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If the young man down the street decides not to buy health insurance, that doesn’t affect you, right?
Well, perhaps not directly. And maybe not immediately.
But experts say uninsured people can have an effect on society in a number of ways. These effects include an increase in your insurance premiums and how much a hospital stay will cost you.
Experts are especially worried about rising premiums and medical costs as the number of people without health insurance in the United States increases again.
A report by The Commonwealth Fund released earlier this month estimates that the percentage of working-age Americans without health insurance went up from 12.7 percent in 2016 to 15.5 percent this year.
This is a reversal of a trend that began when the Affordable Care Act (ACA), also known as Obamacare, took effect in 2014.
In 2013, the percentage of uninsured was about 18 percent. It had decreased every year since then until this year.
The Commonwealth Fund study authors said the recent percentage jump means 4 million more Americans lost healthcare coverage in the past two years.
The authors said the number of people with employer-sponsored health insurance remained about the same. That means the 4 million decline came almost entirely from people with individual plans from the insurance marketplace.
They also noted the percentage of low-income people without health insurance rose from 21 percent to 25 percent.
The highest number of uninsured was in the South, where about 20 percent of people don’t have health insurance.
In addition, uninsured rates rose in the 19 states that haven’t expanded their Medicaid programs under the ACA.
The uninsured breakdown also fell along party lines. The percentage of Democrats without health insurance remained steady at about 9 percent. However, the percentage of Republicans without coverage rose from almost 8 percent to nearly 14 percent.
Experts told Healthline that some of the 4 million who lost coverage did so voluntarily. Others could no longer afford the premiums or were unaware of their options.
The impacts of an uninsured population
ACA insurance marketplaces don’t directly affect most Americans, despite the attention paid to them in the media.
For starters, employer-based plans cover about 56 percent of the population with insurance.
Another 20 percent are enrolled in Medicaid, with 16 percent covered by Medicare.
The military provides insurance for another 5 percent of the population.
However, experts say the rising number of uninsured people can send ripple effects throughout the entire healthcare system.
For starters, the departure of insured consumers affects the individual insurance markets.
Kurt Mosley, the vice president of strategic alliances for Merritt Hawkins health consultants, told Healthline that premiums can rise for everyone if younger, healthier people leave the overall insurance pool.
We got an inkling of what might lie ahead this past week when insurers in Virginia and Maryland filed their initial requests for premium increases for next year in ACA insurance markets. The hikes ranged from 15 percent to 91 percent.
“You have to remember that the insurance industry is a business,” Mosley said.
Officials at America’s Health Insurance Plans (AHIP) agree.
“For both taxpayers and those who are insured, plans are more affordable when everyone is covered. Those who depend on their coverage to access care regularly, as well as those who have coverage to protect them in case they get sick. In the individual market specifically, we need to ensure broad participation in the market and help deliver affordable and meaningful benefits to consumers,” Cathryn Donaldson, communications director for AHIP, told Healthline in a statement.
There’s also the impact the lack of coverage has on individuals without insurance.
Mosley notes that uninsured people don’t go in for blood tests, colonoscopies, EKGs, and other services that might catch illnesses and diseases early.
“People without insurance don’t get preventative care,” he said.
What happens when those folks get sick? They go to an emergency room, which can cause crowding and long wait times.
Although hospitals technically have the option whether or not to treat uninsured people, the vast majority of care is for patients without insurance.
In 1985, the Emergency Medical Treatment and Labor Act (EMTALA) was approved. It was passed in response to a practice where private hospital emergency rooms were sending uninsured patients to public hospitals. EMTALA forbid financial discrimination for hospital treatments.
But the act was never funded, and therefore never enforced. It was eventually placed under the Medicare program. Hospitals voluntarily agree to comply with the provisions.
Mosley notes that most emergency rooms do treat seriously ill or injured people, regardless of insurance.
Many times, the hospitals don’t get reimbursed for treating those who are uninsured.
“Hospitals have to eat those costs,” said Mosley.
Mosley and other experts say those losses can contribute to higher overall medical costs, as hospitals have to balance their budget.
“When people are uninsured, there is a cost that is imposed on the system,” Dan Mendelson, president of Avalere Health consultants, told Healthline.
“As the number of uninsured ticks up,” added Donaldson, “it puts a strain on the entire market as states and taxpayers face more uncompensated care costs as public hospitals and emergency rooms take on more uninsured patients.”
Mosley notes that people who decide not to buy health insurance are simply rolling the dice that nothing serious will happen to them.
“It truly is a gamble,” he said.
The experts say when those gambles don’t pay off, there’s an overall effect on society.
Without healthcare when they need it, people can face mounting hospital bills that can leave them bankrupt. Some may not get medical care until a disease has a progressed to the point they need expensive treatments or hospice.
They may not be able to come into work as often. They become less engaged. They can also end up on expensive programs like Medicaid, food stamps, or similar programs.
“An unhealthy society hurts us all over,” said Mosley.
“We all have an interest in a strong society and economy,” noted Mendelson.
“We don’t live in individual silos,” added Leni Preston, vice president of Consumer Health First. “This impacts the health of our communities.”
Trend will probably continue
This recent increase in uninsured people isn’t expected to be a one-year blip.
The experts say you can expect the trend to continue in 2019.
“We will likely continue to see slippage,” said Mendelson.
One reason is the individual mandate under Obamacare will go away next year. That rule required everyone to have insurance coverage or face a financial penalty on their income taxes.
The Commonwealth Fund report states that the 5 percent of people with insurance they surveyed said they’ll drop their insurance plans once the mandate expires.
The report also states that the Trump administration’s actions to reduce advertising, promotion, outreach, and guidance about available insurance plans will further reduce enrollment.
The authors explain that states allowing insurance companies to offer plans below minimum ACA standards will also impact enrollment. Although those plans are cheaper, the report says their lack of services might discourage people from signing up.
Mendelson adds that having government leaders in the Republican party bash the ACA for the past two years may have led a lot of people to feel like the plans aren’t worth their money.
“Health insurance is a lot about trust. Messages matter,” he said.
“It’s time,” Mosley added, “for the government to stop playing politics with this.”
What’s the future for Obamacare?
The nonpartisan Congressional Budget Office (CBO) also sees some long-term problems.
In a November 2017 report, CBO analysts predicted the repeal of the ACA mandates would reduce the federal deficit by $338 billion over the next 10 years.
However, the report predicted the mandate repeal would also increase the number of uninsured people by 13 million by 2027.
They also predicted insurance premiums in ACA markets would go up by 10 percent per year, although other “nongroup” insurance markets would remain relatively stable.
To turn around this trend, the authors of the Commonwealth Fund report recommend that government officials increase advertising for ACA enrollment, help make plans more affordable, and work with insurers to come up with more consumer-friendly plans.