Uninsured

Are the uninsured eligible for ACA coverage?

- Almost half are eligible for financial assistance (through Medicaid or tax credits) - Others are ineligible/unable to purchase because of: 1. Coverage gap 2. Immigration status 3. No financial assistance because of ESI offer 4. No financial assistance because of income

What are the most common reasons for being uninsured, according to surveys?

1. Cost is too high (45%) 2. Lost job or changed employers 3. Lost Medicaid 4. Ineligible for ESI 5. Family status change

Impact of being uninsured on your health

25% higher chance of dying - More likely to report access barriers - Less likely to get preventive screenings - More likely to be diagnosed with severe conditions - More likely to be hospitalized for preventable conditions - Receive poorer care in hospitals

About what percentage of non-elderly are uninsured?

8.8%; 27-28 million people - Higher rates of uninsured adults than children because it is much easier to get Medicaid as a child

How has the uninsured rate changed since the ACA was enacted?

Declined by 20 million+ since 2010

Spillover effects

High rates of uninsured can affect the insured members of a community Create access barriers for everyone - Privately insured in communities with high rates of uninsured are less likely to have a place to go, routine care, or specialist care when needed

Who experienced the biggest drop in uninsured rate (gain in coverage) after ACA?

Hispanic population - Still the highest percentage of uninsured within the Hispanic population WHY? Fears of getting deported, so people fail to seek enrollment

Underinsured definition

Inadequate insurance coverage (unaffordable, necessary services aren't covered) Ex. Having insurance but having very high deductible (have to pay full cost of care while trying to meet the deductible) Ex. Annual income may be too high to qualify for charity care or sliding scale

Does a good economy always lead to greater numbers of insured?

No - only sometimes Increased coverage often comes from employers offering health insurance to attract workers - Employees get better jobs (with coverage that they didn't have before) - Employees get higher wages (to pay for private plans)

How do uninsured rates differ across racial and ethnic groups?

Percentage of each ethnicity uninsured (high to low): 1. Hispanics 2. Black 3. Asian 4. White

Of the poor, near poor, and not poor, who experienced the greatest drops in uninsurance after ACA?

Poor and near poor - Only a small drop for the not poor

How do uninsured amounts of care compare to insured?

Receive less than half as much care as the insured - A lot of this is uncompensated care for which the provider is not paid by the recipient - A lot of this is funded through the federal government - Also, private insurance often covers more than the actual costs of the insured to foot bill for uninsured

How does rural coverage compare to urban?

Rural populations: 1. Higher proportion covered by Medicare and Medicaid 2. More likely to be self-employed or work for small employers (no ESI) 3. More likely to be uninsured (especially in remote) 4. Tend to stay uninsured for longer periods 5. More likely to live in non-expansion states 6. More likely to fall into coverage gap in these states HOWEVER rural uninsured have fewer barriers to access

T/F: Rural uninsured are more likely to have a usual source of care and use services than urban uninsured.

TRUE (everyone knows everyone, aren't discriminated against, rural providers take on safety net role)

What are some of the major reasons for being uninsured?

Too expensive (even if eligible for Medicaid or tax credits) Confusing about eligibility rules Immigration status

T/F: We will always have some number of uninsured people no matter how strong outreach and education is.

True 1. Those with ineligible immigration status. 2. Those who fall in the Medicaid coverage gap 3. People who choose to remain uninsured

T/F: More than half of bankruptcies in 2007 were medical in nature

True Mostly well-educated middle-class homeowners,

T/F: Most people who file for bankruptcy are insured.

True - Means that many are underinsured - Gap in coverage is a predictor for bankruptcy

How do OOP costs compare for uninsured vs. insured?

Uninsured pay about 30% of costs OOP, while the rest is uncompensated (mostly covered by federal government - 63% of uncompensated care bill)

Impact of unpaid medical bills

Uninsured way more likely to have medical debt - Hurts credit rating badly - Can hurt financial situation even more (affect rent/mortgage rates, etc.) - Everything else in your life can become more expensive too

Does a bad economy always lead to greater numbers of uninsured?

Yes - People lose jobs & ESI - People with ESI may not be able to afford anymore - Marketplace insurance may be too expensive - More people may fall in coverage gap of non-expansion states

Once covered, are there barriers to care?

Yes - Higher for public compared to private insurance - Higher for adults compared to children

Is poverty linked to being uninsured?

Yes - Of adults, the highest percentage of uninsured are the poor (<100%FPL) - However, for children, the near poor (100-200%) are the ones falling through the cracks. Medicaid program is very robust for poor children.

Have rural populations gained coverage through ACA?

Yes (by 8%)

What age population is most likely to be uninsured?

Young adults (19-25)