Is there such a thing as frictional uninsurance in the United States? Is there a small segment of the population that will not be formally covered in our fragmented, opt-in system that also has numerous explicit and implicit one way coverage options such as the sixty day COBRA retroactive eligibility window?
overnor Baker announced today that the Massachusetts Health Connector completed Open Enrollment with the highest membership in the 13-year history of the state’s health insurance exchange, covering 282,000 people with health insurance.
“The Health Connector just completed its most successful Open Enrollment since the start of the Affordable Care Act, signing up more than 65,000 new people with health insurance coverage,” said Governor Charlie Baker. “Massachusetts leads the way with the best insured rate in the country, with over 97 percent of our residents covered due in part to the Health Connector’s strong efforts to create a culture of coverage in the Commonwealth.”
This is super impressive. Massachusetts is running near universal coverage even in a national political messaging environment that is anti-coverage. Getting the last three percent of the population covered will be extremely difficult.
That chunk of the population has a variety of quasi-coverage mechanisms without signing up for insurance. There is some uncompensated care. There is Medicaid retroactive coverage if an individual who is uncovered would be Medicaid eligible and has a major medical event. There is the sixty day window after a loss of qualified insurance for an individual to elect COBRA coverage.
At any given point in time, in the US systems of health finance, there will be some people who are uncovered but who have access to an option for coverage. I don’t know if that frictional uninsurance is 3% or 1% or a fraction of 1% but this population is analytically important and odd as they are both covered and uncovered at the same time.