The Consequences of Insufficient Household Income

lost productivity due to absenteeism among full- and part-time caregivers cost the U.S. economy more
than $28 billion in 2010 (Chari, Engberg, Ray, & Mehrotra, 2015; MetLife Mature Market Institute, 2010;
Witters D., 2011).
• Finally, having a significant portion of a population vulnerable to poor health perpetuates the
most fundamental forms of inequality. While life expectancy has increased for Blacks and the lowincome
population, rates are still below those for wealthy Whites, and stark disparities remain. The gap
in life expectancy is as much as 30 years between the richest and poorest U.S. counties (Powell, 2016).
FUTURE TRENDS: HEALTH CARE FOR ALICE FAMILIES
The trend for low-income households to have poorer overall health than higher-income households will
increase as health care and healthy food costs rise and the U.S. population ages. Five overall trends will
impact health care for ALICE and poverty-level families in the future: groups who may persistently lack
insurance; the future of the ACA; doctor shortages; increased demand for caregivers; and the ongoing
challenges of meeting basic needs.
Despite gains, there remains a small population that persistently lacks insurance. New research from
the Harvard School of Public Health shows that health insurance coverage not only makes a difference in
health outcomes, but also decreases financial strain (Baicker & Finkelstein, 2011). While the number of
uninsured has fallen significantly in the last five years, there are three groups of people that did not benefit
from the drop and that may continue to face persistent problems with lack of insurance:
• In many of the 19 states without Medicaid expansion, people who earn less than the FPL may
still not qualify for state Medicaid requirements due to extremely strict state Medicaid eligibility
requirements (Garfield, Damico, Stephens, & Rouhani, 2015; Skopec, Kenney, & Zuckerman, 2016).
• In the states without Medicaid expansion, 2.6 million people fall into the “Coverage Gap” that
exists between the Medicaid eligibility threshold (often far below the FPL in those states) and
72 UNITED WAY ALICE REPORT – THE CONSEQUENCES OF INSUFFICIENT HOUSEHOLD INCOME