High Stakes for Low-Income People in Debate Over Health Care Reform Law

Mar 28, 2012

By Alan W. Houseman

For the last three days, the Supreme Court has heard arguments on the constitutionality of the Affordable Care Act (ACA). While the court's ruling will impact all Americans, the stakes couldn't be higher for low-income children, youth and adults.

The most recent census data show that 49.9 million Americans were without health insurance in 2010, an increase of 900,000 people from just the year before. This includes 7.3 million children without any health insurance. At the same time, poverty has risen to 15.1 percent and unemployment has remained above 8 percent since February 2009. More and more American families are falling out of the middle class and joining the growing number of poor families living on the edge. These families are struggling to afford the basics. With many having lost jobs during the recession, they are without employer-sponsored health insurance. For low-wage workers, employer-sponsored insurance is often not even offered and private health insurance is just too expensive to afford.

As a result of the health care reform law, however, virtually all uninsured low-income Americans will become insured. A major reason why many non-elderly adults currently lack coverage is because of restrictions in the  Medicaid eligibility rules.  Beginning in 2014, the ACA creates a Medicaid eligibility category that will cover nearly all uninsured individuals living under 133 percent of the federal poverty line.  This change is estimated to cover 16 million people including many of the 7.3 million children now uninsured.  The ACA also creates a subsidy system of refundable and affordable premium credits to families with incomes between 133- 400 percent of the federal poverty line to help those who cannot afford coverage under the new state-based Health Insurance Exchanges. 

According to census data, children fare better than non-elderly adults in health care coverage and fewer children are uninsured.  Over the last 4 years, there was increased coverage for children because of Medicaid and the Children's Health Insurance Program (CHIP), even though the number of children in families with employer-based coverage fell.  This trend will continue under the ACA, which protects Medicaid and preserves and extends CHIP through September 30, 2012 with full funding provided through 2015.

Young adults remain the most uninsured group, despite an important provision already in effect that allows young people to remain on their parents' health plans up to their 26th birthday.  As a result, 2.5 million additional young people are insured and able to visit a doctor when ill, or access preventive health care that will help them stay healthy.  Millions more young adults will benefit in 2014 from the expansion of Medicaid and subsidies under the Health Insurance Exchanges. The law will also provide insurance coverage to all youth below the age of 25 who were formerly in foster care for a period of six months or more.

These are just a few of the many provisions in the health care reform law that directly benefit low-income children, youth and adults.

Whatever the outcome of the Supreme Court case, it is essential that the nation tackle the complicated health care system and its high costs, which are leading contributors to many families' economic insecurity. Policies like the Affordable Care Act that help more people stay healthy and productive improve family well-being and strengthen the nation and our economy.

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