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Health Insurance & Affordable Care Act

'Obamacare' Reforms Well-Targeted, Report Says

Despite new laws, 15 million poor people have no new coverage options

WebMD News from HealthDay

By Karen Pallarito

HealthDay Reporter

TUESDAY, March 25, 2014 (HealthDay News) -- Nearly 32 million Americans had inferior health insurance coverage in 2012, putting them at risk of skimping on needed health care or piling up medical debt, a new report finds.

Another 47 million had no insurance at all, according to the Commonwealth Fund report released Tuesday.

People who are underinsured are likely to have experiences like the uninsured, said Dr. David Blumenthal, Commonwealth Fund president, at a Monday teleconference.

"They are, for example, more likely to skip needed health care," he said.

Most of the underinsured are low- or middle-income people -- the population that the new U.S. health reform law was designed to help, fund officials said. They said their findings indicate the legislation is well-targeted.

The report is believed to provide the first state-by-state analysis of the nation's "underinsurance" problem. It found a low of 8 percent underinsured in New Hampshire and highs of 16 percent to 17 percent in Tennessee, Mississippi, Utah and Idaho.

However, the report also highlights a glaring gap in coverage that could persist despite the expansion of coverage under the health reform law. More than 15 million uninsured and underinsured Americans are poor, earning less than the federal poverty level, and living in states that have not expanded Medicaid.

"Unless these states join the expansion, there will be no new affordable options available to this population," cautioned Cathy Schoen, the fund's senior vice president and lead author of the report, at the teleconference.

The Commonwealth Fund is a private foundation that supports independent health care research.

Congress passed the Affordable Care Act, also called Obamacare, in 2010, ushering in new consumer protections and health insurance options. The rollout of private health plan options through state marketplaces and the expansion of Medicaid took effect this year.

Twenty-four states decided not to expand Medicaid in 2014. In states like Idaho, which has the nation's highest percentage of underinsured individuals -- 17 percent, the Affordable Care Act has been a boon and a bust.

Some Idahoans are benefiting from the subsidies available to help people purchase better coverage, but people who fall below the poverty line have no coverage options because the state did not expand Medicaid.

"It left a big hole," said Terri Sterling, a director at the Idaho Community Action Network, a Boise-based organization helping to empower low-income and working Idahoans.

By the Commonwealth Fund's definition, people are underinsured if they have coverage but spend 10 percent or more of their income, or their family income, on out-of-pocket medical care, excluding the premium.

People with very low incomes, below 200 percent of the federal poverty level, are considered underinsured if they spend 5 percent or more of their income on medical care.

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