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Q&A

Health coverage for all, and what that means

How many people don't have insurance? And how many of them could get it under legislation being developed in Congress?

August 16, 2009|Noam N. Levey

WASHINGTON — A centerpiece of President Obama's healthcare agenda -- and of the bills being developed on Capitol Hill -- is extending insurance to all Americans. Here is a rundown of the basics about what health coverage looks like now and what may change:

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Where do most people in America get their insurance now?

An estimated 253.4 million people had coverage in 2007, according to the most recent analysis by the U.S. Census Bureau. The majority of those had private insurance, most of it obtained through an employer. Eighty-three million people got health insurance from the government through Medicare, Medicaid or some other program such as the Veterans Health Administration.

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How many people don't have coverage?

The Census Bureau estimated that 45.7 million people under age 65 did not have insurance in 2007. (Most discussions focus on those under 65 because senior citizens have access to Medicare.)

Many experts believe that the number of uninsured is higher now, perhaps more than 47 million, because many people have lost coverage in the economic downturn. Even more people may go without coverage for a time as a result of changing jobs, leaving school or some other event. An analysis by the consumer group Families USA estimated that about 64.5 million people were uninsured for at least six months in 2007 and 2008.

The majority of the uninsured, more than 8 in 10, are in working families.

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Can any of the uninsured afford coverage?

Probably. Many younger people and healthy people choose not to get coverage. Some 4.5 million of the uninsured make at least four times the federal poverty level -- or $43,320 a year for an individual and $88,200 for a family of four -- according to an analysis by the Urban Institute and the Kaiser Commission on Medicaid and the Uninsured. The analysis estimated that 15 million of the uninsured are below the federal poverty line of $10,830 for an individual and $22,050 for a family of four.

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Couldn't those people qualify for government assistance?

Many probably could. One of the challenges that has confounded policymakers is how to get more poor people to sign up for aid. Congressional Democrats pushing healthcare legislation want to expand eligibility for Medicaid -- the federal-state health insurance program for the poor -- and ramp up outreach efforts.

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How many of the uninsured are illegal immigrants?

As many as 7 million. And 3 million are legal immigrants, according to the U.S. Census.

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Will all of the uninsured be covered under plans being developed in Congress?

Not all of them. The bills written by senior House Democrats and by the Senate health committee would explicitly prohibit illegal immigrants from getting federal aid for health insurance. Although all the major proposals would require everyone to get health insurance, millions of people still are not expected to sign up.

Under the House bill, the percentage of people with coverage (excluding illegal immigrants) is expected to go from 83% in 2010 to 97% in 2019, according to the nonpartisan Congressional Budget Office, which is charged with analyzing the cost and effect of proposed legislation. The Senate health bill would boost the coverage rate to 90%.

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Where will people be getting their health insurance if Democrats succeed in pushing an overhaul through?

Critics contend that Democratic plans to create a government insurance program will dramatically change the market by driving private insurers out of business. But the CBO estimated that in 10 years, most Americans under 65 still will get private insurance through their employers. In fact, the number of people with employer-based coverage is expected to grow.

As many as 30 million would get their insurance through exchanges created by the legislation. These new, highly regulated marketplaces would offer a choice of health plans provided by private insurers and the government. Of those in the exchanges, fewer than 11 million are expected to get their insurance from the government plan, according to the CBO.

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noam.levey@latimes.com

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