1 in 4 Uninsured Are Eligible for Aid But Aren't Enrolled: Washington Post Friday, April 25, 2008

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1 in 4 Uninsured Are Eligible for Aid But Aren't Enrolled Washington Post Friday,

April 25, 2008; 12:00 AM FRIDAY, April 25 (HealthDay

News) -- One in four Americans -- about 12 million people -- who don't have

health coverage are eligible for Medicaid and the State Children's Health

Insurance Program (SCHIP) but aren't enrolled, a new report shows. The results were released Friday by the National

Institute for Health Care Management Foundation. Reasons cited for the lack of enrollment

include: They're not aware of the programs; they don't know how to enroll, they

fear being linked with a publicly financed program; and it can be difficult to

stay enrolled, the report said. There are 47 million uninsured people in the

United States .

Most of the 12 million people without insurance who qualify for public coverage

but aren't enrolled are in low-income families. This includes 6.1 million

children, or 64 percent of all uninsured children. Most of these children are

in families with incomes below 200 percent of the federal poverty level

($41,300 for a family of four or $20,420 for individuals). The report noted that since public program

eligibility is more restrictive for adults, only 29 percent of uninsured

parents (3.6 million) and 10 percent of uninsured childless adults (2.4

million) can enroll in public programs. More than half of the 47 million

uninsured people in the United

States are childless adults. "The paucity of public coverage for

low-income childless adults is really troubling. This is a population that

really can only be helped by an expansion of public programs or some form of

subsidy, yet we don't see a lot of that out there across the states,"

Chockley, president and CEO of the NIHCM Foundation, said in a prepared

statement. The report, based on 2006 data from the 2007

Current Population Survey, also estimated that of the 10 million uninsured

non-U.S. citizens, 5.6 million are undocumented immigrants, and 4.4 million are

legal residents. Boosting enrollment among people who are

eligible for public programs wouldn't significantly reduce the number of

uninsured parents and childless adults, the report authors said. They noted

there are 9.1 million uninsured childless adults and 4.8 million parents with

incomes below 200 percent of the federal poverty level (FPL) who aren't

eligible for public coverage. One third of each group has incomes below 100

percent of the FPL. Extension of current public programs or providing public

subsides would help these adults. Currently, only seven states provide public

assistance to low-income childless adults, and about half the states deny

access to traditional Medicaid benefits for working parents in families above

63 percent of the FPL (about $13,000 for a family of four). This means there's

plenty of room for expansion to reach the poorest adults, the report authors

said. They noted that providing coverage to more

parents would likely increase enrollment of eligible children in Medicaid and

SCHIP, since there's evidence that children are more likely to be enrolled in

these programs if their parents are eligible. About 40 percent of uninsured people have

moderate to higher incomes, according to the report. Since most of those with

incomes above 200 percent of FPL have insurance, it's difficult to find

affordable solutions without disrupting those who have insurance. Tax credits,

tax system changes, high-risk pools, reinsurance and mandates are among the

policy options that can be used by government. Insurance products designed for

previously uninsured people are being developed by the private sector. "What this report shows us is that reaching

universal coverage is a very complicated proposition, but that we can get a

quarter of the way there by getting more people who are eligible for public

programs enrolled, and we can make a lot of headway, too, by looking for

subsidies for low-income childless adults and parents," Chockley said. More information

The American

College of Emergency Physicians has more

about uninsured patients.

SOURCE: National Institute for Health Care Management Foundation, news release,

April 25, 2008

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