Report Finds Alarming Rise in Uninsured Americans

By Ori Nir

Published March 14, 2003, issue of March 14, 2003.
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WASHINGTON — As a wide coalition of civil rights organizations, unions, faith-based groups and medical professionals launched “Cover the Uninsured Week” Monday, a new study published this week shows an alarming increase in the number of Americans without health insurance.

The report, prepared for the Robert Wood Johnson Foundation, which is the chief funder of the week-long public-awareness campaign for universal health insurance, estimates that 74.7 million Americans under 65 were uninsured sometime during 2001 or 2002.

This number, which includes all Americans who went without insurance at some point, is significantly higher than the more widely circulated figure from the U.S. Census Bureau, which only counts Americans who go without health insurance for an entire calendar year. The number of Americans uninsured for all of 2001 was 41.2 million, according to the Census Bureau. It is not yet certain what the number was for 2002, but experts’ estimates range between 45 and 50 million.

“This new report demonstrates that being uninsured is a much more common problem than we had realized up to this point,” said Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation. “People who are without health coverage for any period of time are at risk of devastating their personal health and financial well-being.”

“Cover the Uninsured Week” — an effort comprising symposia, rallies and media campaigns to promote universal healthcare — comes as the idea of universal insurance is increasingly being endorsed by health professionals, patients, insurers, employers, advocacy groups and the medical industry.

The Jewish Council for Public Affairs and the Union of American Hebrew Congregations are participating as national sponsors. The Religious Action Center of Reform Judaism, the Washington lobbying arm of the UAHC, is offering a “social action packet” on its Web site that rabbis can download to use at synagogues. The packet includes background information on the issue, ideas for community action and public education within the congregation and beyond, as well as a “Jewish text on healthcare,” supplemental prayers on healthcare and a copy of a sample letter to a legislator supporting universal healthcare.

“We were delighted to see this national effort of so many religious and other organizations to draw attention to the problem of the uninsured,” the center’s director, Rabbi David Saperstein, told the Forward. Providing health insurance to all Americans, he added, “will be one of our priorities, particularly covering uninsured children.”

Proponents of universal healthcare say the insurance crisis becomes more urgent — and expensive — as time progresses. “We have gone from spending about 5% of the gross domestic product on healthcare in 1960 to about 14% today,” said Len Nichols, vice president of the Center for Studying Health System Change, an independent Washington think tank. “You can’t do that without healthcare costs per capita growing faster than wages, and if that happens over a sustained period of time, ultimately, employees find themselves paying 14% or 20% or even 25% of their income to health insurance. That’s unreasonable, and that’s when something’s got to give.”

The health risks of not being insured are immense. Uninsured adults are three times as likely as insured adults to forego a needed doctor visit, fail to fill a prescription or skip a recommended medical test or treatment because of their inability to pay, according to data collected by the Alliance for Health Reform, a Washington advocacy group.

The uninsured are also more likely to receive less frequent cancer screening — or none at all — resulting in higher premature mortality rates, according to a comprehensive study published last year by the Institute of Medicine, a Washington think tank affiliated with the National Academy of Sciences.

Patients without insurance are less likely to have regular access to medications for conditions such as hypertension or infection, or to have adequate diagnostics and treatment services after traumas such as serious injury or heart attacks — all of which can result in increased risk of death. The uninsured die younger and tend to be less healthy, overall, than insured people.

“As a means of preventive health, I don’t see an alternative to being adequately insured,” said Edward Howard, executive vice president of the Alliance for Health Reform.

The push for universal insurance comes as soaring insurance costs and a recession are hitting the public and private sectors, making health insurance increasingly difficult for employers to subsidize, states to offer or individuals to afford.

Employers have been facing double-digit increases in the cost of healthcare during the last few years. Overall, healthcare costs climbed 13% in 2002 — this year it is expected to increase another 15% — and premiums, accordingly, increased more than 12%.

With healthcare costs increasingly becoming one of the chief causes for business bankruptcies, some employers are trying to pass on some of the burden of healthcare costs to their employees. Some are increasing the employee’s share of the premiums, some are raising patient co-payments and some are firing full-time employees and hiring temporary workers in their stead, to save on benefits.

Deficit-strapped states have cut or are planning to cut Medicaid, the public-health insurance program funded jointly by states and the federal government that provides coverage for low-income Americans for acute and long-term care.

Such conditions have produced growing interest in healthcare reform on both sides of the congressional aisle. Democrats, particularly liberal Democrats, have traditionally pushed for such change. Now, both centrist Democrats, such as Senator John Breaux of Louisiana, and Republican leaders, such as new Senate majority leader Bill Frist of Tennesee, are pushing for reform. Breaux’s recent detailed proposal for universal healthcare is now recognized by many as a credible draft for reform. “Breaux is a real centrist, who can talk to both sides of the aisle, and he’s saying that such a solution is a better use of our money than [President Bush’s proposed] tax cuts,” Nichols said.

Breaux’s proposal, which he calls a “new social contract,” would require everyone to buy a basic healthcare plan, with government subsidies for low- and middle-income Americans. Specifications of the insurance package would be defined by the federal government, while states would be responsible for organizing purchasing pools so all Americans would be guaranteed access to medical care at a group rate.

Democratic presidential candidates are sure to make healthcare reform a centerpiece of their 2004 campaigns, posing a challenge both to Bush’s re-election campaign and to Republicans running for Congress. Ironically, it may take a Republican government to carry out such a monumental task, Nichols said. “It took Nixon to go to China. It may take an all-Republican Washington to have universal healthcare.”

But the likelihood of that happening, Nichols added, is close to zero. “Considering the kind of resources it would take to bring about substantial expansion of coverage, coupled with the steps it would take to seriously address cost growth from a system-wide perspective — which have to be part of any reform effort — it’s just not going to happen between now and 2004.”

In a February 4 speech, Bush declared that the problem of uninsured Americans “will not be solved with a nationalized healthcare system that dictates coverage and rations care.” What the current administration may propose instead, Nichols said, is an initiative to offer tax-cuts to low-income Americans who buy health insurance individually in the free-market. Such a program, Nichols said, may not be a panacea for the ailing health system, but could offer a “partial remedy.”






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