I saw a headline today in the newsfeed, "
Record 35 million Americans have health coverage through ACA" (CNN.com, 29 Apr 2022). The article explains how that number is up from 27 million two years ago. And the current figure is actually 35.8 million today— closer to 36 than the 35 in the headline. That represents almost 11% of the US population.
Who are these 11%?
It's Not Just "Poor People"
The article doesn't detail much about who, demographically, the 11% covered by the ACA, including the Medicaid expansion related to it. There's a common knee-jerk reaction in the US that anyone on a such a plan is on a "government handout" and thus is a poor person too lazy to get a job. I know from personal experience, though, that it's a very socioeconomically diverse group. And for many of them it is
not a "government handout". It's not a subsidy.
Here are Five Things about the kind of people I know who use the ACA.
❖ Entrepreneurs Health care coverage in the US has, for almost 100 years now, been tied largely to one's employer.
Large employers can negotiate group rates that make the cost of insurance affordable. But what about people who work at
small employers? What about otherwise well educated, highly skilled people with strong entrepreneurial spirit who want to
start their own companies? For decades before the ACA of these people were deterred from doing so by the prohibitive cost of health care insurance on the individual market.
I remember working a job just out of college at a software company started by a former colleague, Jeff. and his best friend, Other Jeff. They hired Also Jeff's grad school wiz programmer classmate Chris then they hired me. The little 4-person company didn't offer insurance. They couldn't afford it. Well, for the founders Jeff and Other Jeff that was okay because they had insurance from other sources. Jeff's wife, Jill, had a job with a big company and got health insurance for both of them. Other Jeff was a trust fund baby and could afford paying insurance premiums on the pre-reform solo market that were the equivalent of $3,000/month (inflation adjusted) today. Chris and I... well, we were young and decided we would take our chances. I lucked out with that; Chris... ate ramen for the rest of the month anytime he had to visit a doctor.
❖ Independent Contractors The thing about health care coverage tied to employers is that it's tied to "permanent" employment status. If you're a part-timer, a temporary employee, or a contractor you're generally not eligible for benefits— even if the company that employs you is a big, wealthy corporation.
Shortly after seeing how Jeff and Other Jeff needed health insurance through other sources to be able to start their own company I met an acquaintance, Carey, who was just a bit old than me and was working as an independent contractor. He was very dialed in to the challenges with health care for professionals like him and the early reform efforts. These efforts, BTW, weren't "Obamacare". This was the mid 1990s, before Barak Obama had even run for his first elected office. Back then the political right was screaming about
Hillarycare. Carey pointed out that people like him didn't need socialized medicine as much as "portable" health insurance, i.e., affordable insurance that's not tied to a specific employer and their willingness to provide it to you as a benefit.
❖ Early Retirees Another group of people left out by traditional health insurance tied to employment are those who've retired. Americans 65+, of course, are covered by Medicare. But what about those who retire early? Especially as you get older— 50, 55, 60, 63— health insurance gets even more expensive. The prohibitive cost of buying it on the individual market has kept a lot of people otherwise ready to retire early toiling away in corporate America. The ACA has made that individual market more affordable. ...Note, not by
subsidizing it with tax dollars, but by reform rules requiring insurers to offer group rate policies to individuals. My friends Dave and Ella are two people in this category. Hawk and I will likely join them—
in being early retirees on ACA plans— in a few years.
❖ The Working Poor Plenty of people out there are working long hours at jobs... but they're not great-paying jobs, and they're classified as part-time so there are no benefits. In the past these folks would fall through the cracks in the system. Too well off for "welfare" and too poor to afford insurance or even regular care, they'd avoid going to clinics until they got
really sick. ...And then when they were really sick, they'd rack up huge medical debt.
The ACA benefits people in this category in two ways. First, insurance plans are cheaper. Again, this is not because "government handout"; it's because of
reform. But there is
also an element of government handout. The ACA provides partial subsidies for people earning up to 4x the federal poverty limit.
❖ Adults 18-25 One of the health care reforms packaged with the ACA is that adult children can stay on their parents' health care plans until they turn 26. This group isn't included in the 35.8 million figure because they're not actually
on ACA plans (unless their parents are too) but it's an important change to appreciate. This is enormous for adults just starting out in life as the pressure to find insurance after turning 18 was immense. For those of us who attended university full-time, most of us had coverage through the university's student health program, but we still faced the same pressure upon graduation. Many people I know scrambled for corporate jobs, taking work that paid benefits instead of work they
wanted. The extension to age 26 helps people start pursuing they careers they want instead of settling for anything that pays benefits.
Update: Sharp eyed readers may wonder why I'm so positive in this article on the ACA improving health insurance after
I blasted insurance as a "racket" just a few days earlier. It turns out health insurance in the US solves a critical major problem in the mess that is US health care.
Read about that in a subsequent article.
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