FRIDAY, April 25 (HealthDay News) -- One in four Americans -- about 12 million people -- who don't have health coverage are eligible for Medicaid and the State Children's Health Insurance Program (SCHIP) but aren't enrolled, a new report shows.

The results were released Friday by the National Institute for Health Care Management Foundation.

Reasons cited for the lack of enrollment include: They're not aware of the programs; they don't know how to enroll, they fear being linked with a publicly financed program; and it can be difficult to stay enrolled, the report said.

There are 47 million uninsured people in the United States. Most of the 12 million people without insurance who qualify for public coverage but aren't enrolled are in low-income families. This includes 6.1 million children, or 64 percent of all uninsured children. Most of these children are in families with incomes below 200 percent of the federal poverty level ($41,300 for a family of four or $20,420 for individuals).

The report noted that since public program eligibility is more restrictive for adults, only 29 percent of uninsured parents (3.6 million) and 10 percent of uninsured childless adults (2.4 million) can enroll in public programs. More than half of the 47 million uninsured people in the United States are childless adults.

"The paucity of public coverage for low-income childless adults is really troubling. This is a population that really can only be helped by an expansion of public programs or some form of subsidy, yet we don't see a lot of that out there across the states," Nancy Chockley, president and CEO of the NIHCM Foundation, said in a prepared statement.

The report, based on 2006 data from the 2007 Current Population Survey, also estimated that of the 10 million uninsured non-U.S. citizens, 5.6 million are undocumented immigrants, and 4.4 million are legal residents.

Boosting enrollment among people who are eligible for public programs wouldn't significantly reduce the number of uninsured parents and childless adults, the report authors said. They noted there are 9.1 million uninsured childless adults and 4.8 million parents with incomes below 200 percent of the federal poverty level (FPL) who aren't eligible for public coverage. One third of each group has incomes below 100 percent of the FPL. Extension of current public programs or providing public subsides would help these adults.

Currently, only seven states provide public assistance to low-income childless adults, and about half the states deny access to traditional Medicaid benefits for working parents in families above 63 percent of the FPL (about $13,000 for a family of four). This means there's plenty of room for expansion to reach the poorest adults, the report authors said.

They noted that providing coverage to more parents would likely increase enrollment of eligible children in Medicaid and SCHIP, since there's evidence that children are more likely to be enrolled in these programs if their parents are eligible.

About 40 percent of uninsured people have moderate to higher incomes, according to the report. Since most of those with incomes above 200 percent of FPL have insurance, it's difficult to find affordable solutions without disrupting those who have insurance. Tax credits, tax system changes, high-risk pools, reinsurance and mandates are among the policy options that can be used by government. Insurance products designed for previously uninsured people are being developed by the private sector.

"What this report shows us is that reaching universal coverage is a very complicated proposition, but that we can get a quarter of the way there by getting more people who are eligible for public programs enrolled, and we can make a lot of headway, too, by looking for subsidies for low-income childless adults and parents," Chockley said.

More information

The American College of Emergency Physicians has more about uninsured patients.

-- Robert Preidt

SOURCE: National Institute for Health Care Management Foundation, news release, April 25, 2008

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