http://articles.sfgate.com/2010-09-24/opinion/24086986_1_health-insurance-health-reform-law-universal-coveragePPACA was not designed to provide universal coverage. In fact, if the new law works as planned, in 2019 there will still be 23 million uninsured. Yet the consequence of being uninsured can be lethal: Research published last year shows about 45,000 deaths annually can be linked to lack of coverage. That number is probably more than 50,000 today.
As Don McCanne, senior health policy fellow at Physicians for a National Health Program, has observed, PPACA is an underinsurance program. Employers, seeing little relief, will expand the present trend of shifting more insurance and health care costs onto employees.
Individuals buying plans in the new insurance exchanges (which won't start until 2014) will discover that subsidies are inadequate to avoid financial hardship. Inevitably, they will end up with underinsurance, spotty coverage and high deductibles.
And workers who are unemployed or without employment-based insurance will move into Medicaid (Medi-Cal in California), where providers are reimbursed at such low rates that many will not accept patients.
When Congress passed the new law last spring, it based its decision on a faulty assumption - namely, that the rest of the population will have sustainable private health insurance. But between 2008 and 2009, the number of people covered by private health insurance decreased from 201.0 million to 194.5 million, and the number covered by employment-based health insurance declined from 176.3 million to 169.7 million.
If this trend continues, as it's bound to do under current economic conditions, the ranks of the uninsured will expand and the new law will fall far short of the mark - either the cost will exceed projections, or coverage will be need to be reduced.