Why the Census Bureau report on the uninsured is not reassuring


Don McCanne, M.D.


While many are celebrating the fact that the Census Bureau reported a slight decline in the percentage of individuals who are uninsured, decreasing in one year from 15.7 percent to 15.4 percent, that celebration is premature since the total number of uninsured has not changed significantly, remaining at 48 million. If you look at the numbers of uninsured in isolation from the other changes in health care financing, next year’s numbers will be more impressive since many will enroll in the expanded Medicaid program and others will enroll in the plans to be offered in the state Marketplaces (state insurance exchanges) – more impressive numbers, yet deceptive.


What will be disappointing is that the number will fall far short of what should be expected for “universal” health care coverage. Even after Obamacare is fully implemented, the Congressional Budget Office predicts that 31 million will remain uninsured.


The plans to be offered through the state exchanges that most people will select have low actuarial values, meaning that the patient will have to pay a significant amount out-of-pocket whenever health care is needed, especially because of high deductibles. Many who qualify for subsidies will still find them inadequate to prevent financial hardship.


Of perhaps greater concern for those who are insured is the deterioration in the quality of the insurance that will be covering most of us. Employers are now introducing not only high deductibles, but some are moving to “narrow network” panels – panels of covered physicians and hospitals that offer their employees far fewer choices. Further, some employers are switching to defined contributions (“vouchers”) for private insurance exchanges which transfers the future increases in health care costs from the employers to the employees and their families.


What is really sad is that we could have covered the remaining 31 million people who will be uninsured while eliminating underinsurance plans that leave patients exposed to excessive costs while diminishing their choices of their health care providers. We could have done this simply by enacting a single payer national health program – an improved Medicare program with better benefits which would include absolutely everyone, and we could have done this without spending any more than we do now. 


Although political forces will require that we let Obamacare play out for a couple of years, we will soon see that no coverage for some, and poor coverage for far too many of us will no longer be acceptable.  Maybe then we will have the wisdom to demand an affordable program that will work well for all of us: Improved Medicare for All.



Suggested reading:


United States Census Bureau, September 2013, Income, Poverty, and Health Insurance Coverage in the United States: 2012 http://www.census.gov/prod/2013pubs/p60-245.pdf


PNHP, September 17, 2013, 'Stronger medicine than Obamacare needed to end uninsured crisis': health expert http://www.pnhp.org/news/2013/september/stronger-medicine-than-obamacare-needed-to-end-uninsured-crisis-health-expert


Tag lines: Affordable Care Act, Obamacare, Congressional Budget Office, uninsured, underinsured, Medicaid, Medicare for all, single-payer, state insurance exchanges.