The Affordable Care Act’s future is now uncertain because of the results of the presidential election. Before policymakers decide what they will do next, it is important to understand where things now stand with respect to enrollment in health insurance and the remaining portion of the population that is uninsured.
It turns out that counting up who is uninsured is not as easy as one might assume. As we note in a recent paper, official estimates have been plagued for years with measurement errors. The Current Population Survey (CPS), which is conducted annually by the Census Bureau, has consistently undercounted the number of Americans enrolled in Medicaid, and thus overstated the number of uninsured. Further, among those properly counted as uninsured, there are millions of people who have been eligible for Medicaid, the Children’s Health Insurance Program, or employer coverage. No policy change was needed to put health insurance within reach of this population.
Still, there is no question that the Affordable Care Act did expand enrollment in health insurance rather substantially. In fact, as shown in data compiled by the Kaiser Family Foundation, it is now the case that nearly all persons who are residing in the United States legally either have health insurance, or could enroll in a plan if they chose to.
In sum, only 2.6 million people — those in the Medicaid coverage gap — are legal residents of the US, have low incomes, and do not yet have a realistic path to securing health insurance. The rest of the currently uninsured — around 25 million people — are already eligible for coverage of some sort, have sufficient incomes to enroll in unsubsidized coverage offered on the exchanges, or are residing in the country without proper documentation.
As policymakers consider what they would like to do next in health policy, they should keep in mind that, no matter what they do, there is likely to be a relatively large number of people who are counted as uninsured in official surveys. The goal, therefore, should not be to reduce the measured number of uninsured to zero but to ensure all Americans have a ready path to affordable insurance coverage, even if some portion of the populations chooses not to take advantage of what is available to it.