National health reform will expand insurance coverage by about 30 million people, reducing the number of uninsured by more than half. In this report, the authors analyze the likely composition, state by state, of those who will remain uninsured. Of the nonelderly adults uninsured under national health reform, 37% would be eligible for Medicaid but not enrolled and 25% would be undocumented immigrants. Sixteen percent would be exempt from the individual mandate because they had no affordable insurance option. The authors find significant state and regional variation in the characteristics of the uninsured.
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The Patient Protection and Affordable Care Act (ACA)
will expand insurance coverage by about 30 million people. Although this still falls short of universal coverage, the number of uninsured people will be reduced by more than half. Safety net providers and programs, therefore, will still face the challenge of substantial numbers of uninsured who cannot afford a full range of needed services.
Even more than the number of uninsured, the composition of the uninsured will change substantially under the ACA, and accordingly, their reasons for being uninsured. Beginning in 2014, most Americans will be required to have health insurance coverage meeting certain minimum requirements and will be subject to financial penalties if they do not comply. Exemptions will also be granted if no affordable insurance coverage is available and for a variety of other specialized circumstances,
such as people who are Native Americans, prisoners or have
religious objections.1 Medicaid eligibility will expand greatly
for adults in many states, but little or not at all for children. Due
to CHIP, their eligibility levels for public coverage are already
much higher than for adults. Undocumented immigrants are
not subject to the mandate, nor are they eligible for Medicaid
or for any federal subsidies.
This brief analyzes this changing composition, state by state,
of those who will remain uninsured. This information can
assist states and communities in health policy planning on
several fronts, such as planning for expected demand in the
new insurance exchanges. Most importantly, knowing how
many and what kinds of people will remain uninsured will
assist safety net providers, organizations, and support systems
to determine ongoing needs for those who cannot afford
access and optimal structures for addressing those needs.
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