RAND: House bill could halve U.S. uninsured by 2019
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In addition, those without insurance in 2019 will be younger, healthier and wealthier than would be expected in the absence of the policy changes, according to the analysis.
H.R.3962--which was passed in November 2009 by the House of Representatives by a vote of 220 to 215--sought to expand health coverage for Americans who are uninsured. RAND's analysis estimated that H.R. 3962 would reduce the number of uninsured to approximately 24 million by 2019, under the assumption that the implementation would begin between 2013 and 2015 and a period of at least three years would be necessary for companies to ready themselves for the offerings.
According to projections, the number of uninsured individuals will decline in every age group--with the largest reduction (11 million) noted in the 18–34 age group, and the smallest (four million) noted among children age 0–17. In addition, those who report their health status as fair or poor are less likely to be uninsured in 2019 and a higher proportion of those who report their health is excellent or good are likely to be uninsured after implementation of the legislation, said RAND.
In terms of spending, personal healthcare expenditures would increase by 3.3 percent as a result of the reform, as previously uninsured individuals become insured and utilize more healthcare services and previously insured people select more generous plans in response to subsidies.
Increased federal and state Medicaid expenditures, as a result of eligibility expansion, is estimated to increase government spending by $1 trillion between 2013 and 2019. Also, the consumer financial risk report said that newly insured individuals are projected to have higher utilization rates and higher average expenses, estimated at $1,918 yearly, according to the findings of the analysis.
Options for expanding coverage that were noted by the report were employer-sponsored, Medicaid and nongroup insurance (including health insurance exchanges). By 2019, about 12 million additional people would be enrolled in employer-sponsored insurance, 10 million more enrolled in Medicaid and 8 million more enrolled in nongroup compared to current enrollment rates, Rand estimated.
Moreover, premiums in the large group market are likely to decrease from $8,011 to $7,821, according to the report.
Should a cost-sharing subsidy be available as part of the terms of H.R. 3962, the report estimated that 95 percent would choose the basic, 3 percent would choose the enhanced and 2 percent would choose the premium health insurance plan offering. If no cost-sharing subsidy is available, the report estimated that 73 percent would choose basic, 15 percent would choose enhanced and 12 percent would choose premium plans.
“Shifting people onto the basic plan is only one of the effects of the cost-sharing subsidy. Being a form of subsidy, albeit not very common, it reduces the cost of acquiring health insurance and increases the insured rate. The net effect is to insure an additional 1.7 million people at an additional cost of $13.8 billion,” concluded RAND.