• E-mail
• Print
• Comment
• Font Size
• Digg
• del.icio.us
• Discuss article

Most Americans Worry About Insurance-or Lack Thereof

Posted on: Friday, 31 March 2006, 06:00 CST

By Anonymous

The Uninsured/Underinsured

The statistic is so often repeated that it seems nearly meaningless: Almost 4,6 million Americans are uninsured. But when different components of that statistic are examined individually, the number takes on stark meaning.

The poor/working poor. With several states, including Mississippi, Missouri, Oregon, and Tennessee, considering or already having cut eligibility for Medicaid, another half million people altogether have been or will be left without coverage.

A new study by the Urban Institute for the Kaiser Commission on Medicaid and the Uninsured finds that if states proceed with planned Medicaid cutbacks, only 8 percent of Medicaid recipients have the option of getting health coverage offered by an employer, even though 38 percent of them are working. Even then, affording the average annual $2,717 premiums for employer-sponsored health insurance is a major problem for families on Medicaid, whose earnings averaged less than $12,000 in 2005.

Unless premium assistance or tax credits are substantial, cutting benefits for Medicaid recipients will result in more uninsured people with a corresponding increase in morbidity and mortality, the study concludes. Only when income is above 150 percent of the federal poverty threshold do coverage options become available for some adults who currently have public coverage.

Children. Proposed cost-containment measures to reduce the number of Medicaid/State Children's Health Insurance Program enrollees will not ease hospital emergency department volumes and may indeed reduce ED capacity as hospitals grapple with a swelling number of uninsured patients, says a report by the Center for Studying Health System Change commissioned by Kaiser Family Foundation and published in the January-February issue of Health Affairs. Because Medicaid/SCHIP patients are sicker and poorer than the uninsured-more than one- fourth of Medicaid/SCHIP enrollees have chronic conditions versus 5.9 percent of the uninsured, for example-their rates of ED visits are three times greater than the visit rates for the rest of the population.

Shifting Medicaid/SCHIP enrollees to the ranks of the uninsured will lead to a very small net decrease in ED volume because these patients will continue to have higher medical needs than the current uninsured population, and losing Medicaid coverage will also limit their access to office -based physicians, forcing them to go to EDs even more frequently. Consequently, EDs will be providing greater amounts of uncompensated care, and private hospitals will likely limit the uninsured care they provide, shifting even more of the burden to public hospitals.

Workers over 50. A Commonwealth Fund survey of U.S. adults age 50- 70 has revealed that one-fifth of workers over 50 and their spouses are uninsured or were uninsured for a time since turning 50. Increasingly costly health insurance coverage and the burden of paying off medical debt are creating barriers to care for this age group, more than half of whom have chronic medical conditions. Even among those with incomes between $40,000 and $60,000,42 percent said they were worried about being able to afford insurance. More than two-fifths of respondents with family incomes under $25,000 and 30 percent of those earning $25,000-$60,000 had not sought access to medical care in the past year because of cost.

No Quick Fixes

Some states have tried to address the insurance issue with mandates requiring that large employers provide health insurance to workers, such as the "Wal-Mart" law recently passed in Maryland and California's defeated Proposition 72. However, such mandates fail to reduce the ranks of the uninsured, says a new study by the not-for- profit Employment Policies Institute. The uninsured comprise mostly the unemployed, part-time workers, those employed at small firms, and the newly employed who have yet to accrue the tenure required for eligibility-people who are unaffected by the mandates.

Even President Bush has weighed in on this troubling issue. In one of his recent weekly radio addresses to the nation, the president addressed the issue by focusing on plans to "help our small businesses stay vibrant and strong," which include making health insurance more accessible to small companies. Bush said he would ask Congress to make health savings accounts more affordable and portable and to allow small businesses to purchase health insurance at a discount by pooling risk with one another.

Congress also has approved legislation extending federal funding for state high-risk health insurance pools through 2,010. Passed unanimously by both the House and Senate, the State High Risk Pool Funding Extension Act of 2006 (H.R. 4519) provides $15 million in FYo6 for seed grants to states without high-risk pools and $75 million a year through FY10 to offset operational losses for existing high-risk pools, distributed according to existing statutory requirements.

Currently, 33 states have established high-risk health insurance pools. As of December 2004, 182,381 individuals were participating in these state pools. The majority of high-risk pools cap premiums between 125 percent and 200 percent of market rates, and pools often are subsidized through insurer assessments and other funding mechanisms.

Total Retail Sales and Sales per Capita for Prescription Drugs Filled at Pharmacies in the 10 Most Populous States in 2004

HEALTHCARE WORKERS WITHOUT HEALTH CARE: Over 12 percent of Healthcare workers have no health insurance coverage, said UCLA and Harvard researchers analyzing data from the 2000 National Health Interview Survey.

Copyright Healthcare Financial Management Association Mar 2006

Source: Healthcare Financial Management

More News in this Category