Despite ACA, remember that millions will remain uninsured

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Who will still be uninsured a decade from now?

We know millions of people are going to get covered under the Affordable Care Act. But who won’t be?

In 2023 there will still be 31 million uninsured, according to the Congressional Budget Office.

Who are they?

  • The undocumented (Even in the unlikely event that Congress passes a sweeping immigration bill this year, the path to citizenship will be slow and health coverage won’t come for years.)

  • People whose income is low enough that they qualify for expanded Medicaid but who live in states that have opted not to expand.

  • The rest are people who are exempt from the individual mandate (affordability, etc.) or who just decided they don’t want to be covered and will pay the penalty. Or they are part of the “hard to reach population” that qualifies for government assistance but never quite understand it’s for them or get the help they need to actually enroll.

Remember that it’s not 31 million out of the roughly 48 million who are now uninsured – without the law, the number of uninsured would have kept growing.  Thirty-one million is still a lot of people – and someday Congress may come around to doing something about it (but that someday is not imminent). But as a percentage of the population, it’s a sharp drop.

Right now about 80 percent of the non-elderly are uninsured insured* (the elderly are covered by Medicare). That’s one in five uninsured.

In a decade, 89 percent will be uninsured (92 percent if undocumented people are included). So that’s just a bit over one in 10 remaining uninsured. That’s a change.

Update: If you want the  most current uninsurance rates for the entire population – including the elderly on Medicare – it has dipped slightly to 15.4 percent according to the just-released Census figures. I don’t think the Census bureau does forecasts for future insurance/uninsurance rates – at least I didn’t find them when I searched summary tables of various population growth projections. If someone has them, please email me and we’ll post them.

Here is an article about the remaining uninsured (focusing on clinics that will still have plenty to do in a suburb in Virginia – which isn’t expanding Medicaid, as of now) and a conservative critique of the coverage numbers.

*Correction: Eighty percent of the non-elderly are insured, according to this table from the Congressional Budget Office. An earlier version of this post incorrectly said 80 percent of the non-elderly were not insured. 

Joanne Kenen