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medicaid
For-Profit US Health System Continues to Leave Many Millions Uninsured Each Year
"With so many unsettling questions about the future of key social safety net programs, policymakers must focus on solutions for delivering consistent insurance coverage to everyone," said one researcher behind a new study.
Jan 10, 2025
More than 10 million workers in the United States who held full-time jobs in 2023 still lacked health insurance for the entire year.
That's just one of the troubling findings from a report released Friday which fleshes out how America's "patchwork" system of employer-provided plans, individually purchased coverage through state-level exchanges, and Medicaid, are leaving many millions of Americans without care year after year.
The new study by the Center for Economic and Policy Research (CEPR) looked at the demographic characteristics of the uninsured population from 2018 through 2023 using Census Bureau data and found lack of healthcare coverage along class, racial, and ethnic lines, as well as disparities when it comes to levels of educational attainment.
"The Affordable Care Act has delivered insurance coverage for millions of Americans, but there are still considerable gaps in coverage—particularly for workers who find themselves too young for Medicare and who earn wages above thresholds for Medicaid coverage," said Emma Curchin, one of the authors of the paper and a research assistant at CEPR.
"These gaps leave millions of people—many of them working full time all year—unable to secure insurance coverage. With so many unsettling questions about the future of key social safety net programs, policymakers must focus on solutions for delivering consistent insurance coverage to everyone," she added.
After it passed in 2010, the Affordable Care Act—which sought to expand health insurance coverage, including by creating nex exchanges in the for-profit market—was able to reduce the share of the U.S. population that was without health insurance by roughly half between 2009 and 2023. While 16.7% of the population lacked insurance in 2009, the latest available data shows 8% of the population is without insurance. But even with the ACA, the study found that more than 27 million U.S. residents are without insurance, and almost 16 million workers have full-time jobs, part-time jobs, or are unemployed but actively seeking work.
The report, which focused on workers between the ages of 18 and 64 found that among full-time, year-round workers, Hispanic workers were most likely to be uninsured (21%). The rate of being uninsured among that group was about four times higher than the corresponding rate for Asian or white workers, which stood at 5.1% and 5.5%, respectively.
Unmarried people are more likely to be uninsured than married people, and full-time workers who live in a household with a child or children are less likely to be uninsured—which "may reflect the greater likelihood that households with children are eligible for Medicaid, because Medicaid eligibility is determined in part by income relative to household size," according to the authors of the study.
For all worker types, higher educational attainment means lower rates of being uninsured, the researchers found. Someone who works full-time and full-year but has less than a high school degree has an uninsured rate 15 higher than a worker with an advanced degree. Workers who complete some of college but do not hold a degree are almost twice as likely to uninsured compared to those who do finish with a degree.
Across racial and ethic groups and levels of educational attainment men consistently have higher uninsured rates than women.
Other findings include that uninsured rates declined as wages increased. 21.4% of full-time, full-year workers in the bottom of the wage distribution lack health insurance, compared with only 1.7% for workers who are in the top wage quintile. Whether you were born inside the U.S. and citizenship status also play a large role in uninsured rates. 28.9% of full-time, full-year workers who were born in a different country and are not citizens are uninsured, but only 6.7% of full-time, full year workers born in the U.S. are uninsured, and 8.6% of these types of workers who were born abroad but who hold U.S. citizenship are uninsured.
What's more, "lack of coverage is particularly acute for part-time or part-year and unemployed non-citizen workers: 36% of part-time workers and 39% percent of unemployed workers are uninsured," the researchers note.
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GOP Attack on Medicaid Puts 'Millions of People at Risk of Losing Benefits': Analysis
"In short, recent proposals for a per capita cap or block grant would cause people to lose health coverage and benefits, shift costs and risks to states, and destabilize healthcare providers."
Jan 07, 2025
Republican proposals to impose a per person cap on federal Medicaid funding or turn the government health insurance program for lower-income Americans into a block grant would leave millions of people without coverage or care, according to an analysis published Tuesday.
The Center on Budget and Policy Priorities (CBPP), a progressive think tank, examined GOP policy proposals including the per capita funding cap and making Medicaid a block grant and found that such policies "would dramatically change Medicaid's funding structure, deeply cut federal funding, and shift costs and financial risks to states."
"Faced with large and growing reductions in federal funding, states would cut eligibility and benefits, leaving millions of people without health coverage and access to needed care," CBPP added.
Policymakers should protect #Medicaid’s federal-state funding to avoid harming millions of people. Caps or block grants would force deep cuts, shift costs to states, destabilize providers, and threaten access to care. www.cbpp.org/research/hea...
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— Center on Budget and Policy Priorities (@centeronbudget.bsky.social) January 7, 2025 at 9:41 AM
According to the analysis:
Many of those losing Medicaid coverage would be left unable to afford lifesaving medications, treatment to manage chronic conditions like cardiovascular disease and liver disease, and care for acute illnesses. People with cancer would be diagnosed at later stages and face a higher likelihood of death, and families would have more medical debt and less financial security. A large body of research shows that Medicaid improves health outcomes, prevents premature deaths, and reduces medical debt and the likelihood of catastrophic medical costs.
"Before resurrecting harmful per capita cap proposals, policymakers should consider how similar past proposals would have impacted states' budgets and thus their ability to support Medicaid enrollees," CBPP advised.
The analysis comes as Republicans—who control both houses of Congress and, starting on January 20, the White House as President-elect Donald Trump takes office—pursue a massive tax cut that would be funded in part by cutting social programs including Medicaid. GOP lawmakers are also considering work requirements for Medicaid recipients in order to help pay for the tax cut, which critics argue would primarily benefit rich people and corporations.
According to a 2024 report by the National Association of State Budget Offices, Medicaid—which, along with the related Children's Health Insurance Program, serves nearly 80 million U.S. adults and minors with limited income and resources—makes up more than half of all federal funding for states.
Total Medicaid spending was approximately $860 billion for fiscal year 2023, with the federal government contributing around 70% of the funds. The CBPP analysis notes that "under a per capita cap, states would get additional funding as the number of enrollees increased, but if the caps were set at an insufficient level, the state's funding shortfall would grow as more people enrolled."
The report also says that "the design of per capita caps can expose states to cuts even if spending falls below caps for some eligibility groups, and even if spending growth falls below the cap on average over time. And as the caps would be permanent, the size of the cuts and the number of states affected would continue growing over time. These losses in federal support would impose significant strain on states and put millions of people at risk of losing benefits and coverage."
Under a block grant, "the funding shortfall would be even worse since federal funding wouldn't change in response to enrollment increases," the analysis states.
"In short, recent proposals for a per capita cap or block grant would cause people to lose health coverage and benefits, shift costs and risks to states, and destabilize healthcare providers," the publication concludes. "The federal funding cuts to states would be large and unpredictable. Restructuring Medicaid's financing would also make the program highly vulnerable to future cuts, as it would impose a funding formula that could be easily ratcheted down further—for example, by setting the cap or its growth rate even lower. Policymakers should reject proposals for per capita caps and block grants and instead retain the current federal-state financial partnership."
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'The GOP Promised to Make Life Easier for Working Families,' But Here's the Real Agenda
"Mike Johnson is committing to slashing Social Security and Medicare to get the speaker's gavel," said one progressive group.
Jan 03, 2025
As Republicans took full control of Congress this week and U.S. President-elect Donald Trump prepared to take office later this month, Democratic lawmakers renewed warnings about how the GOP agenda will harm working people and pledged to fight against it.
"Today, the 119th Congress officially begins. Our top priority over the next two years must be fighting for working families and standing up to corporate power and greed," Rep. Pramila Jayapal (D-Wash.), chair emeritus of the Congressional Progressive Caucus, said on social media Friday.
"While Republicans focus their energy for the next two years on giving tax breaks to the rich and cutting vital public programs, Democrats will continue working to lower costs and raise wages for all," Jayapal promised. "We'll always be fighting for YOU."
In addition to members of Congress being sworn in on Friday, nearly all Republicans in the House of Representatives reelected Rep. Mike Johnson (R-La.) as speaker and the chamber debated a rules package that Democrats have criticized since it was released by GOP leadership earlier this week.
"Their governance will be marked by consolidated power, scapegoated communities, and campaigns of punishment."
The package fast-tracks a dozen bills on a range of issues; they include various immigration measures as well as legislation attacking transgender student athletes, sanctioning the International Criminal Court, requiring proof of United States citizenship to register to vote in federal elections, and prohibiting a moratorium on hydraulic fracturing, or fracking, for fossil fuels.
"Speaker Johnson has said that the 119th Congress will be consequential. Today, both in Speaker Johnson's address and in the rules package the Republicans have passed, Republicans have shown us what the consequences of their leadership will be," Rep. Delia C. Ramirez (D-Ill.) said in a statement. "In their first order of business, Republicans advanced a legislative package that abuses the power of Congress to persecute trans children athletes, take federal funding away from sanctuary cities like Chicago and Illinois, scapegoat immigrants, erode voting rights, and put new criminal penalties on reproductive care providers."
"For the first time in history, they seek to make the speakership less accountable to the full body of legislators and to limit our ability to consider emergency bills," Ramirez noted. "Overall, they are using the rules to make Congress less transparent, less accountable, and less responsive to the needs of the American people. Their governance will be marked by consolidated power, scapegoated communities, and campaigns of punishment."
Speaking out against the package on the House floor, Jayapal said it "makes very clear what the Republican majority will not do in the 119th Congress," stressing that the 12 bills "do nothing to lower costs or raise wages for the American people."
These bills also won't "take on the biggest corporations and wealthiest individuals who profit from the high prices and junk fees and corporate concentration that's harming Americans across this country," she said. "Because guess what? These corporations and wealthy individuals are the ones that are controlling the Republican Party for their own benefit."
Jayapal highlighted the exorbitant wealth of Trump's Cabinet picks, just a day after the president-elect announced corporate lobbyist and GOP donor Ken Kies as his choice for assistant secretary for tax policy at the Treasury Department—which is set to be led by billionaire hedge fund manager Scott Bessent, as Republicans in Congress try to pass another round of tax cuts for the rich.
GOP lawmakers are also aiming "to make meaningful spending reforms to eliminate trillions in waste, fraud, and abuse, and end the weaponization of government," Johnson said in a lengthy social media on Friday. "Along with advancing President Trump's America First agenda, I will lead the House Republicans to reduce the size and scope of the federal government, hold the bureaucracy accountable, and move the United States to a more sustainable fiscal trajectory."
In other words, responded the Progressive Change Campaign Committee (PCCC), "Mike Johnson is committing to slashing Social Security and Medicare to get the speaker's gavel."
Republicans have a slim House majority and Trump-backed Johnson was initially set to fall short of the necessary support to remain speaker, due to opposition from not only Congressman Thomas Massie (R-Ky.) but also Reps. Ralph Norman (R-S.C.) and Keith Self (R-Texas). However, after a private conversation, Norman and Self switched their votes.
"Johnson cut a backroom deal with the members that voted against him so they'd flip their votes. So he will get gavel now. I'm sure in time we'll find out what he sold out just so he'd win," Rep. Maxwell Alejandro Frost (D-Fla.) said on social media.
"What did Johnson sell out to become speaker? Social Security or Medicare? Or perhaps veterans?" he asked.
Citing a document circulated ahead of the vote by Johnson's right-wing critics that lists "failures" of the 118th Congress, the PCCC said: "Looks like all of the above. But his holdouts put Social Security in their first bullet of grievances."
After the vote, Norman and 10 right-wing colleagues released a letter explaining that, despite sincere reservations, they elected Johnson because of their "steadfast support of President Trump and to ensure the timely certification of his electors."
"To deliver on the historic mandate earned by President Trump for the Republican Party, we must be organized to use reconciliation—and all legislative tools—to deliver on critical border security, spending cuts, pro-growth tax policy, regulatory reform, and the reversal of the damage done by the Biden-Harris administration," they added.
Politicoreported that "House Republicans are hoping to start work on the budget targets for critical committees on Saturday—the first step in kicking off their ambitious legislative agenda involving energy, border, and tax policy."
According to the outlet:
"The Ways and Means Committee is just going to be able to draft tax legislation according to what the budget reconciliation instructions are," said House Ways and Means Chair Jason Smith (R-Mo.), who will be leading the charge on extensions of... Trump's tax cuts.
"And so when the conference figures out what they want in those instructions, we'll be able to deliver according to those parameters," said Smith, when asked about the primary goal of a GOP conference meeting tentatively scheduled for Saturday at Fort McNair, an Army post in southwest Washington.
That followed Thursday reporting by The Washington Post that Trump advisers and congressional Republicans "have begun floating proposals to boost federal revenue and slash spending so their plans for major tax cuts and new security spending won't further explode the $36.2 trillion national debt."
As the newspaper detailed, 10 policies that Republicans have considered are tariffs, repealing clean energy programs, unauthorized spending, repealing the Biden administration's student loan forgiveness, shuttering the Education Department, cutting federal food assistance, imposing Medicaid work requirements, blocking Medicare obesity treatment, ending the child tax credit for noncitizen parents, and cutting Internal Revenue Service funding.
"The GOP promised to make life easier for working families," Rep. Katherine Clark (D-Mass.), the Democratic whip, said on social media in response to the Post's article. "Now, they want to slash your school budget, raise your grocery costs, and hike your energy bills—all to pay for billionaire tax cuts."
"We will not allow Republicans to cut Social Security, Medicare, Medicaid, and food assistance to pay for tax cuts for the wealthy," she added Friday. "No way."
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