Four Million U.S. Children Had No Health Insurance in 2024

Original Article ↗ Hacker News Discussion ↗

Runaway Costs and Self-Insurance

  • Multiple commenters report family premiums around $2,000/month even for high-deductible “bronze” plans, with actual annual medical spending often far lower if paid cash.
  • This leads some to “self-insure” for routine care, saving the foregone premiums in cash or HSAs and gambling against catastrophic events.
  • Others argue this only “works” until a $100k–$500k+ event (cancer, major surgery, medevac), at which point unpaid costs are shifted to the system via bankruptcy, cost-shifting, or public programs.

What Insurance Should Cover

  • One camp wants health insurance to function like classical insurance: low premiums, high deductibles, coverage only for rare, expensive events.
  • Commenters note such truly catastrophic-only plans largely no longer exist; regulations require broad coverage, premiums are still high, and frequency of expensive health events makes pricing difficult.
  • Some argue routine and preventive care should be subsidized because:
    • People underuse necessary care when faced with out-of-pocket decisions.
    • Public-health benefits (e.g., vaccination, early treatment) don’t align with purely individual incentives.
  • Attempts to exclude conditions tied to “bad choices” are criticized as unworkable and morally fraught; almost anything, including childbirth, can be framed as a lifestyle choice.

Market Structure and Incentives

  • Comments highlight that the ACA pegs insurer profits to a percentage of care costs, creating incentives for higher provider prices.
  • High prices are attributed to malpractice insurance, defensive medicine, private equity ownership, specialized facilities/equipment, and opaque pricing.

Public Programs, Eligibility Gaps, and Children

  • CHIP and Medicaid theoretically cover most low- and middle-income children, with state thresholds ranging from ~175% to 400% of the poverty line.
  • Reasons children remain uninsured include:
    • Families in income “gaps” (too much for Medicaid/CHIP, too little for employer or ACA coverage).
    • Undocumented status and ineligibility for federal programs.
    • Parents not signing up due to ignorance, bureaucracy, or general dysfunction; churn and paperwork interruptions in coverage.
  • Some argue uninsured children still get emergency care; others stress that non-emergency care (like cancer) is exactly what’s being missed and that medical-expense bankruptcy is real.

Broader Policy and Politics

  • Proposals include Medicare coverage for prenatal, neonatal, and pediatric care for all children, or rebalancing resources from the elderly to children; there is disagreement on whether current Medicare spending is fiscally sustainable.
  • Several note that the government already tracks uninsured rates; debate centers on whether this metric should be a primary economic KPI.
  • Polls are cited showing high reported satisfaction with existing coverage (especially Medicare/Medicaid), which commenters say helps explain resistance to sweeping reforms, despite cost and access problems for many.
  • International comparisons are contested: some emphasize lower costs and better outcomes abroad; others stress long wait times and doctor shortages there versus faster access and high-end care for the well-insured in the U.S.