Despite the existence of many different insurance plans and models, there is still a significant uninsured population in the US. While there are many reasons for this, the result is a fragmented healthcare system.
Insurance options in the US range from public options that you’ve already learned about, like Medicare for the elderly and CHIP for children, as well as private options like employer-based insurance (which is required for an employer if they have 50+ employees). Another insurance option available is purchasing non-group, or individual insurance.
Before the Affordable Care Act, the individual insurance market was limited to healthy people. Insurance companies were looking to avoid the high-risk associated with negative health conditions. However, most healthy young individuals were not looking to buy their own insurance. They did not feel as if they had enough health fees to deem insurance necessary. One of the biggest goals of the ACA was to expand this market.
This was accomplished by making insurance more affordable with tax credits and subsidies, in addition to the Individual Mandate that called for every person to have health insurance. It is important for insurance pools to have as many healthy people as possible, as it pools more money to fund the sicker individuals. Trump has since gotten rid of subsidies and the Individual Mandate.
There are also large gaps in the public insurance sphere. Traditional Medicaid only covers low income children, parents, and pregnant women, as well as those with disabilities. This leaves out low income single adults, a population whose size varies from state to state as the income cutoff differs per state. While states can expand the Medicaid program as they see fit, it can be incredibly expensive even with help from the federal government. Therefore, there is a coverage gap — there are many who have incomes less than 100% FPL, but who do not qualify for Medicaid. These people are disproportionately young and nonwhite, and most live in the South, where a lot of states have not expanded.
The Affordable Care Act aimed to expand coverage and did make significant strides for certain populations, but a lot of people remain uninsured. The biggest reasons that people don’t have insurance are:
- It is too expensive
- A change in employers or loss of a job
- No longer qualify for Medicaid
Additionally, Trump made budget cuts in outreach, so many people who qualify for subsidized insurance do not know about it. At the end of the day, many of the barriers preventing people from being covered could be solved by simply generating more awareness for the types of systems out there.