Remember those heady pre-Obamacare days when Barack Obama promised, “I will sign a universal health care bill into law by the end of my first term as president”? Key the term “universal health care,” which means that virtually everyone would be insured.
Today, the public is painfully aware of just how much space there is between President Obama and his promises—in numerous areas.
New U.S. Census Bureau figures are out claiming the uninsured have declined from 13.3 percent of the population to 10.4 percent, which means 8.8 million more people had coverage in 2014 than 2013. There are still 33 million uninsured, and the Congressional Budget Office predicts there will continue to be just under 30 million for the next decade.
To be sure, we’ve see a sharp decline in the uninsured, but it’s far short of the universal coverage Obama promised. And yet the administration and various advocates boast as if Obamacare has exceeded its coverage goals.
Indeed, the legislation’s drafters were so confident of attaining near-universal coverage that the law began phasing out federal payments to hospitals that treat a disproportionate number of uninsured, known as “DSH payments.” If there are no uninsured, the reasoning went, there would be no need for DSH payments. But those hospitals have been complaining because, while the payments have declined, they are still treating a large number of uninsured patients.
Moreover, the smaller number of newly insured means the cost per insured has gone up. Obamacare spends an additional $1 trillion over 10 years, according to early CBO estimates, and we’re getting 8.8 million newly insured people for it, or about $11,000 per insured person per year.
While the number of uninsured may continue to decline, especially if the states that haven’t expanded Medicaid decide to do so, it is unlikely we will see the uninsured number drop to anything like the initial predictions. There are several reasons for this.
First, there are lower-income families that are eligible for Medicaid but don’t take the time or trouble to sign up. The policy journal Health Affairs estimated prior to Obamacare’s passage that two thirds of uninsured children were eligible for Medicaid or the Children’s Health Insurance Program (CHIP) but weren’t enrolled.
Medicaid coverage has grown significantly since the passage of Obamacare, mostly due to increased eligibility standards. And the mandate requiring people to have coverage surely spurred some of the new enrollees, even in states that didn’t expand Medicaid. But it is very likely that there are still millions of Americans eligible for Medicaid who haven’t taken the time to enroll—and won’t until they need it.
In addition, although the primary reason for being uninsured is the cost of coverage, there have always been millions of Americans with good incomes who don’t want to spend their money on health insurance. According to the Census Bureau’s new numbers, 5 to 6 percent of those making more than $100,000 are still uninsured.
Finally, the Census Bureau does not check respondents’ immigration status. The National Institute for Health Care Management estimated in 2008 that about 10 million of the uninsured were immigrants, with 4.4 million being documented non-citizens and 5.6 million undocumented. The vast majority of the undocumented will likely never get coverage because they have other uses for their earnings, such as sending them home to help their families.
In short, while Obamacare has reduced the number of uninsured significantly, it will never solve the uninsured problem—not even close. Like so many of President Obama’s ventures, taxpayers are getting meager results, given the hundreds of billions, even trillions, we are spending.
What a waste. When Obama entered office, there was wide bipartisan support for addressing the problem of the uninsured, providing low-income families with subsidies so they could afford coverage, and ensuring that people with preexisting medical conditions could get coverage.
A less ambitious plan would have led to similar coverage results, but taxpayers would have been much better off. And the president would have saved the country a years-long health care battle that has cost us all.