The Washington Post
WASHINGTON -- Even as Democrats seek the biggest expansion of health coverage in decades, as many as 23 million people could still be without insurance by 2018, illustrating the complexity of achieving the long-held Democratic goal of universal health care.
The legislation that the Senate passed Christmas Eve, which is expected to resemble closely the final bill that is hashed out between the House and Senate over the next month, would leave about 8 percent of the population under age 65 without health insurance, according to the nonpartisan Congressional Budget Office. It would extend insurance to 31 million of an estimated 54 million who would have no coverage without the legislation.
"The impact of the reform overall is that we can focus more on care and less on how we pay for the uninsured, but the problem is still going to be there," said Chip Kahn, president of the Federation of American Hospitals, a lobbying group that has endorsed the Democratic plan.
But those who would be left uninsured have drawn little attention. This is in part because their ranks would include many who choose not to get health insurance, even though they can afford it -- such as some healthy people under 30, who have little effect on rising health care costs because they rarely go to the doctor. Though starting in 2014, individuals would face fines if they do not buy coverage, some may still refuse.
About a third of the uninsured would be illegal immigrants. Neither party supports expanding insurance to cover them, even though states spend millions caring for them at hospitals, where ERs accept patients regardless of coverage.
Some Republicans have seized on the uninsured number to attack the health care legislation, even though they oppose mandating the purchase of insurance and covering illegal immigrants. "After raising billions in new taxes, cutting about a half-trillion dollars from Medicare, and imposing stiff new penalties for people who don't buy insurance and increasing costs for those that do, 23 million people will still not even have health insurance," Sen. Charles Grassley, R-Iowa said before the Senate vote.
White House spokesman Reid Cherlin countered that "tens of millions of Americans will gain affordable coverage under this bill."
