Week 3 – The Uninsured Population
James R. Freehahn
HSM 315 The American Healthcare System
Instructor Dr. Cheryl Chance, PhD.
March 14, 2015

The Patient Protection and Affordability Act H.R. 3590
Introduction
There has been much debate regarding the impact of the Affordability Care Act on health care since passed in to law. In this paper, I will discuss one of the key components, the uninsured population. The Affordable Care Act (ACA) legislation constitutes the largest change to America’s healthcare system since the creation of Medicare and Medicaid.
Acquiring affordable health insurance coverage can become a reality for many patients, including those who have been uninsured as a result of pre-existing conditions or limited finances. Even after passing the ACA, almost one in three uninsured adults lack coverage because of cost.
The Uninsured Population
Millions of people in the United States go without health insurance each year. Because nearly all of the elderly are insured by Medicare, most uninsured Americans are nonelderly (below age 65). The characteristics of the nonelderly uninsured in 2013indicated 41.3 million were uninsured, 35.4 million were adults, and nearly 15.8 million are under the age 35.
The family poverty level is a significant contributing factor involved with uninsured. The U.S. Census Bureau’s poverty threshold with two adults and one child was $18,751 in 2013. This is the official measurement of poverty used by the federal government. The report revealed 9.6 million live <100% poverty, 10.6 million live in the 100-199% poverty level, while 9.9 % are in the 200-399% poverty level.
While a majority of the nonelderly receive their health insurance as a job benefit, not everyone has access to or can afford this type of coverage. Affordable health insurance coverage has been issue for a large segment of the population in the United States (U.S.) for some time. The Affordable Care Act (ACA) allows patients to secure an affordable health plan through the health insurance marketplace in their state. Even with this assistance almost 1 in 3 unisured adults lack coverage today. Interestingly, cost, or the perception of it, was the big barrier. Fifty-three percent of the uninsured who are eligible for assistance under the ACA perceived the cost of health insurance in general as the main reason they do not have coverage. The number of uninsured people steadily increased throughout most of the past decade due to decreasing employer sponsored insurance coverage and rising health care costs. The recent recession led to a steep increase in uninsured rates from 2008 to 2010 as a high jobless rate led millions to lose their employer sponsored coverage. Many times uninsured patients delay getting proper health care, often until it’s too late. The result is our nation’s 46.3 million uninsured patients live sicker and die younger.
Today, about 11 million adults have become newly insured under the Affordable Care Act by mid-December 2014. Based on their answers to a recent survey, 48 percent of the roughly 30 million adults remaining uninsured at the end of 2014 were eligible for assistance under the law, including 30 percent who were eligible for marketplace tax credits and 18 percent who were eligible for Medicaid. And yet they did not get coverage.
The uninsured often face unaffordable medical bills when they seek health care. These bills can quickly translate into medical debt since most of the uninsured have low or moderate incomes and have little savings. Under the ACA, as of 2014, Medicaid coverage is expanded to nearly all adults with incomes at or below 138% of poverty in states that expand, and tax credits are available for people who purchase coverage through a health insurance Marketplace. Early data suggest that the ACA has helped expand coverage to millions of previously uninsured people, but some, particularly poor adults in states that have not expanded Medicaid, are still left