The Uninsured: 45.8 Million and Counting ...

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http://www.motherjones.com/commentary/columns/2005/08/uninsured.html

 

The Uninsured: 45.8 Million and Counting ...

 

Commentary: Yet again the number of Americans living without health

insurance has increased.

 

By Karen Davenport

 

August 31, 2005

 

Article created by the Center for American Progress (link)

 

For the fourth year in a row – and for the tenth time since the last

national effort to expand health insurance coverage in 1993 – the

number of Americans living without health insurance has increased.

This week, the Census Bureau released its analysis of the most recent

Current Population Survey, which estimates that 45.8 million Americans

did not have health insurance during 2004. The last time our nation

seriously engaged on this issue, " only " 40 million Americans lacked

health care coverage.

 

This isn't an accidental crisis, such as a natural disaster – like

Hurricane Katrina, which has just devastated the Gulf Coast, and has

prompted a national emergency response. Instead, we have chosen a path

which results in 45.8 million Americans being likely to suffer more

and die earlier because they lack health insurance. Through a

combination of tax provisions, entitlement programs and public

commitments, we rely on a jerry-rigged system that provides indirect

subsidies for some types of private insurance, but no support for

other kinds of insurance and health care spending. Similarly, public

insurance programs provide coverage for certain categories of people,

and no help at all for others who are left out in the cold. At the

same time, we are unable to exert serious influence on health care

costs, thus placing a growing burden on those lucky enough to have

coverage, while the price of health insurance dampens employers'

willingness to create new jobs.

 

Health care costs continue to escalate, and health insurance becomes

more expensive every year. Health spending per privately insured

person increased 8.2 percent in 2003 –which is modest in comparison to

11.3 percent per capita growth in 2001, but which still outpaces

overall economic growth of 5.6 percent. In fact, growth in per capita

health spending has trumped growth in per capita Gross Domestic

Product (GDP) every year since 1998. As health care costs increase,

premiums increase – and as employer-sponsored health insurance becomes

more expensive, employee responsibility for a portion of the premium

(pdf) creates new stresses on family budgets. Meanwhile, nearly 27

million Americans purchase health insurance in the individual market –

a troubled market that subjects people to significantly higher

premiums depending on their health history.

 

As Americans are priced out of private health insurance, our previous

policy choices have created few alternatives. The Medicaid program,

which covers lower-income individuals and families who meet certain

eligibility restrictions, covered more than 50 million people in 2003.

Changes in private insurance coverage, premium increases, and the job

loss and income decline associated with the recession fueled Medicaid

enrollment growth among families – 11.6 percent from 2000 to 2002, and

7.1 percent from 2002 to 2003. Today's Census Bureau statistics

demonstrate that Medicaid continued to provide a critical safety net

in 2004 – and without Medicaid, the number of uninsured individuals

would have grown even more. But many Americans – particularly single

adults and married couples who do not have children – cannot qualify

for Medicaid coverage, no matter how low their income may be. Other

public programs – such as Medicare – have strict eligibility

requirements related to age and disability, and do not provide a

meaningful option for most people who are uninsured.

 

What can be done? In the short run, we need to make sure that today's

efforts to bail out the leaky boat that is our health care system

aren't stymied by a hole in the bucket. The Medicaid program has

provided an essential safety valve during a sluggish economy and

ensured that many children who lost employer-sponsored coverage

remained insured. But state revenues have not fully bounced-back from

the economic downturn, and governors and federal policymakers are

looking for budget savings from the Medicaid program. States continue

to seek " waivers " of federal Medicaid requirements, which allow them

to exert more control over Medicaid spending and result in reduced

coverage for people with Medicaid. And Congress intends to find $10

billion in federal Medicaid savings over the next five years as it

completes budget legislation this fall. These savings may result in

reduced Medicaid eligibility, reduced Medicaid coverage for critical

services, or increased financial pressure on Medicaid enrollees.

 

While protecting Medicaid is important, the long-run challenge is even

more significant. Recreating our health care system to ensure that all

Americans enjoy a right to affordable health care coverage, improve

the value of coverage, and fully finance this investment is a signal

challenge for our country. The Center for American Progress has

advanced a plan for ensuring universal coverage by strengthening

existing sources of insurance coverage, and establishing new options

for individuals and businesses to purchase coverage through group

arrangements, in combination with financial support to ensure that all

can afford coverage. This plan also emphasizes new investments in

prevention, quality and health information technology, and is fully

financed through a dedicated value-added tax (VAT).

 

Beyond advancing this – or any other – policy proposal, though, the

nation must re-engage in the coverage debate. There is broad support

for doing so – more than half of all Americans consider universal

coverage a moral issue, and of the 72 percent of Americans who believe

that the nation should cover all citizens, more than 60 percent stated

that their belief is grounded in moral convictions. In light of the

latest numbers on the uninsured, this majority of Americans should be

outraged that policymakers have yet to grapple with this moral

question. The challenge – if we don't want to live through another

decade of year-by-year increases in the number of Americans living

without health insurance – is to transform this conviction into a

demand for change.

 

Karen Davenport is the Director of Health Policy at the Center for

American Progress.