Essay on The Impact of the Affordable Care Act on North Carolina’s Uninsured Population
To date, the program “ObamaCare”, which requires every American to have health insurance, is very contradictory and discussed. During the presidential election, Barack Obama promised to make health insurance universal and accessible to all people. He fulfilled his promise by signing “Affordable Care Act” in 2010, which became legal on 1 October 2013. Law aims to change the health care system of the USA.
It is known that in 2008 the US budget lost $43 billion dollars due to uninsured citizens. Harvard Law School has estimated that 62% of personal bankruptcies in 2007 were caused by expensive medical bills. In addition, Congressional Budget Office (CBO) in 2011 informed that reform Obamacare would reduce the federal deficit in the US for nearly $150 billion dollars within 10 years, and a year later his predictions changed to $84 billion dollars over the same period. At the same time introducing a new program within these 10 years, would cost federal budget about $1.7 trillion. The reform was started in 2010 after Congress supported Obama’s bill (eHealth, 2014).
There is no free health care in the USA, and its costs are the highest in the world. The new reform requires the vast majority of uninsured Americans buy insurance in 2014. People with low incomes are provided with government subsidies. However, the verdict of the Supreme Court has allowed a number of states not to expand the already existing system of health care to the poor Medicaid, as required by federal law. Thus, in many states there is a layer of citizens who are not enough poor to get help, and not rich enough to get subsidies for insurance.
White House said in a press release that 24 states have decided not to expand the program Medicaid. “Some states are so fixated on policy of Obamacare reform that they refused to extend the coverage of the program Medicaid, which could help many working families get insurance. As a result, 5.4 million people in these states remain uninsured.” The administration estimated that the largest number of such citizens live in Texas – 1.2 million people. It is followed by Florida (848,000), Georgia (478,000) and North Carolina (377,000). The White House believes that 4.6 million people will receive health insurance through Medicaid expansion in states, which have expanded it (eHealth, 2014).
The program “Obamacare” obliges everybody to buy insurance, in case of unwillingness – fine. This year it is $95 per person and up to $285 per family. Amount of the fine will increase by 2016 to $695 per person and up to $2,085 per family (eHealth, 2014). Many people disagree with such policy. According to polls, up to 25% of the uninsured are not going to buy health insurance. They believe that it is cheaper to pay a fine. Prices for insurance plans vary, depending on their type. There are 5 of them: “Bronze”, “Silver”, “Gold”, “Platinum”, “Catastrophic”. Each of them requires a different amount of the monthly payment (premium), with additional co-payment and deductibles. And the prices are not quite cheap (Schoen, 2010).
The Affordable Care Act is meant to extend coverage to almost all 47 million nonelderly uninsured Americans, including the 1.6 million uninsured citizens of North Carolina. It was supposed that Medicaid would cover the most uninsured, low-income people and legal immigrants who have lived in the USA for at least five years. But in 2012, the US Supreme Court, in National Federation of Independent Business v. Sebelius, 132 S. Ct. 2566, made a decision that this mandatory Medicaid expansion was coercive to the states unconstitutionally. According to this decision the Medicaid expansion is a voluntary choice of each state.
The number of Americans who get Medicaid coverage was supposed to increase in January 1, 2014, not considering if the state expands Medicaid to cover the newly insured people. It happened because before that some citizens of North Carolina are currently eligible, but are not enrolled yet. Some of them will prefer to enroll in 2014 or later, as they get to know about the new insurance coverage options that will be offered according to the ACA. Thus, the woodwork population will increase the Medicaid enrollment regardless of whether the state chooses to expand Medicaid. In case the state, under legislation from the North Carolina General Assembly decides to expand Medicaid eligibility, a great number of North Carolinians will become newly eligible in 2014.
Now, in order to qualify for Medicaid, a man must be a citizen or lawful permanent immigrant in the USA for not less than five years and must meet definite categorical, income, and resource requirements. The program Medicaid is usually limited to kids from poor families, or pregnant women or those who have dependent kids under the age of 19 living with them (eHealth, 2014). Elderly people (65 and older) and disabled are also limited by this program. In case the individual meets these categorical eligibility rules, his income must be below a certain amount threshold and have limited resources or assets to qualify. Such categories as childless, nonelderly, and nondisabled adults are not currently qualified for Medicaid despite their income (See Figure 1.) Due to such eligibility limits, North Carolina’s Medicaid program covered only 30% of all poor adult population of the state whose incomes are more than 100% of the federal poverty level (FPL) in 2010-2011 (CBS, 2013).
In the past, Medicaid didn’t cover adults because eligibility was limited to specific categories of low-income people, including children and their parents, pregnant women, the elderly, or disabled people. Almost in all states of the USA, adults who did not have dependent children were ineligible for Medicaid, despite their income level, and income restrictions for such parents were rather low (less than the half the poverty level). The aim of ACA is to fill in these gaps by extending Medicaid to almost all nonelderly people with incomes at or less than 138% of poverty ($32,500 for a family of four people in 2013).
In North Carolina, which don’t implement the expansion of Medicaid program eligibility for adults will stay rather limited (it is shown by the dark blue shading in Figure 1). Now in North Carolina, Medicaid eligibility for non-disabled people is limited only to parents whose incomes are less than 43% of poverty, or $10,100 per year for a family of four people, so parents who don’t have dependent children stay ineligible despite of their income (Health Care and Education Reconciliation Act, 2013).
According to the ACA, in North Carolina, more than four in ten (42%) uninsured non-elderly individuals are eligible for financial aid in obtaining coverage (Figure 2). One of the key ways for uninsured people to get coverage is the new coverage option in the state which is called Marketplace. Currently almost 513,000 (every third person) uninsured North Carolinians are qualified for premium tax credits to assist them in buying the coverage in the Marketplace (The Henry J. Kaiser Family Foundation, 2014).
Despite the fact that Medicaid eligibility is not expanding though the state, some uninsured citizens are eligible for Medicaid in 2014. Reflecting higher eligibility levels for kids than for grown up population, the majority (77%) of uninsured North Carolina citizens who are eligible for Medicaid consist of kids who are already eligible but not yet enrolled in coverage. Rather small number of uninsured grown up people (2% of the uninsured in North Carolina) is eligible for Medicaid in the state under eligibility pathways in place before the Affordable Care Act. The lack of knowledge about eligibility and historic enrollment barriers prevent a part of population from enrollment in the program (The Henry J. Kaiser Family Foundation, 2014).
North Carolina has 319,000 adults without insurance (20% of the uninsured in the state) who could be eligible for Medicaid if North Carolina expand fall into the coverage gap. All these people are all below the poverty line and that is why have extremely limited incomes. Since these people do not receive an affordable coverage option as a part of the ACA, they will probably remain uninsured Obamacare Info for North Carolina, 2014).
The Affordable Care Act will help a lot of currently uninsured citizens in North Carolina receive health coverage, but at the same time many of those who could have got financial assistance as a part of Medicaid expansion will still remain outside its reach. Later, the impact of the Affordable Care Act will depend on take-up of coverage among the eligible uninsured people, and outreach and employment efforts will be a key factor in determining the affects of the law at the uninsured rate in North Carolina. The Act requires most people get health coverage, but some individuals (those with the lowest income or those with no an affordable option) are not liable and others may again stay uninsured (The Henry J. Kaiser Family Foundation, 2014).
Do you like this essay?
Our writers can write a paper like this for you!
(No Ratings Yet)
Loading...