If a number of specific policy actions are implemented, Congress could potentially supplement the Affordable Care Act in such a way as to bring health insurance to 12 million more Americans, finds a report from the Robert Wood Johnson Foundation.
That doesn't necessarily mean Congress will take action, with partisan division the governing body's current modus operandi. But the statistics show that with some of the changes to the law over the past several years, the rate of the uninsured has started to climb once more -- and is estimated to be about 32 million people, or 12 percent of the non-elderly population, by 2020.
The array of policy initiatives suggested by the authors carries a small likelihood of being passed in full, so the suggestions are more of a wish-list than a prediction. Still, there are a number of specific steps outlined in the report that would drive the uninsured rate back down to an estimated 7.3 percent.
The policy suggestions include reinstating the individual mandate, as well as cost-sharing reduction payments to insurers; expanding Medicaid eligibility in all states for families earning 138 percent of the poverty level; prohibiting short-term health plans, or so-called "skinny" plans; and streamlining Medicaid expansion via auto-enrollment from the TANF and SNAP programs.
Further suggested policy changes include introducing a permanent federal reinsurance program for non-group coverage; increasing the ACA's financial assistance and adjusting its tax credit eligibility; and capping provider reimbursements at levels somewhere above Medicaid levels.
The projection, if all of the changes were to occur, is that the number of uninsured would dip to about 20 million, with federal spending on acute care rising from just under $420 billion to just shy of $540 billion.
The likelihood of these measures being taken is low, given opposition to most of those ideas by the Trump administration.
What those policies would mean for hospital reimbursement remains unclear. A recent TransUnion Healthcare analysis found that upwards of 30 percent of self-pay accounts -- those patients without health insurance or those who have a patient balance after insurance -- will generate more than 80 percent of the self-pay revenue collected by hospitals.
That means if hospitals aren't optimizing their revenue cycle, they could potentially be leaving millions of dollars on the table.
Following years of decline since the Affordable Care Act was passed in 2010, the uninsured rate grew from 10.9 percent in the fourth quarter of 2016 to 12.2 percent in the fourth quarter of 2017.