By Jennifer Ng’andu, Deputy Director, Health Policy Project, NCLR
If there’s one thing that people know about the Affordable Care Act (ACA), it’s that the nation’s health care law includes an individual mandate, or requires that all Americans obtain health insurance beginning in the year 2014. If there’s one thing that people don’t know about the ACA, it’s that this responsibility will not apply to most Americans, including most Latinos. Since the day of the ACA’s passage, there has been misinformation leading many to believe that this requirement will be far reaching and leave many Americans vulnerable to serious penalties. Luckily, the Urban Institute has come forward to clear this matter up. Yesterday, they released a brief that shows, for all intents and purposes, that only about 7 percent of non-elderly Americans would actually face the mandate in any real way.
The facts are that most Americans will either already have insurance; others will be able to get it with new options. Here’s the breakdown:
- Most Americans, including Latinos, are insured and will still be insured after the Affordable Care Act’s enactment. NCLR often discusses the point that Latinos are the most uninsured community in the country, because we fight for those with the least access to health care. Still, nearly seven in ten Latinos already have insurance.
- In fact, in accordance with President Obama’s classic line, “you can keep what you have,” most people will still get insurance through their employers and nothing will change. This includes about four in ten Latinos who have employer-sponsored insurance.
- Half of the uninsured would soon gain health care through Medicaid or the Children’s Health Insurance Program through new coverage in the Affordable Care Act. This will be critical for Latinos; one in four uses those programs today.
- The other half would have ready access to a new insurance marketplaces, exchanges, and anyone under 400 percent of the federal poverty level (FPL) would get a tax benefit to help pay for coverage.
Where the challenge lies is with those who remain uninsured after the ACA is fully carried out, a good 23 million Americans by Congressional Budgetary Office (CBO) estimates. What will happen to them? Most will have the ability to claim an exemption from any responsibility to purchase health coverage. The Affordable Care Act contained safeguards that said that if you cannot afford to pay, face hardship, have religious beliefs that dictate you remain uninsured, or are among a series of people who were prohibited from buying insurance or to whom the law did not apply—you will not be penalized if you remained uninsured. That’s a lot of the 23 million. In fact, this was one of the conditions of NCLR support for the Affordable Care Act. A mandate is only fair if the people who don’t have means to fulfill it are free from repercussions.
Yesterday, the Supreme Court of the United States spent hours in hearings to decide whether or not the mandate was constitutional, and will soon decide whether or not the fate the entire ACA is tied to this part of the law. Why does this matter to Americans if it applies to only a select group? Without the mandate, the estimates of the number of Americans who would go uninsured after health reform would increase from the original 23 million to between 40 and 42 million—an increase of nearly 40 percent over the mandate projections. This result has a lot to do with the likelihood that those Americans who chose uninsurance would be the healthiest Americans…at the time. And those who chose insurance would more likely have a greater need for health care and would be more expensive to cover. Urban Institute estimates that health insurance premiums would increase between 10–25 percent, putting affordable health insurance out of reach for many more Americans.
If the justices decide that the mandate does not hold up to our forefathers’ vision, the Affordable Care Act can still move forward—but at what consequence?