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Private health insurance, who lacks it?
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Safety-net hospitals are facing deep deficits and service cuts across the country. LA County is proposing to reduce services at its six outpatient centers, which provide about 400,000 patient visits per year, to close a $195 million deficit. Two-thirds of their patients are uninsured. In Atlanta, Grady Hospital is in deep financial trouble, and its Joint Commission accreditation is at risk. Grady provides S50,000 outpatient visits and more than 30,000 hospitalizations a year (only 9 percent covered by private insurance), and trains one in four Georgia physicians. It has the region's only Level l trauma center and ambulance fleet. Yet besides mving $71 million to creditors, it faces a $53 million deficit this year and is $366 million behind in needed capital improvements. The wait for elective orthopedic procedures is, according to one doctor, "infinity."
Cook County's Stroger Hospital (previously "Cook County") in Chicago is facing another $lOS million in cuts after being forced to close clinics and layoff 1,000 doctors, nurses, and other health workers to save $100 million last year. Without new funding, the County will have to close a center that treats one-third of the area's HIV patients, all 12 neighborhood clinics, and two public hospitals, Provident and Oak Forest. Only Stroger Hospital and the facility that treats jail inmates will remain, and officials admit that there's "no way" they'll be able to take care of all the people who have "no insurance and no other means."
About 300 public hospitals have closed in the past 15 years, including LA's Martin Luther King Jr. Hospital and Washington's, DC General Hospital. The nation's 1,300 public hospitals account for two percent of all hospitals but provide 25 percent of the nation's uncompensated care (New York Times, 1/8/08, Los Angeles Times, 2/14/08, Cain's Chicago Business, 2/8/08).
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From Health Affairs of February 20, 2008 by John Holahan and Allison Cook
The number of uninsured Americans increased by 3.4 million between 2004 and 2006, despite improving economic conditions. The dominant factor was a decline in employer-sponsored insurance coverage. Although the recent decline was less than that experienced from 2000 to 2004, growth in public coverage was small, and the number of uninsured people increased by 1.0 million children and 2.4 million adults.
The decline in employer coverage can be traced to greater increases in health insurance premiums than in wages. As health insurance becomes more and more expensive, it adds more to the cost of a worker's total compensation package. To the extent that firms cannot shift this back to workers in the form of lower wages, they become less likely to offer coverage.
It is striking that the rate of employer coverage declined and the number of uninsured people increased even after the U.S economy rebounded from the recent recession. This erosion will likely continue, particularly for low-income workers, because the basic factors underlying it seem unlikely to change.
For the original article CLICK HERE .
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The uninsured were less likely to receive timely screening tests and more likely to be diagnosed with advanced stage disease than patients with private coverage. Patients with Medicaid coverage also fared poorly, partly because many beneficiaries receive coverage only after diagnosis. (Ward et al, Association of Insurance with Cancer Care Utilization and Outcomes, CA Cancer J Clin,January, 2006).
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NOT IN POVERTY BUT NOT INSURED
More than one-third of the 46 million (official underestimated count) uninsured in the USA live in families with incomes of more than $40,000. The nation's median household income was $46,326 in 2005. These people are among the fastest growing subgroup of uninsured today.
Among families earning $30,000 to $39,999 the number of uninsured rose 31% from 2000 to 2005. For many trying to enter the individual coverage market, the cost can cause sticker shock, said Jessica Waltman, vice president of policy and state affairs with the National Association of Health Underwriters.
Rates for individual policies can run anywhere from a few hundred dollars to more than $2,000 a month -- depending on a person's age and health history -- and consumers are facing ever-increasing deductibles and out-of-pocket spending.
To find this article from The Indianapolis Star of April 22, 2007 By Tim Evans CLICK HERE
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Entrances and Exits: Health Insurance Churning, 1998-2000
Much like being officially "uninsured" having unstable health insurance coverage limits access to care. [Currently the census counts as uninsured only those who are without insurance for an entire calendar year Jan 1 - Dec 31. Even those uninsured feb 15 one year through nov 15 the next year, 21 months continually, are not officially uninsured] People who go through periods in which they have no coverage are less likely to have a regular doctor and more likely to delay seeking care when they're sick.
Fully 22 % of the US experienced at least one spell without any health coverage over the two-year period, in addition to the 9% who were uninsured for the full two years. Young adults, Hispanics, people with low levels of education, those who transition into and out of poverty, and those with private, nongroup insurance were most likely to have unstable coverage. So, in the case of a comparison over two years the official rate of uninsurance counted only about 40% of those who suffered from uninsurance during those two years.
Read the full report at the Commonwealth Foundation
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Despite Being in Families with a Full-Time Worker
Full-time Employment is one-third as effective if you are hispanic
Commonwealth Fund data from March 2000 study
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Out-of-Pocket Health Costs for Seniors Under Current Law and "Premium Support" Proposals
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Medicare offers little help with prescription drugs or nursing homes and imposes steep deductibles and copays for many needed treatments.
From AARP March 1998 and April 1995; Commonwealth Fund mAY 1999
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Dozens of reports and many news articles at this website have shown that the uninsured are less likely to get the care they need and tend to get lower quality care when they get any.
From Arch Int Med 2000 1269 & Analysis by RWJF
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UNMET HEALTH NEEDS OF THE UNINSURED
From JAMA 2000: Vol 284, 2061
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Between 2000 and 2004, the number of "officially uninsured" Americans increased by six million, primarily because of a decline in employer-sponsored insurance. All of the increase occurred among adults, for whom the drop in employer coverage was not offset by an increase in public coverage. About two-thirds of the growth in the uninsured was among Americans below 200 % of the federal poverty level. About half of the growth in the uninsured was among young adults ages 19-34, about 55 % among whites, and 73 % among native-born citizens. The decline in employer coverage is likely to continue. Increases in health care costs, and thus health insurance premiums, are likely to continue to grow faster than workers' earnings. The decline in employer coverage will be further exacerbated if the shift from working in large and midsize firms to small firms and self-employment and from high- to low-coverage industries continues.
This article from the journal Health Affairs of November 1, 2005
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[REPORTING ON] HEALTH INSURANCE UNCHANGED
The percentage of the nation's population without health insurance coverage remained stable, at 15.7% in 2004. The number of people with health insurance increased by 2.0 million to 245.3 million between 2003 and 2004, and the number without such coverage rose by 800,000 to 45.8 million.
[EINO: Even this terribly high number near 16%, which opens so many millions of Americans to avoidable tragedy is an absurd figure. The census bureau does worse with uninsurance than labor department does with unemployment. Why not just count those who are uninsured and left-handed that would be a further improvement in lowering the official uninsured level? Read about the other half of uncounted uninsured, or about the additional 16 million Americans who don't have their chronic conditions covered, or about how limited most coverage is for certain types of illness, like mental illness which all other industrialized nations cover.]
US Census Bureau. August 30, 2005. The document may still be available at: CLICK HERE
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UNINSURED AS LIKELY AS INSURED TO PERCEIVE NEED FOR CARE BUT HALF AS LIKELY TO GET CARE
By J Hadley and PJ Cunningham
While considerable research shows that uninsured people are less likely to seek and receive medical care, some contend that the uninsured are uninsured by choice and can obtain care when needed. The validity of this concept has been undercut with a new study finding that there is no difference between insured and uninsured in their perception of a need to see a medical provider when they experience a serious new symptom. However, the uninsured were less than half as likely to see or talk to a doctor after perceiving they needed care. This indicates that lack of insurance is a major barrier to uninsured people getting needed medical care.
Center for Studying Health System Change. October 2005
The article may still be available at: CLICK HERE.
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HEALTH CARE UNINSURED AND POVERTY INCREASE AS SUPER-RICH REAP TAX-CUTS
From the spring 2006 newsletter of PNHP
( www.pnhp.org )
Between 2000 and 2004 (during the first GW Bush term) the number of uninsured Americans increased by 6 million. The rise in uninsurance was driven by two factors: rising poverty and a fall in employer-sponsored coverage. The number of Americans living at or below 200 percerrt of poverty increased by 9.1 million between 2000 and 2004. The overall U.S. poverty rate increased from 11.3% to 12.7% . These low-income adults were much more likely to lack coverage in 2004 (40.3 % uninsured) than adults overall (20.6 %).
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WHAT ACCOUNTS FOR DIFFERENCES IN USE OF HOSPITAL EMERGENCY DEPARTMENTS ACROSS US COMMUNITIES?
For years, conservatives have blamed immigrants and low-income Americans for the rise in the number of emergency room visits. A new study published today in the journal Health Affairs thoroughly debunks this baseless myth in the July 10, 2006 issue of Health Affaris. This study found that the areas with the greatest numbers of uninsured, Latino, and immigrant residents actually had the lowest rates of emergency room use.
The study is a useful new tool in the fight to improve access to health care. It shows that efforts to prevent immigrants and the uninsured from using emergency room services will not solve the problem of overcrowded emergency rooms. It also debunks the charge that these groups are to blame for the problems with our health care system. Scapegoating of these groups for political purposes must end. Instead, policymakers and health care administrators should focus on real solutions, like improving the capacity of outpatient physician services and ensuring that everyone has access to those services.
For more information, you can read the full article CLICK HERE
Or the abstract CLICK HERE |
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REFERENCES
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It is not true that Americans who forego health insurance have plenty of money for their basic necessities. Rather they frequently are facing a choice between necessities for themselves and their families.
From US Census Bureau "Extended measures of well-being: meeting basic needs"
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1. Findings from Federal
Agency for Healthcare Research and Quality, MEPS Survey
AHRQ (301-427-1406) or http://www.meps.ahrq.gov/
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UNINSURED AMERICANS
Only Counts those Uninsured for a Whole Fiscal Year
(Jan 01 to Dec 31 of a given year, if uninsured for 20 consecutive months February of one year through October of the following year Americans are NOT OFFICIALLY COUNTED AS UNINSURED in either year)
Data from Center for Policy Studies & NHIS
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