Congressman Tom Price, M.D.

10/26/2009
Congress' Health Care Bills Leave Millions Uninsured

USA Today
John Fritze
October 26, 2009

The high cost of health insurance premiums would continue to put coverage out of reach for millions even if Congress approves legislation President Obama says is intended to ensure "that every American has affordable health care."

The number of people who remain uninsured will depend on how House and Senate leaders reconcile separate versions of health care legislation to arrive at a final bill. The factors include the size of government subsidies to help low-income families pay for insurance and the scope of penalties that would be charged for those who don't buy a plan.

"A lot of this really depends on affordability," said Diane Rowland, executive vice president of the Kaiser Family Foundation. "As they put these bills together, one question is, 'Are the subsidies ... going to be sufficient to make coverage affordable?' "

The non-partisan Congressional Budget Office estimates 17 million Americans would remain uninsured under the Senate Finance Committee's 10-year, $829 billion health care bill. Health experts such as Rowland say that number would include families who earn too much to qualify for Medicaid but not enough to pay for insurance.

Others who could remain uninsured under the Finance Committee bill include people who choose to pay a proposed $750-a-year fine rather than buy coverage and those who are eligible for Medicaid but don't enroll.

Senate Majority Leader Harry Reid, D-Nev., is working behind the scenes to merge the Finance Committee bill with one passed in July by the Senate health committee.

The Finance Committee's bill would expand coverage to 29 million Americans who wouldn't otherwise have it, ensuring that 94% of U.S. residents are covered, according to the Congressional Budget Office. An early analysis found that a proposal being developed in the House would cover an additional 6 million to 7 million people, said Brendan Daly, a spokesman for House Speaker Nancy Pelosi, D-Calif. The speaker is leading negotiations in her chamber to combine three House bills into one.

Details of the House and Senate proposals are evolving. Lawmakers, including Senate Finance Committee Chairman Max Baucus, D-Mont., have said that no matter how the legislation is crafted, not everyone will have coverage. Those who could remain uninsured include:

•Those who can't afford it. All of the health care bills would mandate that individuals have health insurance and would provide subsidies to help low-income families pay for premiums. The Finance Committee bill would allow people to opt out of buying coverage if the lowest-cost plan available equals 8% or more of their income after subsidies.

A Center on Budget and Policy Priorities study estimates a family of three earning $27,465 a year would pay 4.5% of its income for insurance under the Finance panel's bill, more than four times the amount the same family would pay under the health committee's bill. "A family ... at that level is stretching it every day to make ends meet," said Judith Solomon, a senior fellow at the center.

•Individuals and families who choose to pay a penalty instead of buying insurance. The Congressional Budget Office has not said how many people it believes would make the decision, but it estimates the government would collect $900 million in penalties in 2016.

About 48% of those penalties would come from people earning between 100% and 300% of poverty, or between $18,310 and $54,930 for a family of three, according to the budget agency. About 29% of the money would come from people earning more than five times the poverty line.

•People who are eligible for Medicaid and other programs but do not enroll. Marc Cohan, director of litigation for the National Center for Law and Economic Justice, said one reason eligible people do not apply is because of the bureaucracy involved. "A lot of people ultimately throw up their hands in despair and walk away," he said.

Sen. Jim Bunning, R-Ky., criticized the Finance Committee's bill this month for adding "hundreds of billions of dollars more in new taxes ... and yet 25 million people will still remain uninsured." The number includes 8 million illegal immigrants who would not be covered under any of the bills in Congress.

USA Today