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Health care reform cuts nation's uninsured by nearly 20 million

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The 2010 health care reform law will make a huge dent in the number of Americans without health insurance, according to the latest estimates from congressional researchers.

This year, an estimated 36 million people under age 65 will be uninsured, down from an estimated 55 million if Congress had not passed the Patient Protection and Affordable Care Act, according to a Congressional Budget Office report released Monday.

And the number of uninsured will continue to fall in succeeding years, dropping to 31 million in 2016 and 30 million in 2017, the CBO report says.

The two key reasons for the drop in the number of uninsured are health care reform law provisions that, starting in 2014, gave premium subsidies to the lower-income uninsured individuals to purchase coverage in public health insurance exchanges and heavily subsidize states that expanded eligibility for their Medicaid programs.

For example, 12 million people are expected to receive coverage this year through the state and federal exchanges, with enrollment rising to 21 million in 2016.

Those estimates, though, do not take into account the potential impact of an upcoming U.S. Supreme Court decision. The court will rule on whether federal premium subsidies are available in the 37 states in which the federal government runs the exchanges. Last year, more than 80% of enrollees in both the federal and state exchanges received federal premium subsidies.

On the other hand, employer-based coverage will decrease. This year, the CBO projects that 156 million nonelderly Americans will have employer-based coverage, 2 million fewer than if the health care reform law had not been passed; while in 2016, CBO projects that 153 million nonelderly Americans will have employment-based coverage, 7 million less than if lawmakers had not passed the ACA.

That finding is not surprising, insurance industry observers say. For example, small employers employing low-income workers will have much less of an incentive to offer coverage. In 2015, employers with fewer than 100 employees are exempt from the health care reform law's $2,000-per-full-time-employee penalty for not offering coverage, while their low-income employees will be eligible for federal subsidies to offset premiums for coverage purchased in exchanges. In 2016 and succeeding years, employers with fewer than 50 employees are exempt from the coverage mandate.

In addition, some larger employers already have dropped coverage for employees working fewer than 30 hours a week, enabling those employees — if they make less than 400% of the federal poverty level — to get subsidized coverage in the exchanges without the employer being hit with the ACA's $2,000 penalty.