Policy: Technology

EXography: States say most uninsured still won't be covered in 2014

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% reduction in uninsured

Percent reduction in uninsured as a result of ACA
Source: Urban Institute. Map by Luke Rosiak/Washington Examiner Watchdog,Richard Pollock,Barack Obama,Obamacare,Health Care,EXography,Kathleen Sebelius,,Technology

More than two-thirds of the estimated 46 million uninsured Americans still won't have health insurance at the end of Obamacare's first year of operation, according to forecasts by the 50 states.

The state projections could underestimate the true number of uninsured because the data was compiled before the disastrous Obamacare launch revealed major problems with its web portal.

According to the Urban Institute, which compiled the state estimates, about 63 percent of the uninsured will still be without coverage on Oct. 1, 2014. (See the accompanying map for state-by-state data)

The state projections contradict President Obama's promise that passage of the Affordable Care Act would assure every American of health insurance coverage.

It also appears that in some of the states where officials most enthusiastically embraced Obamacare, the plight of the uninsured will persist for years to come.

In a June 2009 speech before the American Medical Association, Obama declared that “we are not a nation that accepts nearly 46 million uninsured men, women, and children.

"We are not a nation that lets hardworking families go without the coverage they deserve; or turns its backs on those in need.

"We're a nation that cares for its citizens. We look out for one another. That's what makes us the United States of America. We need to get this done.”

But the state projections suggest it won't be done in 2014.

In Maryland, for example, officials estimated that there are 800,000 uninsured in the state. But Maryland Health Connection, the state's Obamacare exchange, projected enrolling only 150,000 people by the end of 2014. Only 3,800 were enrolled by Nov. 30, 2013.

Nina Smith, a spokesman for Democratic Gov. Martin O’Malley - who is considering seeking his party's 2016 presidential nomination - said large numbers of people will continue to be uninsured after 2020.

“In terms of the actual number of uninsured, the 800,000 number, we expect to cut that by half in 2020,” Smith told the Examiner.

In California, there are six million uninsured individuals. But Dana Howard, the deputy communications director for Covered California, the state’s Obamacare health exchange, said 1.5 to two million will still be without coverage in four years.

“We’re looking at between 3.5 to four million [enrolled] by 2017,” he said. So far, the state claims 777,000 have signed up, about 13 percent of its total uninsured.

Colorado won't make much of a dent in its estimated 800,000 uninsured people in 2014, either.

Connect for Health Colorado spokesman Ben Davis said about 75,000 individuals would be enrolled in 2014.

Davis said a “mid-point” enrollment would be 135,000. Fewer than 10,000 Coloradans had enrolled in the exchange to date.

“There’s no doubt the intent of the law is to give everyone health insurance,” Davis said. "But I don’t think a vast majority of American citizens do think that the result of the ACA is going to be that every single person is going to have health insurance. I don’t think that’s realistic.”

New York officials projected that 68 percent of their state's uninsured will still be without coverage. Florida would see the number of uninsured would drop 31 percent, but that will leave nearly 70 percent still without coverage.

In Missouri, two out of three would be without coverage. In North Carolina where the 2012 Democratic National Convention was held, only 29 percent are projected to get coverage. And in Vermont, three out of four would be without coverage in 2014.

The state projections are consistent with a Congressional Budget Office report earlier this year that said there will always be at least 30 million uninsured Americans.

“Even if everything goes right, they saw 30 million people still being uninsured,” noted Grace Marie-Turner, president of the Galen Institute, a conservative health think tank, referring to the CBO estimate. “Which misses by a long shot the promise of universal coverage,” she said.

Genevieve Kenney, a senior fellow at the Urban Institute, agreed with Turner. “Even when you look at full implementation, this set of policy changes is not expected to drive the number of uninsured to zero,” she said.

Thomas Miller, a health care senior fellow at the American Enterprise Institute, said expectations for reducing the uninsured have to be pared down.

“Clearly this law, its implementation, even on a good day from what we have seen, falls far short of the stated goal of covering people who were uninsured and lacking coverage,” Miller said.

Complicating the picture here is the fact that, while the law mandates that all Americans must carry health insurance by Jan. 1, 2014, it also contains hardship exceptions.

One of the exceptions applies for those who do not file tax returns. A second exempts people who would pay premiums higher than 8 percent of their household income.

Turner said neither exception makes sense since “many of them are people who most need help at the lower income scale.”

A third exemption is simply called a “hardship” exemption.

Miller said the vague nature of the hardship exemption gives a lot of leeway to Health and Human Services Secretary Kathleen Sebelius.

“The hardship exemption is pretty much within the purview of the Secretary of Health and Human Services. The secretary is not particularly pinned down to many hard and fast parameters in the statutory text as I recall,” Miller said.

“But it remains there for any open-ended interpretation,” he said.

Dana Howard at Covered California said the hardship exemption will be administered by the states, but ordered by federal officials.

“You’ll have to talk to the federal government about that,” Howard said. “The federal government will be the party responsible for identifying those people.”

In the end, Turner predicted that “we very likely could end up with more people uninsured than we had before.”

States with SMALLEST reduction in uninsured Reduction Remaining uninsured
Massachusetts 0% 307,000
Vermont 25% 41,000
Alabama 28% 508,000
Georgia 29% 1,366,000
Mississippi 29% 385,000
States with LARGEST reduction in uninsured Reduction Remaining uninsured
Iowa 53% 132,000
Kentucky 54% 296,000
Michigan 55% 557,000
North Dakota 55% 31,000
West Virginia 57% 117,000
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