High Cost Causes Uninsurance

The Center for Economic and Policy Research has published a report about low-wage workers and health insurance coverage (http://www.cepr.net/documents/publications/health-low-wage-2012-02.pdf).

Here is an excerpt:
Center for Economic and Policy Research
February 2012
Health-insurance Coverage for Low-wage Workers, 1979-2010 and Beyond
By John Schmitt

In 2010, over 38 percent of low-wage workers lacked health insurance from any source, up from 16 percent in 1979.

Coverage problems are particularly severe for Latino workers. Almost 40 percent of all Latino workers (not just low-wage workers) have no health insurance of any form. African American (about 22 percent) and Asian (about 17 percent) workers are also much less likely to have coverage than white workers (about 12 percent).

Affordable Care Act of 2010

For simplicity, if we assume that all adults – workers and non-workers – have the same coverage rate, then under CBO’s projections, workers as a group would have a 5.8 percent non-coverage rate after the ACA. By comparison, in 2010, the actual non-coverage rate for all workers was about 17.7 percent. The CBO gives no guidance about how the coverage improvements for workers would be divided across the wage distribution. If, at the extreme, we assume that all of the uncovered workers are low-wage workers by our definition – that is that all 5.8 percent of workers remaining without coverage are in the bottom quintile – then the non-coverage rate for low-wage workers would be about 29.0 percent. This would be a reduction of one-fourth in the share of low-wage workers without coverage relative to the actual non-coverage rate for low-wage workers in 2010 (38.5 percent). A less extreme assumption about the distribution of non-coverage rates by wage level after the ACA would produce larger gains for low-wage workers. For example, if instead we assume that the top 80 percent of workers have a frictional 3 percent non-coverage rate, then an overall non-coverage rate for workers of 5.8 percent implies a 17.0 percent non-coverage rate for low-wage workers, well short of universal coverage, but a non-coverage rate that is less than half of the current rate.

The ACA will not produce universal coverage for low-wage workers. But, if the ACA is not enacted – due to judicial or legislative action – every indication is that coverage rates will continue their three-decades-long decline.
The decline in coverage rates has its roots in two long-standing economic processes. The first is the rising cost of health care, which has squeezed workers’ wages and made it less economical for firms to offer health insurance, especially to low-wage workers. In the absence of reforms to the existing health-care system, these costs – and implicitly the pressure on workers’ after-health-insurance compensation – are projected to continue rising indefinitely.

My comment:
The principle flaw with the Affordable Care Act is the approach to reform which emphasizes increased coverage rather than reduced cost. We can not 'afford' increased coverage without first reducing the cost of care and the overhead related to financing health care. Low wage workers will never be adequately 'covered' for health care financing under ACA. The real problem in business as usual for American health care is the wasteful spending on poor quality care and inefficient financing. We need legislation (best at the state level) which addresses the high cost of American health care. Coverage will naturally follow reductions in cost.
Dr. Joe Jarvis