The good news from last week’s Congressional Budget Office report was that Obamacare will cost 20 percent less through 2019 than originally expected. That’s in part because medical inflation has slowed more than the CBO anticipated back in 2010 when the law went into effect.
But the report had bad news too. Fewer people are signing up for coverage than the government had hoped. In fact, the CBO estimates that 31 million of us will still be uninsured 10 years from now.
The Supreme Court bears some of the responsibility on that front. It ruled in 2012 that even though Congress intended for all the states to expand their Medicaid programs to include more low-income individuals and families, states could opt out of that requirement. And many with Republican governors and legislatures did. .
The other main reason for the sobering estimate of uninsured 10 years down the road: many people still can’t afford to buy health insurance, even with financial help from the government.
Back in 2010, the CBO predicted that 13 million people would have signed up for coverage by the end of this year through the Obamacare exchanges—which have been operating in every state and the District of Columbia since the fall of 2013. The CBO revised its projection downward last week to 12 million, but the actual number very likely will be less than that. The Obama administration’s enrollment target for 2015 is just 9 million.
The CBO projects that health plan enrollment on the exchanges will jump to 21 million next year and that an additional 16 million previously uninsured Americans will be covered by either Medicaid or the Children’s Health Insurance Program by the end of 2016.
The vast majority of the people who have enrolled in exchange plans so far have had incomes so low they were eligible for federal subsidies to help them pay their premiums.
But millions of other people earn just a little too much to qualify for financial help from the government, and many of them are choosing to remain uninsured.
Although the Obama administration and Congressional Democrats who voted for the law don’t talk much about it, a significant percentage of the population will always be in a kind of no-man’s land. They earn too much to quality for either Medicaid or federal subsidies, but they also earn too little to be penalized for not buying it.
The law states that most people who remain uninsured have to pay a penalty, but many people are exempt from that provision for various reasons.