Medicare, Medicaid Responsible for Decrease in Uninsured Rate, Not Obamacare

Single-Payer Medicare for AllThe number of people without health insurance dropped slightly in 2011 from 50 million to 48.6 million people–a decrease Democrats are eager to pounce on as proof that Obamacare is working.

“Thanks to Obamacare, the ranks of the uninsured fell this year,” writes Kevin Drum for Mother Jones Magazine.

“Attention Obamacare haters: The law you despise appears to be working,” says the New Republic.

Larry Levitt of the Kaiser Family Foundation proposes that, “The biggest decline in the ranks of the uninsured is among young adults aged 19-25. This suggests that the Affordable Care Act (ACA) provision allowing young people up to age 26 to stay on their parents’ policies is succeeding at increasing the number of people with health insurance.”.

If Larry Levitt’s theory was correct, however, then the total number of people with private insurance would have increased. But the Census Bureau tells us that, “Both the rate and number of people covered by employment-based coverage in 2011, 55.1 percent and 170.1 million, were not statistically different from 2010.”

True, private coverage among people between 19 and 25 increased by 539,000 people. 40 percent (215,600) of those people obtained coverage through their parent’s health plan. But again, the total number of people with private insurance stayed the same–meaning there is little reason to assume the ACA has had any impact yet.

So how did the number of uninsured decrease by 1.3 million people?

Simple: people are getting older and poorer. Therefore, a much stronger case can be made that already existing government programs (Medicare and Medicaid), not Obamacare, are responsible for increased health coverage.

Uninsured Totals
[Chart: Health Insurance Coverage Status and Type of Coverage by Age: 2010 and 2011 (click to enlarge)]

Unlike private insurance, “The number of people covered by government health programs increased to 99.5 million from 95.5 million.” Essentially, 2 million people were added to Medicaid (50.8 million) and 2 million people were added to Medicare (46.9 million) in 2011.

Steady poverty and unemployment resulting in decreased median income for everyone except the rich means more people are eligible for Medicaid (thus the 2 million person increase). The poverty rate remained at 15 percent, meaning 46.2 million people were living in poverty in 2011. Wages fell for the majority of Americans and inequality between the rich and poor increased. The Center on Budget and Policy Priorities explains that:

“For the 20 percent of households in the middle, average household income fell 1.7 percent, or $876. For the top 20 percent, average income rose 1.9 percent, or $3,286. For the top 5 percent of households, average income rose 5.1 percent, or $15,184. Incomes fell for the bottom four-fifths of American households, while rising only for the top fifth.”

Right now, Obamacare requires states to maintain their current eligibility levels for Medicaid (meaning they are not allowed to drop people from coverage), but all this does is maintain the status quo–it doesn’t insure new people. Income eligibility is supposed to increase to 133 percent of the federal poverty level by 2014, but the Supreme Court decision on Obamacare makes that unlikely to happen in every state. Therefore, decreased income and the steady erosion of employment-based insurance are likely the reason for increased Medicaid roles.

Medicare’s eligibility age wasn’t lowered and stayed at 65 under Obamacare so that’s not the cause for higher enrollment. According to the Washington Post, “The portion and number of Americans covered by Medicare continued to rise, as more baby boomers entered retirement age.”

Again, 4,000,000 people were added to Medicaid and Medicare (which have existed for 47 years) in 2011 while only 215,600 people were covered by the Obamacare’s young person provision (which has existed for 1 year).

It should be clear by now that major gains in health insurance coverage came from an increase in government health insurance coverage. Either way, we have a lot more work to do before we end the US healthcare crisis.

48.6 million people are currently uninsured. 48,000 people will die this year because they don’t have health insurance. Job-based insurance premiums for a family of four increased 4 percent last year and nearly doubled since 2002. This is a tragedy, not cause for celebrating Obamacare.

Even when Obamcare is fully implemented in 2014, the Congressional Budget Office estimates that 30 million people will still be uninsured. Healthcare and drug costs will continue to rapidly rise–as is happening under the Massachusetts plan from which Obamacare is modeled. And a dozen governors plan to ignore Obamacare‘s Medicaid expansion to 133% of the federal poverty rate in their states. Yet the Democrats have no plans to strengthen Obamacare.

According to the Democratic platform released at the Democratic National Convention this month, there are no calls for waivers to allow for state single-payer. There’s not even a mention of a public option. As Jon Walker of Fire Dog Lake says, “The platform of the Democratic Party is basically that the ACA is great how it is and there is very little need to improve it.”

We know it doesn’t have to be this way. With a national single-payer health program we’d cover everyone living in the US and save $500 billion a year. President Obama knows this is true and that single-payer is the solution.

Stuart Altman, President Nixon’s former health aid and advisor to Obama in the lead up to health reform recently recalled that, “Every once in awhile Obama would say, ‘Wouldn’t single-payer be simpler?’ The answer is yes. But America wasn’t ready for it.”

America is not only ready for a national, single-payer healthcare plan, it desperately needs one. Yet, despite all that Medicare and Medicaid has done to protect the most vulnerable, cuts to these programs loom no matter who wins the election next month. Those who believe in the right to healthcare should defend these programs at all costs.

Jeff Muckensturm is on the national staff of Healthcare-NOW!, a national network of single-payer advocates and organizations. Find out more about the single-payer movement at