San José, CA – On Oct. 1, millions of Americans without health insurance overloaded the opening of the Affordable Care Act (ACA or so-called Obamacare) online exchanges. Almost 3 million people tried to log on to the national www.healthcare.gov web site, while the California web site www.coveredca.com had more than 5 million hits.

The large demand for health insurance that overwhelmed the federal as well as many state exchanges comes from the large number of people in the U.S. who have no health insurance. About 15%, or more than 45 million people, had no health insurance for all of last year according the newly released report on Income, Poverty, and Health Insurance in 2012. Oppressed nationalities (African Americans, Asian Americans, Chicanos, Latinos and Native Americans) had even higher rates of going without health insurance, with the rate topping 30% for Chicanos and other Latinos.

The main reason for so many people going without health insurance is that businesses have been cutting health insurance benefits for their workers. In addition, the restructuring of the labor market to replace full-time, permanent jobs with more and more part-time and temporary jobs that intensified during the last recession also means fewer workers have health insurance. While young people have the highest rates of lacking health insurance, the biggest drop over the years have been among workers aged 25 to 64.

While the ACA promises to cover millions of Americans who lack health insurance, mainly through the expansion of Medicaid, which will be available in many, but not all, states to all low-income people. But millions more, including the 11 million undocumented in this country, will still not have health insurance even after the ACA is fully up and running.

The fundamental problem is that it is not profitable to insure everyone, and that for-profit health insurance spends about ten times as much for administration, profits for share-holders, huge salaries for CEOs, than government health insurance does. With the ACA based on forcing individuals to buy health insurance from private insurers through a combination of penalties (individual mandate) and subsidies, it actually expands this expensive and wasteful part of U.S. healthcare.

The example of Massachusetts, which pioneered a very similar plan to the ACA, shows both what this ACA can and can’t do. Massachusetts has the lowest rate of people without health insurance, at about 3%. On the other hand, Massachusetts is the most costly in terms of total health care spending, coming at 36% above the national average.

To both cover all Americans and lower costs, what is really needed is a single federal government health insurance, similar to Medicare, but available to everyone, also known as a single-payer system.

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