Why Obamacare will never enroll all Americans

Nearly half of Republicans will opt to pay a fine rather than enroll in Year 1 of Obamacare, according to a new poll. That is likely to change in years ahead, but the ranks of the uninsured are not going away, forecasts say.

A “substantial minority” of uninsured Americans say they will ignore Obamacare’s requirement that they purchase health coverage for 2014, according to a new Gallup poll.

Sixty-three percent of people currently without health insurance plan to go ahead and get a policy for next year, according to the survey, which was released on Tuesday. But 28 percent – more than one in four – say they won’t, even though that means they’ll have to pay a fine to the federal government.

“The percentage planning to pay the fine has changed little in the last month, even as the 2014 deadline for having insurance draws nearer,” writes Gallup’s Jeffrey Jones.

Age does not appear to factor into this decision. Younger uninsured people were just as likely to say they would, or wouldn’t, get a policy as older counterparts.

But political partisanship did make a difference. Fully 45 percent of Republicans who now don’t have a health policy said they would rather pay a fine than get one. Only 15 percent of uninsured Democrats, and 31 percent of uninsured independent voters, felt that way, too.

“The biggest challenge to achieving universal coverage ... may not be in making Americans aware of the requirement or in getting younger uninsured Americans to sign up. Rather, it may be getting those likely to oppose the law, namely Republicans, to overcome their ideological opposition to the law and sign up for insurance,” writes Mr. Jones.

Reducing the number of uninsured US residents is one of the primary goals of the president’s signature health law, whose formal name is the Affordable Care Act. One way it aims to accomplish this goal is to simply require it. The law contains an individual mandate directing that most Americans get health insurance or pay a fine.

For 2014, the fine is $95 per each uninsured adult and $47.50 per each uninsured child, up to a maximum of $285 per family, or 1 percent of family income minus personal exemptions, whichever is greater.

Gallup estimates that 17 percent of the US population does not have health insurance right now. If 28 percent of these say they won’t get coverage for next year, that means a minimum of 5 percent of the population will remain uncovered in 2014.

When next year rolls around, the actual number is likely to be much larger. The Congressional Budget Office estimates that 14 percent of Americans won’t have health insurance in 2014, despite Obamacare’s mandate.

And this 14 percent figure excludes the millions of illegal immigrants in the US, who aren’t eligible for Obamacare subsidies intended to help middle- and lower-income citizens afford policies.

As the fines get steeper in coming years the percentage of uninsured Americans will slowly shrink, according to CBO.  By 2017 it will plateau at 8 percent of US citizens.

Why won’t the Affordable Care Act reach its goal of universal coverage? Partly, it’s because there are many exceptions to the individual mandate. Prisoners serving time in jail don’t have to get health insurance, for example. People undergoing difficult life circumstances, such as divorce or homelessness, are exempt. You don’t have to get coverage if the lowest-priced “bronze” plan available through your local ACA exchange marketplace would cost you more than 8 percent of your income.

Plus, there are people who just won’t go along with the federal government’s requirement, as the Gallup poll shows.