Why doesn’t everyone have insurance, and why does it matter?
Most people have health insurance — usually private insurance through work, or public insurance like Medicare or Medicaid. But about 30 million people in the U.S. are uninsured — and even more during the pandemic — usually because they are between jobs, can’t afford the premium, or don’t qualify for a public program. So they have to pay for care out of pocket and many can’t afford it. Here’s what some services cost:
People who are uninsured are more likely to delay or skip getting needed doctor care or prescription drugs, and often rack up large medical debts. They are also at higher risk of dying: 20,000–50,000 people die each year in the U.S. due to being uninsured.
How big is the problem?
At the end of the Obama administration in 2016 about 11% of adults (22 million people) were uninsured. In 2018 the number increased to 14%, 1 in 7 adults, or about 29 million people. In 2020, during the COVID-19 pandemic, because so much health insurance is linked to jobs and employment dropped sharply, the number of uninsured rose by 14–28 million people — nearly doubling the number of uninsured as in 2018.
Why did the number of uninsured increase and how did Trump affect this?
The 2017 tax law ended the requirement to buy health insurance. The Trump administration also reduced financial assistance available to the near-poor to buy private insurance on state-based insurance exchanges. The Trump administration is trying to fully repeal Obama’s Affordable Care Act, including insurance exchanges and Medicaid expansions; this would further increase the number of uninsured. The severity of the COVID-19 pandemic has contributed to the sharp rise in the uninsured.
What does Biden propose?
Biden proposes a “public option”, which would allow individuals to join Medicare or a similar government insurance program. Based on income and other factors, some people would get free enrollment, and others would have to pay a premium. He also proposes lowering the Medicare eligibility age from 65 to 60, increasing premium subsidies for people using state insurance exchanges, and strictly enforcing rules that assure access to health insurance.
Does the choice of President matter?
A second Trump administration would continue to dismantle the Affordable Care Act; no alternative insurance policy has been proposed. This could mean an added 10–20 million uninsured, with 10,000–20,000 more deaths per year. A Biden administration would implement a public option, earlier Medicare eligibility, and premium assistance. This would lower the uninsured by 10–15 million, avoiding 10,000–15,000 deaths per year.
I hope this information helps you decide your vote.
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