Last Sunday, standing at the mic with a grammy in hand for best new artist, Chappell Roan finally got the U.S. talking about the uninsured again. Reading from her notebook, she used the moment to call for adequate wages and health care for aspiring artists. She explained, “If my label would have prioritized artists’ health, I could’ve been provided care by the company I was giving everything to. So, record labels need to treat their artists as valuable employees with a livable wage and health insurance and protections.”
It was a wake-up moment for me
Chappell Roan @ Hollywood Palladium 11/18/2022. Photo by Justin Higuchi.
For at least the last couple of years, it seemed like the nation had stopped talking about the uninsured. A freezing of Medicaid disenrollments during the tumult of the pandemic increased the number of people on Medicaid. And generous Biden-era subsidies for private coverage, encouraged more than 20 million people to find private coverage. Combined, this lulled some of us into a sort of complacency.
Moreover, with more people on Medicaid than ever, universal health care felt more possible. I audaciously (or naively, I’m not sure which) proposed getting us there with Medicaid-for-All. And when the COVID-19 protections for people on Medicaid ultimately ended, the impact was somewhat smaller than expected. Medicaid and Children’s Health Insurance Plan (CHIP) enrollments today stand at about 79 million people, down only 14 million people from early 2023.
Medicaid has continued to help keep the uninsured rate low. In fact, the number of uninsured has reached its lowest point in modern history. Just over 25 million people were uninsured in 2023, reflecting an uninsured rate of only about 9.5%, the lowest rate ever. This fact allowed many of us to focus on almost everything else in the health care system—fixing prescription drug prices, insulin availability, Medicare advantage, and artificial intelligence, for example.
Even political threats of dismantling the ACA had gone quiet
And in the last few years, it seemed that conservative political winds had shifted to–if not quite liking the Affordable Care Act-at least tolerating its steadily rising public popularity. The ACA’s Medicaid expansion, for example, had reached a total of 40 states, once thought impossible early in the ACA. This tally includes (rather quietly) reaching even highly conservative places like Arkansas, Utah and West Virginia. And some of the 10 remaining states are considering their own versions of expansion.
Even President Trump, in a now-famous campaign moment, offered a political head-scratcher with his support for the ACA. Instead of dismantling the ACA, he said that he instead chose to save it. In fact, of course, he worked hard to overturn the law, supporting a GOP-led repeal effort, filing legal briefs with the supreme court, and defunding ACA outreach and enrollment. But still, the absence of the typical, outright antagonism toward the ACA was (dare I say it?) mildly reassuring.
Of course, the sense of complicity this generated was nonsense
The problem of the uninsured remains, affecting nearly 1 in 10 people in the U.S. And Chappell Roan was one of them just a few years back. Her story of being dropped from her employer, having difficulty finding work, and not being able to afford health insurance is relatable for many Americans. Yet, we should remember that even those who are working are not safe. We know that the vast majority (more than 75%) of the uninsured live in a household where someone is working full time.
And this reawakening to the problem of the uninsured should not just be about the status quo. The Trump administration has signaled big changes ahead with regard to Medicaid, likely re-allowing state work requirements that the Biden administration rescinded. Executive orders have also indicated reduced efforts to limit drug prices, perhaps even rescinding the Biden-era Medicare drug price negotiation program. And there are immediate retractions of the extended ACA enrollment deadlines.
None of these steps will help reduce the uninsured rate. And we owe Chappell Roan for waking us up, and getting us all talking about the uninsured again.
Gregory Stevens
Even more concerning:
Half of our population is “underinsured”…..meaning unable to come up with the deductible which causes bankruptcy and poor credit rating!