Health Reform WK-EDGE Health insurance numbers similar to 2018, but will COVID-19 change that?
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Tuesday, September 1, 2020

Health insurance numbers similar to 2018, but will COVID-19 change that?

By Cathleen Calhoun, J.D.

KFF study shows similar number of millions uninsured or under insured as were two years ago, but the impact of COVID-19 is not yet captured.

When the U.S. entered the COVID-19 pandemic earlier this year, 30 million people were uninsured, and 40 million people were under insured, but those numbers are certain to climb, according to the Kaiser Family Foundation (KFF). In its biennial study this year, KFF found both the number of people without health insurance, and the number of those under insured, had statistically irrelevant changes from its 2018 study. The 2020 study breaks down the numbers to show, among other details, why people have chosen not to buy health insurance. The KFF also warns of likely growing numbers of uninsured, and under insured, and suggests policy options that may provide relief.

Survey. In January 2020, before the COVID-19 public health emergency, the KFF interviewed a nationally representative sample of 4,272 adults ages 19 to 64 about their health insurance coverage through June 2020. In all, 400 interviews were conducted on landline telephones and 3,872 interviews were conducted on cell phones. According to the KFF, the sample was set up to generalize to the U.S. adult population and to allow separate analyses of responses from low-income households.

Study highlights. The main take-away from the study is that the numbers have not changed much since the previous study in 2018. In detail, the study found:

  • 43.4 percent of U.S. adults ages 19 to 64 were inadequately insured in the first half of 2020—statistically unchanged from the last time the survey was conducted in 2018.
  • Adult uninsured rate was 12.5 percent, 9.5 percent of adults were insured but had a gap in coverage in the past year, and 21.3 percent were underinsured. Again, all of these findings were statistically unchanged from 2018.
  • No statistically significant change in coverage inadequacy between the months leading up to the pandemic and the months that followed, but as the pandemic continues, this may change.
  • Half of adults who spent any time uninsured or who were under insured reported problems paying medical bills or said they were paying off medical debt over time.
  • People who reported problems paying medical bills had continuing financial problems including damage to their credit ratings and depleted savings.

Impact. The study found high uninsured rates among people of color, small-business workers, people with low incomes, and young adults. Specifically, more than one-third of Latino adults, workers in small businesses, and adults with low incomes were either uninsured at the time of the survey or spent some time uninsured in the past year. People with incomes below 133 percent of the federal poverty level (i.e., $16,971 for an individual and $34,846 for a family of four in 2020) reported uninsured rates that were three times higher than adults with incomes at 400 percent of the poverty level or higher (i.e., $51,040 for an individual and $104,800 for a family of four).

ACA. Why aren’t more people buying health insurance in the individual market or in marketplaces under the Affordable Care Act (P.L. 111-148)? Affordability was the number one reason that health insurance was not being purchased, with 71 percent of those who did not enroll citing cost as the main reason.

Conclusion and policy suggestions. The study notes that the Congressional Budget Office projects a 5 percent contraction in the U.S. economy in 2020. In addition, millions will suffer income loss due to furloughs, wage cuts, and declining business revenue, according to the KFF. As a result, many households will face unaffordable health care costs. The KFF recommends the following policy options at the federal and state levels that could potentially provide relief to U.S. families:

  1. Expanding Medicaid in to the 12 states that have yet to do so or providing federal fallback for people in those states.
  2. Enhancing and expanding ACA subsidies.
  3. Allowing more people with unaffordable employer plans to purchase subsidized coverage through the marketplaces, possibly through a public plan.
  4. Increasing outreach and enrollment efforts to inform people of their coverage options, particularly those who lose employer coverage.
  5. Banning non-ACA-compliant plans like short-term policies that leave people exposed to catastrophic health care costs.
  6. Developing an autoenrollment mechanism that will enable people to enroll and stay enrolled in comprehensive coverage.

The KFF study also notes the option of universal coverage, such as Medicare for all, and mentions that taking some smaller steps now would not preclude that option later.

Companies: Kaiser Family Foundation

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