May 17, 2013—About 25 million Americans will gain health coverage by 2023 under the Affordable Care Act (ACA) but about 31 million will remain without insurance, according to new projections from the nonpartisan Congressional Budget Office (CBO).
The health coverage figures were included in CBO’s latest federal budget projections for the coming decade.[ms-protect-content id=”2799″] The agency says there are now 55 million nonelderly uninsured people in the United States.
CBO says it currently expects that, by 2023, 20 percent of the people made potentially eligible for Medicaid under health care reform will have no coverage because they will live in states that do not expand Medicaid at all. Another 10 percent will live in states that extend Medicaid only partially.
ACA’s major provisions, including the voluntary expansion of Medicaid to individuals with incomes below 138 percent of the federal poverty level, are due to go into effect in January 2014.
The CBO analysis did not address how many people would have inadequate health coverage after reform is fully in place. About half of U.S. adults ages 19 to 64 lacked health insurance for at least part of 2012 or were uninsured, the Commonwealth Fund reported recently.
According to the nonprofit health care research group, 46 percent of adults ages 19 to 64, or an estimated 84 million people, did not have insurance for the full year or were underinsured and unprotected from high out-of-pocket costs. Forty-one percent, or 75 million people, reported they had problems paying their medical bills or were paying off medical debt. Forty three percent, or 80 million people, reported cost-related problems getting needed health care.
Drug manufacturers and some members of Congress have questioned the need for 340B drug discounts after health care reform is fully implemented. During the July 2009 markup of the health reform bill in the Senate Health, Education, Labor and Pensions (HELP) Committee, amendments that would have blocked the 340B program’s expansion were drafted. A compromise was reached directing the Government Accountability Office to conduct a thorough study of 340B and to specifically address whether the program should be expanded “since it is anticipated that the 47,000,000 individuals who are uninsured as of the date of enactment of this Act will have health care coverage once this Act is implemented.”
Safety Net Hospitals for Pharmaceutical Access (SNHPA), which represents hospitals enrolled in the drug discount program, said the new studies support its position that there will be a continuing need for 340B in the years ahead. “Even after health insurance expansion, more than 30 million Americans will still lack health coverage and tens of millions more Americans will be underinsured,” the group said. “340B will enable hospitals to continue meeting vulnerable patients’ needs and to continue stretching taxpayer dollars.”[/ms-protect-content]