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social safety net
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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'Austerity Is Labour's Choice': Outrage as Starmer Cuts Winter Fuel Allowance
"Cutting winter fuel allowance is not a tough choice," Jeremy Corbyn said. "It's the wrong choice—and we will not be fooled by ministers' attempts to feign regret over cruel decisions they don't have to take."
Sep 11, 2024
Progressive critics and lawmakers are expressing outrage after the U.K. Parliament on Tuesday voted to cut a winter fuel allowance for millions of Britons, calling the move by the ruling Labour Party, which took power in July, a continuation of the Conservative Party's austerity policies.
The measure turns the allowance, which provides £200 to £300 ($262 to $293) per year to senior citizens for heating bills, into a means-tested program in which only the poorest will qualify. It's expected to reduce the number of people receiving the winter payment from 11.4 million last year to 1.5 million this year. Prime Minister Keir Starmer called it a "tough choice" that was necessary because of the poor state of the British treasury.
A vote to overturn the cut lost 348 to 228 on Tuesday after Labour successfully whipped enough its members of Parliament into supporting the cut. Fifty two Labour MPs abstained, at least 20 of whom had expressed opposition to the plan, and one voted in opposition.
Former Labour leader Jeremy Corbyn, who now represents voters as an independent, condemned Starmer's move.
"Cutting winter fuel allowance is not a tough choice," Corbyn wrote on social media. "It's the wrong choice—and we will not be fooled by ministers' attempts to feign regret over cruel decisions they don't have to take."
"Did he get permission from the Tories to reuse their trademark slogans?" he asked of Starmer in an a Tuesday op-ed in Tribune.
Under the headline, "Austerity Is Labour's Choice," Corybn railed against Starmer and his allies for falling back on the kind of neoliberalism that has dominated the U.K. for decades. He wrote:
It is astonishing to hear government ministers try to pull the wool over the public's eyes. The government knows that there is a range of choices available to them. They could introduce wealth taxes to raise upwards of £10 billion. They could stop wasting public money on private contracts. They could launch a fundamental redistribution of power by bringing water and energy into full public ownership. Instead, they have opted to take resources away from people who were promised things would change. There is plenty of money, it’s just in the wrong hands.
The winter fuel payment was introduced as an unconditional cash transfer in 1997 under then-Chancellor of the Exchequer Gordon Brown. Some economists have argued that U.K. pensioners are in better position today than than were then, and thus the payment no longer makes sense; others have noted that in real terms, the payment is far lower than it used to be, due to inflation, and thus had become a relatively insignificant benefit anyway.
However, progressives have called the cuts, which were first proposed after Labour took office and weren't mentioned during the election campaign, far too drastic, given the roughly 10 million people they'll effect. Meanwhile, Corbyn and others have argued that Labour's move marks a loss for universalism and could auger more cuts to come:
A universal system of welfare reduces the stigma attached to those who rely on it, and removes barriers for those who find it difficult to apply (both are reasons why the take-up of means-tested payments is so low). What next for means testing? The state pension? The NHS [National Health Service]?
Some commentators have objected to rich pensioners receiving benefits such as the fuel allowance. Progressives have responded that the money should simply be clawed back through higher tax rates on the wealthy.
"In my view the government should be looking to raise revenues from the wealthiest in society, not working class pensioners," Jon Trickett, the only Labour MP to vote to nix to the cut, said in a statement issued on social media.
Universal programs make it easier to reach all those who need help, progressives argue. The new winter fuel payment will be set up so that only those who receive a Pension Credit or other similar government benefit will be eligible for it. But only 63% of pensioners who qualify for the credit actually receive it, government statistics show. The government has announced a campaign to try to increase uptake of the credit.
Trickett said that he feared it would lead more senior citizens to fall into poverty during what he predicted would be an "extremely difficult" winter for his constituents in West Yorkshire. "After years of obscene profiteering by energy companies, they are hiking bills yet again," he wrote.
Rachel Reeves, the Chancellor of the Exchequer, said the cut would save the treasury £1.4 billion ($1.8 billion) this year. She argues that the Conservatives, who held power from 2010 until July, initially as part of a coalition, left the national finances in a dire state and Labour must fill a £22 billion ($28.7 billion) budgetary "black hole."
Labour hasn't released an official impact assessment of the winter payment measure. Reeves, like Starmer, has said she didn't want to make the cut, but two weeks ago a video clip of her proposing to cut the allowance as an opposition MP in 2014.
Rachel Reeves has repeatedly said she didn't want to cut the universal winter fuel allowance for pensioners but it was a tough decision forced on her because of the financial black hole left by the last govt
Here's Reeves 10 years ago: pic.twitter.com/1BAIL4racv
— Saul Staniforth (@SaulStaniforth) August 28, 2024
Reeves and Starmer have long tried to establish their fiscal prudence and distance themselves from purportedly free-spending progressives in their party. A progressive commentator on Novara Mediacalled their winter allowance cut an "incredible political fumble."
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Debate Tip for Biden: Attack Trump on Social Security
At Thursday’s presidential debate, Trump should be questioned about his Social Security statements and actions, and Biden should be given the opportunity to explain what Democrats will do.
Jun 26, 2024
At this week’s presidential debate, U.S. President Joe Biden should talk about Social Security whether asked directly about it or not. Biden’s and former President Donald Trump’s positions are radically different. As are the positions of the parties they lead. But the mainstream media fails to report the stark difference. Consequently, the American people are left in the dark.
It is crucial that the American people know where the candidates stand before the November election. The most recent Social Security Trustees Report projects that in 2035, the then-nearly 81 million beneficiaries will experience a 17% overnight cut in their monthly benefits—under the unimaginable scenario that Congress does not act to prevent it.
There is absolutely no question that the president and Congress will act. It would be political suicide to do nothing.
Biden should promise that if reelected, he will push to expand benefits while requiring the uber-wealthy to pay their fair share.
For about half of seniors, Social Security provides the majority of their income; for one in four, it provides virtually all of their income. There is no way that they and their families would quietly accept an almost 20% cut. If the president and Congress failed to act, not only would those politicians be voted out of office, they would not be able to show their faces in public without getting accosted and chased down the street.
Again, the question isn’t whether the president and Congress will act. The question is what they will do, when they act.
Biden and his fellow Democrats have a plan. It is to expand benefits and eliminate Social Security’s projected shortfall by requiring those with incomes in excess of $400,000 to pay their fair share. The Social Security actuaries have already determined that the numbers work. Every indication is that Biden and his allies are ready to act on it, in the open, next year. If Democrats regain the House of Representatives, the Speaker will be Hakeem Jeffries (D-N.Y.) who has cosponsored Social Security expansion legislation and will bring it up for a vote next Congress.
In sharp contrast, although Trump claims that he is the one Republican who will not cut benefits, he opposes raising additional revenue. That only leaves cutting benefits—either legislatively or automatically, when Social Security’s reserves are depleted in 2035. Indeed, not only is Trump against increased revenue, he has made clear that he plans to cut his own and other billionaires’ taxes, if he once more becomes president.
Biden has stated plainly that he will veto legislation that cuts Social Security’s benefits. Notably, Trump has not made a similar promise. Moreover, there is no question that the Republican Party wants to cut benefits, but also doesn’t want to say so directly. The party’s most recent platform, in 2016, states: “As Republicans, we oppose tax increases and believe in the power of markets to create wealth and to help secure the future of our Social Security system.” That implies–though doesn’t state explicitly–that the Republican Party is advocating benefit cuts and privatization.
Republicans in Congress are even clearer. The Republican Study Committee, which includes 80% of all House Republicans and 100% of House Republican leadership, every year releases a budget with deep, draconian cuts and radical, transformative proposals for Social Security. Its FY 2025 budget slashes Social Security’s already inadequate benefits by $1.5 trillion in just the first 10 years.
Those are much deeper cuts than are necessary to eliminate Social Security’s projected shortfall. And they would occur much sooner than if Congress did nothing whatsoever. Even worse, the Republicans have plans to end Social Security as we know it. They are using the excuse of a projected shortfall to undermine Social Security, their true goal.
And despite his rhetoric, that is Trump’s goal, as well. Every one of his budgets as president included Social Security cuts. In an unprecedented move, he unilaterally sought to defund Social Security’s dedicated revenue, which would have led to deeper automatic cuts. Fortunately, Biden became president before the lost revenue could be made permanent.
Tellingly, Trump surrounded himself with a vice president and cabinet full of Social Security arsonists, and appointed a no-show crony to head the Social Security Administration.
Trump’s true attitude about Social Security should not be a surprise. Before running for president, Trump trashed Social Security, calling it a Ponzi scheme. He supported privatizing Social Security and raising the retirement age, with the condescending remark, “How many times will you really want to take that trailer to the Grand Canyon?”
But he also showed he understood how deeply unpopular his positions are even with Republican voters. In 2011, Trump told Sean Hannity that Republicans “are going to lose elections” if they “fall into the Democratic trap” of advocating cutting Social Security, Medicare, and Medicaid without bipartisan cover.
At the presidential debate, Trump should be questioned about his Social Security statements and actions. And Biden should be given the opportunity to explain what Democrats will do, if he is elected to a second term.
If past debates are a guide, though, the moderators may not ask a question about Social Security. If they do ask about it, Biden should be prepared.
If the question calls Social Security an “entitlement,” Biden should explain that Social Security is an earned benefit, not a government handout. If the moderators talk about Social Security running out of money, he should explain that unless Congress were to change the law, Social Security will never run out of money. It is current-funded, which means that as long as people are working and contributing to Social Security, there will always be money to pay benefits.
If they challenge the idea of providing, and indeed expanding, benefits to those who don’t “need” them, he should explain, again, that these are earned benefits, just like people’s salaries. Indeed, they are deferred compensation. It is well past time that our policymakers vote the American people a raise.
Even if not asked directly about Social Security, Biden should talk about it. If asked about the deficit, for example, he should make the point that Republican politicians claim that they want to cut Social Security to reduce the deficit—even though Social Security does not and, by law, cannot add even a penny to the deficit. And proceed to point out the stark difference between the two parties on Social Security.
Biden should make the point that whether to expand or cut Social Security is a matter of values, not affordability. He should explain that Democrats want to expand Social Security, while Republicans want to cut it. Democrats want billionaires to pay their fair share; Republicans want to throw more tax giveaways at billionaires.
Biden should promise that if reelected, he will push to expand benefits while requiring the uber-wealthy to pay their fair share. Indeed, he should let the American people know that protecting and expanding Social Security will be a top priority in his second term. And he should warn the American people that Donald Trump is lying to them when he claims he won’t cut their earned benefits.
President Biden has been the most pro-seniors president in at least half a century. Donald Trump was a disaster for seniors, and would be even worse next time. The American public deserves to know this, so they can vote accordingly.
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