Reform Update: Number of uninsured holds steady at 48 million, Census Bureau finds

The number of U.S. residents without health insurance remained largely unchanged at 48 million in 2012, according to the U.S. Census Bureau, underscoring what's at stake as many states remain opposed or undecided on the massive Medicaid expansion called for in the Patient Protection and Affordable Care Act.

The rate of uninsured edged down from to 15.4% in 2012 from 15.7% in 2011, according to the Census Bureau's annual report on the uninsured.

Approximately 50 million Americans currently receive coverage under Medicaid, or about 16.4% of the population. That number is expected to rise by several million next year when half the country expands eligibility as part of the Affordable Care Act. The Congressional Budget Office's most recent estimate is that Medicaid will cover another 9 million people in 2014.

So far, 25 states plus the District of Columbia have opted to expand coverage that will allow those with making up to 138% of the federal poverty level to sign up for Medicaid. As many as 21 states have rejected plans to expand coverage to their low-income residents, while three states—New Hampshire, Tennessee and Ohio—are still debating whether to move forward.

Non-citizens had the highest rates of uninsured of any demographic at 43%, a figure unlikely to change much under the Affordable Care Act, which explicitly excludes anyone living in the U.S. illegally.

The next most likely people to be uninsured in the U.S. are Hispanics (29%). Young people, ages 19-34, are close behind at 27%. HHS and its partners are aggressively targeting those groups in their outreach efforts.

“It is time for partisan bickering and implementation obstruction to end so that we all work together to secure affordable healthcare for America's families,” said Ron Pollack, executive director of one of those partners, Families USA.

The Census Bureau also found the highest concentration of uninsured residing in Southern and Western states. Many of them will become newly eligible for Medicaid in Western states such as California, Nevada and Arizona.

But in Alabama, Georgia, Mississippi and Louisiana—all states that opted out of expanding their Medicaid programs—residents whose incomes are too low to qualify to receive a federal subsidy for heath insurance are likely to remain uninsured.

In a separate report issued Tuesday, HHS estimated that more than half of the people in the uninsured population will qualify for Medicaid, CHIP or tax credits that will allow them to buy coverage for $100 or less next year. That would be the case for nearly 80% of the uninsured if all of the states expanded Medicaid, HHS said.

Pennsylvania's Republican Gov. Tom Corbett is sending HHS a proposal that would divert funding for the expansion of Medicaid to help low-income residents buy private health insurance, a plan similar in some ways to an alternative plan in Arkansas that federal officials are still reviewing.

Corbett added a few other wrinkles, as well. Under the plan, Pennsylvania's Medicaid recipients would be required to pay a monthly premium for their coverage, and unemployed beneficiaries would have to go through a job training or job search program.

It remains to be seen whether HHS will warm to Corbett's plan and other devised in states led by Republicans looking to find a middle ground. Michigan Gov. Rick Snyder signed law this week calling for beneficiaries to pay up to 5% of their incomes in premiums, co-pays and deductibles. A similar proposal from Iowa remains under review.

A research letter published in the Sept. 18 issue of the Journal of the American Medical Association found that a growing number of adults with Medicaid coverage were visiting the emergency rooms of hospitals throughout California at rates that were higher than those with private insurance and the uninsured.

The study analyzed emergency room visits by adults aged 19-64 from 2005-2010 and found the number of visits overall increased by 13.2 % during that period, to 6.1 million from 5.4 million a year.

Visits among Medicaid recipients increased by 35% in 2010 compared with 2005, while visits from uninsured patients increased by 25% and privately insured patients by 1.2%.

“A lot of times people tend to perceive uninsured people as the cause for emergency department crowding,” said study co-author Dr. Renee Hsia. “When we think about healthcare reform, a lot of the uninsured people are actually going to be transitioned to Medicaid, so actually our emergency departments might become more crowded.”

Hsia said more needs to be done to make sure Medicaid beneficiaries receive their care through a primary-care provider, which she thought would help to reduce the number of emergency department visits by that group.

Follow Steven Ross Johnson on Twitter: @MHSjohnson