In choosing which votes to include in the annual Poverty Scorecard, we consult with national experts in more than twenty different issue areas. This helps us to identify the full scope of the votes most important to poor people and ensure that the Poverty Scorecard fully reflects Congressional action (and inaction) in addressing the complex needs of low-income Americans. This year, a number of the most important poverty-related votes fell into three categories: employment, health care and housing.
Ensuring access to affordable health care is a cornerstone to anti-poverty advocacy. Good health is essential to school performance, worker productivity, and a good life. But fewer workers have access to employer-based health insurance, and high costs and preexisting condition exclusions have prevented many from obtaining needed coverage. Uninsured people are much less likely to get needed care, especially preventive care, and are more likely to incur medical debt, which threatens their financial security.
The Affordable Care Act (ACA), which is arguably the most important anti-poverty measure passed in the last 50 years, has made significant progress in reducing the number of uninsured Americans. Over 41 million lacked insurance in 2013; most of these people were in low-income working families. The ACA fills gaps in coverage by expanding eligibility for the Medicaid program, building on employer-based coverage, reforming insurance so that only age, location, and tobacco use status are considered in setting premiums and providing premium subsidies to make private insurance more affordable. Early evidence indicates that the number of uninsured has dropped significantly since implementation of the ACA began. According to a recent survey, the number of uninsured working-age adults has declined from 37 million in 2010 to 29 million in the second half of 2014. Moreover, the number of adults who had problems paying their medical bills declined from 75 million to 64 million during that time period.
Despite these positive developments, The House of Representatives continued to attempt to undermine the viability of the ACA in 2014. The Simple Fairness Act, H.R. 4118, would delay implementation of the mandate requiring individuals to obtain health insurance or pay a tax penalty. The individual mandate is important to incentivize people, in particular younger and healthier people, to obtain coverage and thereby diversify insurance risk pools and keep down costs. The Simple Fairness Act passed the House by a vote of 250 to 160 but was not considered by the Senate.
Similarly, the Save American Workers Act of 2014, H.R. 2575, would raise the threshold for classification as a full-time employee from 30 to 40 hours for purposes of the employer mandate in the ACA. This would decrease the number of workers entitled to employer-based health coverage by 1 million and increase the number of uninsured. The Save American Workers Act passed the House by a vote of 248 to 179 but was not considered by the Senate.
Finally, the Employee Health Care Protection Act of 2014 would have allowed health insurers to continue offering non-ACA-compliant small group plans through 2018, adding an additional two-year delay on important consumer protections introduced by the ACA. If the bill had become law, this would have lead to insurers selectively offering ACA-compliant plans to younger, healthier groups, undermining small business exchanges that improve the affordability of comprehensive employer-based plans for these firms and their employees. The House passed the bill by a vote of 247 to 167 but the Senate did not consider it.
By contrast, a plurality of states have embraced the opportunities presented by the ACA to improve health care coverage. In particular, a majority of the states including D.C. (29) have opted to expand their state Medicaid programs to cover all adults at or just above (138%) the poverty threshold. Medicaid enrollment has increased by 8 million since open enrollment began. And every state in the nation has a health care exchange or “Marketplace” in which millions have gained coverage with subsidies. Unfortunately, in states that did not expand Medicaid, these subsidized Marketplaces do not help the lowest income consumers who are stuck in a “gap” and cannot access affordable coverage. In addition, the subsidies themselves are under attack in the King v. Burwell case now pending in the U.S. Supreme Court which may have the devastating impact of invalidating subsidies for millions of low income consumers.
In Illinois, a coalition of healthcare and anti-poverty advocates, led by the Shriver Center, pressed for Medicaid expansion, which the state adopted in July 2013. As a result, many more Illinoisans have gained coverage. As of January 2015, more than 217,000 people had enrolled in the Illinois Insurance Marketplace, and even more (287,000) had enrolled in the new Medicaid expansion. More than 296,000 have enrolled in the Get Covered Illinois Marketplace and over 500,000 in the Medicaid Expansion. The Shriver Center is also actively training and assisting navigators and other enrollment specialists, who help consumers select the right plans and overcome barriers to coverage. As part of that work, the Shriver Center manages HelpHub, an online community for enrollment and outreach specialists.
“Although many people don’t think of health care as a poverty issue, an economic justice issue, or even a civil rights issue, it is all of those things,” said Stephanie Altman, Assistant Director of Health Care Justice at the Shriver Center. “Providing health care coverage to everyone is one of the most important ways that we can bring people out of poverty while improving their health and population health at the same time.”