Health insurance increases access to healthcare services. This is true whether providers are paid on a fee for service or capitated basis. A recent study concluded increases in uninsured middle-income families over the past decade are likely due to their inability to afford private insurance, which has been steadily increasing in price yet they make too much money to be eligible for public health insurance (i.e., Medicaid). (Changes in Health Insurance for US Children and their Parents: Comparing 2003 to 2008)
Research teams at OHSU and OCHIN interviewed Oregon parents who corroborated these findings:
- “Even if two people are working, they’re making barely enough money but to the state it’s too much to cover them under their health care [Medicaid].”
- “We made too much money for it [Medicaid]. It was only $200 [to pay for insurance] at the time, which doesn’t sound like a lot but the other two kids would be another $200, so it’s $600 a month.”
- “You can make like $50,000 a year. It’s a reasonable amount…but at the same time I can’t afford $1000 a month for insurance.”
Luckily, the Affordable Care Act (ACA) has provided solutions for middle-income families. A private health insurance marketplace and expanded Medicaid eligibility began covering Americans at the start of the year, but there is another controversy brewing with regard to the subsidy made available through the ACA to help Americans afford coverage. One court has ruled that only states with their own exchange can provide the subsidy, while another has contradicted that ruling. (Implementing Health Reform: Appellate Decisions Split On Tax Credits In ACA Federal Exchange)
An Oregon parent the teams interviewed commented on health reform, saying: “I think that in the future it’s still not going to be good because lots of people will be left without insurance still. We hope not, we hope that they will continue making change to the system each year to improve it.”
Decisions about the subsidy have consequences; a potential 7 million Americans may remain uninsured if the subsidy is not upheld. This is in addition to the 5 million who remain uninsured because they live in a state that did not expand Medicaid. These numbers beg the question: how many uninsured Americans is our country willing to continue to tolerate?