All we want is life beyond the thunderdome

The actual, as opposed to imaginary, health care plan that Paul Ryan put forth and the entire Republican Party signed onto (pdf) has many, many pieces but I’d like to point to the provisions for covering the uninsured. There aren’t any. The GOP health care plan repeals the parts of the PPACA that cover the uninsured, and replaces them with nothing.

Considering that we just had a two year debate on some hypothetical, abstract group we called “the uninsured” I’m a little confused as to why they aren’t popular anymore. The uninsured didn’t really go away. Nothing changed for them when Paul Ryan shot to stardom. Ryan’s awesome charisma is apparently powerful enough to completely eclipse the (formerly) urgent needs of tens of millions of people. That’s a little disconcerting. Where’d they go?

Ryan’s plan repeals the PPACA, except for the portion where 500 billion or so is cut from the privatized portion of Medicare, Medicare Advantage. Despite what the honorable Paul Ryan is telling FOX News personalities and viewers, Ryan’s plan retains the 500 billion or so in Medicare Advantage cuts.

Back when the uninsured were popular we discussed the provisions within the PPACA to cover the uninsured endlessly. What we didn’t do is talk about who they are, as a broad group.(pdf)

I think the broad demographic and class information on the uninsured goes a long way towards explaining why it took 30 years to pass anything at all to address their health care access problem. I think the same information also may explain why tens of millions of people have mysteriously dropped out of the fawning media coverage of the GOP health care plan.

This is who they are:

More than three-quarters of the uninsured are in working families—sixty-one percent are from families with one or more full-time workers and 16% are from families with part-time workers.

The vast majority of the uninsured are in low- or moderate-income families. In total, nine in ten of the uninsured are in low- or moderate-income families, meaning they are below 400% of poverty. The new health reform law targets these individuals through broader Medicaid eligibility and premium subsidies through health insurance exchanges for eligible individuals with incomes up to 400% of poverty that do not have access to employer sponsored insurance.

Adults are more likely to be uninsured than children. Adults make up 70% of the nonelderly population, but more than 80% of the uninsured. Most low-income children qualify for Medicaid or the Children’s Health Insurance Program (CHIP), but low-income adults under age 65 typically qualify for Medicaid only if they are disabled, pregnant, or have dependent children. Income eligibility levels are generally much lower for parents than for children, and adults without children are generally ineligible. Under the Patient Protection and Affordable Care Act (ACA), Medicaid will be expanded in 2014 to provide eligibility to nearly all people under age 65 with income under 138% of the federal poverty level.

Young adults, ages 19 to 29, comprise a disproportionately large share of the uninsured, largely due to their low incomes. Young adults have the highest uninsured rate (32%) of any age group. More than half of uninsured young adults are families with at least one full-time worker, but their low incomes make it more difficult for them to afford coverage.The median income of uninsured young adults in 2008 was $15,000.

More than half (63%) of nonelderly uninsured adults have no education beyond high school, making them less able to get higher-skilled jobs that are more likely to provide health coverage. Thosewith less education are also more likely to be uninsured for longer periods of time.Minorities are much more likely to be uninsured than whites. About one third of Hispanics are uninsured compared to 14% of whites. The uninsured rate among African-Americans (23%) is also much higher than that of whites

It is not now and has never been politically advantageous to address the health care access problems of the working poor and lower middle class- particularly younger people within those groups- because “the uninsured” don’t have any real cohesive organized advocacy or lobbying clout.

That’s why politicians didn’t get anything done on this, prior to the PPACA. There was little or no anticipated political return on the huge political risk inherent in actually doing something to address the chronic problem.

The same uninsured who were (supposedly) vitally important to our national conversation a year ago have gone missing again. Nothing changed for them, yet Paul Ryan somehow succeeded in leading the circus away from any discussion of how his bold and brave plan leaves them, once again, high and dry. Weird how this particular group of Real Americans keep dropping out of our national conversation. If I didn’t know better, I’d think they weren’t important.

30 million people have gone missing, againPost + Comments (44)