By Tom Murphy
Associated Press
One of the biggest misconceptions about President Obama’s health care overhaul isn’t who the law will cover, but rather who it won’t.
If it survives Supreme court scrutiny, the landmark overhaul will expand coverage to about 30 million uninsured people, according to government figures.
But an estimated 26 million Americans will remain without coverage — a population that’s roughly the size of Texas and includes illegal immigrants and those who can’t afford to pay out-of-pocket for health insurance.
“Many people think that this health care law is going to cover everyone, and it’s not,” says Nicole Lamoureux, executive director of the National Association of Free & Charitable Clinics, which represents about 1,200 clinics nationally.
To be sure, it’s estimated that the Affordable Care Act would greatly increase the number of insured Americans. The law has a provision that requires most Americans to be insured or face a tax penalty.
It also calls for an expansion of Medicaid, a government-funded program that covers the health care costs of low-income and disabled Americans.
Additionally, starting in 2014, there will be tax credits to help middle-class Americans buy coverage.
The Supreme Court is expected to hand down a decision this month on whether to uphold the law completely or strike down parts or all of it. If it survives, about 93 percent of all non-elderly, legal U.S. residents will be covered by 2016. That’s up from 82 percent this year.
Still, millions of illegal immigrants won’t qualify for coverage. This population will account for roughly 26 percent of those who will remain uninsured, according to Urban Institute, a nonpartisan think tank.
And many legal U.S. residents will go without insurance, too. About 36 percent of the population that remains uninsured will qualify for Medicaid but won’t sign up for various reasons.
Others likely will make too much money to qualify for assistance but be unable to afford coverage.
Here’s a look at some of the groups that will likely remain uninsured if the law survives:
ILLEGAL IMMIGRANTS
More than 11 million unauthorized immigrants live in the United States, according to the Pew Hispanic Center, a nonpartisan research center. That amounts to nearly 4 percent of the total population. But there are no provisions that address illegal immigrants in the health care law.
They won’t be able to sign up for Medicaid. They won’t be eligible for the tax credits to help buy coverage.
And they won’t be able to use online marketplaces that the government will set up in order for people to get coverage in a process that’s similar to buying plane tickets on travel web sites. Those online exchanges, much like the tax credits, will require proof of citizenship.
“They will still need to find alternative ways to seek care because nothing in the law really expands coverage and affordable coverage options for undocumented immigrants,” says Sonal Ambegaokar with the National Immigration Law Center in Los Angeles.
The topic is a politically divisive issue. On one side, there are people who say that the government should provide health care for all U.S. residents — legal or not. The other side contends that doing so could take valuable resources away from U.S. citizens.
Researchers have found that immigrants tend to use the health care system less than legal residents. Illegal immigrants, in particular, tend to avoid using the health care system until they have to, favoring home remedies first or making cash payments to providers when they need care.
That population also is younger, so it generally has fewer health care needs, says Timothy Waidmann, a researcher with Urban Institute.
Some say excluding illegal immigrants from the overhaul will keep some legal residents uninsured, too.
Ambegaokar, the Los Angeles attorney, points to parents who are illegal immigrants but have children who are legal citizens because they were born in the United States.
If the parents are not eligible, they may not know that their kids qualify. And in other instances, if one child is legal and the other is not, the parents may decide not to sign up either to avoid playing favorites.
LOST IN TRANSLATION
Medicaid, which currently covers more than 60 million people, is expected to add about 17 million more people to its program by 2016 if the law is upheld, according to the nonpartisan Congressional Budget Office, which researches budgetary issues for Congress.
But people are still expected to fall through the cracks. That’s because the requirements and process for signing up for Medicaid can be confusing.
And while the overhaul aims to make the process easier, it won’t smooth out all the wrinkles.
The problem? Many people don’t realize that they qualify for coverage. And that likely will still be the case, albeit to a lesser extent, after Medicaid expands.
LIVING IN THE GAP
The overhaul calls for tax credits to help middle-class Americans buy coverage. But some people who make too much money to qualify for the tax credits may have a hard time finding an affordable option for private health insurance
The subsidies can pay a large chunk of the insurance bill. For instance, a 40-year-old person who makes $50,000 in 2014 and needs coverage for a family of four might receive a government tax credit of more than $8,000.
If the health care law is upheld, Angela Agnew Laws worries that she might remain uninsured like she has been for the past eight years.
Laws, who lives in Leesburg, Va., runs a small business that cleans and maintains commercial buildings. She hopes her income will climb to about $60,000 by 2014, which would be too high for tax credit help.
Laws, 58, figures that she’ll remain uninsured if she can’t find an affordable coverage option that fits a monthly budget already crammed with payments of $1,203 for rent $530 toward her car.
“It’s a scary prospect for me,” she says.
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