Drops in coverage among Hispanic people drove much of the increase in the overall uninsured rate in Changes to the Federal public charge policy may be contributing to declines in Medicaid coverage among Hispanic adults and children, leading to the growing number without health coverage.
These coverage losses also come as COVID has hit communities of color disproportionately hard, leading to higher shares of cases, deaths, and hospitalizations among people of color. The lack of health coverage presents barriers to accessing needed care and may lead to worse health outcomes for those affected by the virus.
Even as the ACA coverage options provide an important safety net to people losing jobs during the pandemic, a Supreme Court ruling in California vs. Texas could have major effects on the entire health care system. If the court invalidates the ACA, the coverage expansions that were central to the law would be eliminated and would result in millions of people losing health coverage.
Such a large increase in the number of uninsured individuals would reverse the gains in access, utilization, and affordability of care and in addressing disparities achieved since the law was implemented. These coverage losses coming in the middle of a public health pandemic could further jeopardize the health of those infected with COVID and exacerbate disparities for vulnerable people of color.
For the third year in a row, the number of uninsured increased in In , Coverage losses were driven by declines in Medicaid and non-group coverage and were particularly large among Hispanic people and for children. Despite these recent increases, the uninsured rate in was substantially lower than it was in , when the first ACA provisions went into effect and prior to the full implementation of Medicaid expansion and the establishment of Health Insurance Marketplaces.
Who are the uninsured? Most uninsured people have at least one worker in the family. Reflecting the more limited availability of public coverage in some states, adults are more likely to be uninsured than children. People of color are at higher risk of being uninsured than non-Hispanic White people.
Why are people uninsured? Even under the ACA, many uninsured people cite the high cost of insurance as the main reason they lack coverage.
Many people do not have access to coverage through a job, and some people, particularly poor adults in states that did not expand Medicaid, remain ineligible for financial assistance for coverage.
Additionally, undocumented immigrants are ineligible for Medicaid or Marketplace coverage. Construction has the eighth-highest rate of incidents involving nonfatal occupational injuries and illnesses, per data from the BLS. Indeed, the top industry in this regard — agriculture, forestry, fishing and hunting — also employs people who are far more likely to be without health insurance than the average worker. Construction accounted for fatal work injuries in , more than any other industry, according to the BLS.
It also tied with mining and oil extraction for the third-highest fatal injury incidence rate, behind transportation and agriculture, forestry, fishing and hunting.
Part of the problem facing workers in these industries is that many of them are contract workers, meaning work on a shorter-term basis.
Other studies have shown that temp workers are at a higher risk of being seriously injured or killed on the job. Nearly a third of the nonfatal occupational injuries that occur happen within the first year on the job. Home Personal Finance. Workers in this field are the least likely to have health insurance Published: March 22, at a.
While Medicaid and the ACA marketplaces have provided coverage options for people losing employer-sponsored coverage who might otherwise become uninsured, some of those losing employer-sponsored insurance may become uninsured.
There are opportunities to narrow disparities in coverage by enrolling eligible people in Medicaid or marketplace coverage. As noted, ARPA includes temporary increases and expansions in eligibility for subsidies to buy health insurance through the health insurance marketplaces as well as incentives to encourage states that have not yet adopted the ACA Medicaid expansion to do so. These provisions increase access to coverage for people of color, which may help to reduce disparities in coverage.
For example, analysis finds uninsured people eligible for zero-premium plans under the ARPA are disproportionately Hispanic. Data also show that, if all remaining states expanded Medicaid, six in ten uninsured adults who would become eligible would be people of color.
The Biden administration has taken actions to facilitate enrollment of eligible people in health coverage. In January , President Biden issued an Executive Order on Strengthening Medicaid and the Affordable Care Act , which established a special open enrollment period beginning February 15, for the federal health insurance marketplace, healthcare.
During the period, people who are currently uninsured can enroll and people already enrolled in marketplace plans can change to different policies without any qualifying event. The administration also restored funding for navigators to help eligible people enroll in health coverage, which research shows can play a key role in helping eligible individuals enroll, and launched initiatives focused on boosting enrollment among Black and Latino individuals.
In addition, the administration reversed changes to public charge policies made under the Trump Administration, which had made immigrant families more reluctant to enroll in health care and other programs even if they were eligible.
It also reversed state waivers that had implemented work requirements for Medicaid coverage, which analysis has suggested can contribute to coverage losses among people who remain eligible for coverage. Even with these recent actions, gaps in coverage remain. It remains unclear, which if any remaining states will implement the Medicaid expansion. Moreover, some uninsured individuals remain ineligible for assistance through Medicaid or the marketplace subsidies, including immigrants who face eligibility restrictions for coverage.
Undocumented immigrants are not eligible to enroll in Medicaid or marketplace coverage and lawfully present immigrants face restrictions that limit Medicaid eligibility for many who have had lawful status for less than five years. There are a range of potential options that the administration and Congress may pursue to fill remaining gaps in coverage. It remains to be seen what additional action may be taken.
Closing remaining gaps in coverage would help to address longstanding disparities in health, which have been exacerbated by the COVID pandemic.
Research shows that having health insurance makes a key difference in whether, when, and where people get medical care and ultimately how healthy they are. Uninsured people are far more likely than those with insurance to postpone health care or forgo it altogether. Being uninsured can also have financial consequences, with many unable to pay their medical bills, resulting in medical debt. As such, future trends in coverage will have a significant impact on disparities in health access and use as well as health outcomes over the long-term.
However, beyond coverage, it also will be important to address inequities across the broad range of other social and economic factors that drive health and to address other inequities within the health care system that lead to poorer quality of care and health outcomes for people of color as part of efforts to advance health equity.
Though a successful state ballot measure in Missouri directed the Medicaid expansion to be in effect by July 1, , the state legislature excluded expanded coverage from its fiscal year FY budget and June 23, circuit court held that the state was not required to implement expansion.
If expansion dose not proceed, an additional nearly , uninsured nonelderly adults would fall into the coverage gap. Summary Health coverage plays a major role in enabling people to access health care and protecting families from high medical costs.
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