Uninsured

While a federal district court struck down the Affordable Care Act as unconstitutional on December 14, the Act and the litigation will continue. The judge didn’t issue a nationwide injunction which would have had the effect of immediately ceasing all aspects of law.

Unsurprisingly, the states defending the law have stated they will appeal this ruling to the Eleventh Circuit. Particularly if the Eleventh Circuit agrees with the lower court the Supreme Court is likely to hear this case though not until its next term beginning October 2019.

The Affordable Care Act individual mandate required uninsured who didn’t purchase health insurance to pay a so-called shared-responsibility payment. In 2012 the Supreme Court held the individual mandate is a constitutional “exercise of Congress’s Tax Power because it triggered a tax.” The Tax Cuts and Jobs Act of 2017 reduced the tax to $0 as of January 1, 2019.

Yesterday, the U.S. Census Bureau released a report with 2017 data on health insurance status in each state. In 2017, 28.5 million people (or 8.8 percent) did not have health insurance at any point during the year. The uninsured rate and number were not statistically different from 2016. In some states the uninsured rate change between 2016 and 2017 was statistically significant. In three states – California, Louisiana, and New York—the percentage of people without insurance decreased, but in 14 states the percentage increased. The states where the uninsured rates increased are Connecticut, Florida, Georgia, Illinois, Iowa, Massachusetts, Minnesota, Ohio, Oregon, South Carolina, Tennessee, Texas, Vermont and West Virginia.

In September, the U.S. Census Bureau released the highly anticipated Health Insurance Coverage in the United States: 2014 report and the Income and Poverty in the United States: 2014 report. The Census Bureau’s annual survey of health insurance coverage found that significantly fewer American adults remained without health insurance in 2014 compared to the year before.

With a special session of the Florida legislature underway to adopt a state budget for the next fiscal year that begins July 1, federalism questions abound. Florida Gov. Rick Scott filed a lawsuit against the Obama administration in April, challenging what Florida Attorney General Pam Bondi characterized in an April 28 press release as “the federal government’s attempt to coerce Florida into expanding Medicaid” by withholding federal funding for hospitals that provide care to the uninsured. The federal government had notified Florida it would withhold $2.2 billion in funding for Florida hospitals in fiscal year 2016.

The Cleveland Clinic, one of the nation’s largest hospitals, reported a 40 percent drop in charity care and credited the good news to Ohio’s Medicaid expansion, according to Kaiser Health News. Free care costs fell from $171 million in 2013 to $101 million in 2014.

One of every 30 people living in 25 states that have declined the option to expand Medicaid eligibility will likely remain uninsured, according to CSG calculations. CSG analyzed data from a new Kaiser Family Foundation report that estimated 5 million low-income adults would fall into a coverage gap, where they would remain uninsured as they are not eligible for Medicaid under their states’ current rules and will not qualify for the new federal tax subsidy to make insurance purchase affordable beginning January 1, 2014.

As the percent of the population with health insurance coverage has fallen—from 86.5 percent in 2001 to 83.7 percent in 2010, according to the U.S. Census Bureau—the focus on coverage has become more acute.

According to the Census Bureau, 49.9 million people – or around 16.3 percent of the U.S. population – were without health insurance coverage in 2010. The percentage of the population that is uninsured that has been dropping for 10 years.  The percentage of insured residents ranges significantly across states, regions, age groups, racial and ethnic groups and income levels.

This brief from the Midwestern Legislative Conference Health and Human Services Committee explores what actions states must take this year in order to set up health insurance exchanges.

The Affordable Care Act mandates that states operate insurance exchanges to enable every citizen across the country to purchase or renew health insurance. The reform legislation provides federal support for “necessary” expenses so states can plan, establish and operate the exchanges for the first year of 2014. Although it specifies several conditions that insurance products offered through the exchange must meet, it allows the states great flexibility in determining how they will regulate and how much reform they will introduce for their state insurance market. Read about what health insurance exchanges can accomplish, how state Medicaid programs will be involved and what decisions states are facing in 2011 and 2012 related to health insurance exchanges.

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