otherwise could not afford it?

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@chai2,

Quote:

You're a generous person I know, and give a lot. Do you ever consider your higher costs as a contribution to the welfare of others who otherwise could not afford it?

That was my thinking. I wasn't overly worried about it because we typically don't go to the doctor all that often. Then something went wrong with me and now I'm a bit wigglier about it.

I have a tumor in my arm. I know I should go in and have another MRI since it's been a year since the last one and I know that it has grown. The MRI will cost a couple of thousand dollars. They'll probably want to remove it since it's been growing and I was warned. There are two orthopedic oncologists in my city and neither of them is in our "network" so I'd pay out of pocket. Since my arm doesn't hurt I ignore it. That's what I mean about not going to the doctor.

Mo had something happen to his eye at football practice today. We're taking a "wait and see" approach where typically I would just run over and have it looked at. That's what I mean about not going to the doctor.

There is probably a lower priced catastrophic policy but the thought of that is terrifying. I know then that we'd all really feel like we should wait and see on everything.

I want everyone to be insured but I want insurance I can use too. I feel kind of screwed over.

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@boomerang,

That is the downside .. you end up not going to the doctors if you are sick because it costs so much. I didn't have much of a choice for a suspected concussion. We waited on the sprained knee when I normally would have brought her right away. As a result she was worse off and could have injured herself further.

This means delaying care that could be quicker and easier and lower costs.

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@Linkat,

That's exactly it.

We're the people caught in the muddy middle.

It sucks.

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Do you have a county hospital? I know we have one in San Jose that's pretty good, because our son used them.

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Here's what happened to people without health insurance since Obamacare

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