Millions Uninsured Despite Eligibility for Health Programs

The uninsured ranks could be a lot lower if people eligible for government programs were actually enrolled in them, according to a report by the National Institute for Health Care Management (NIHCM) Foundation.

The report, “Understanding the Uninsured: Tailoring Policy Solutions for Different Subpopulations,” says that one in four who are eligible for Medicaid or the State’s Children’s Health Insurance Program (SCHIP) public insurance plans are not enrolled in them. That’s 12 million people, and about half are children.

Uninsured patients generate the bulk of the bad debt expense that hospitals and health care providers write off each year. According the American Hospital Association, the industry provided $31.2 billion in uncompensated care in 2006, the last year for which figures are available.

Eligibility for the public assistance programs is based on income and the federal poverty level. The NIHCM’s report says many of those eligible for the programs don’t enroll because they are not aware the programs exist, don’t know how to enroll or fear being linked with a publicly financed program.

However, “administrative hassles,” such as complex forms and re-enrollment requirements also inhibit both enrollment and retention, the report said.
“New enrollees often are daunted by the paperwork required to enroll in a program, while existing enrollees can be involuntarily disenrolled if they do not complete renewal forms,” the report said.

A 2005 law also made it harder to enroll in Medicaid because applicants are required to show proof of citizenship to be eligible. The law was intended to restrict undocumented immigrants from enrolling in the plans. However, the NIHCM said the law has led to inappropriate enrollment denials and delays for large numbers of American citizens.

The report is based on 2006 data from the 2007 Current Population Survey. It categorizes the uninsured according to their eligibility for public programs, incomes, status as a child, parent or childless adult.