The Uninsured

ABSTRACT

As a growing number of Americans find themselves without health insurance, it is demanded that the United States explore innovative policies aimed at extending coverage. The high cost of expanding coverage raises many questions about how best to improve access while preserving individual choice and maintaining quality of care. Differing viewpoints among policymakers, insurers, doctors, hospital administrators, employers, public health advocates, and health policy researchers provide a complete picture of the current and desired state of American healthcare.

INTRODUCTION

This report is gives a look at numerous factors affecting healthcare and how a lack of insurance has implications to not just the individual, but society as a whole. The number of America’s uninsured has increased steadily over the past quarter century. In 2005, nearly 47 million Americans were uninsured, representing close to one-sixth of the nation’s population. Suffering from high levels of economic insecurity and poor health outcomes, the uninsured place large costs on the U.S. economy. Success in extending coverage depends upon making health plans affordable enough so that individuals and families can obtain coverage without excessive financial burden.

Trends in the United States economy continue to unravel the relationship between employer and employee, the means by which workers obtain group health insurance through their employers. The result has been an increasing number of uninsured individuals. Although President George Bush proposed a change in tax laws having an effect on health insurance in his 2007 State of the Union address, health insurance coverage has been a low-priority policy issue in Washington in recent years.

Recent success by Medicaid and the State Children’s Health Insurance Program (SCHIP) in reducing the number of uninsured children has led to interest in expanding these programs to cover uninsured parents. Despite gradual progress towards expanding coverage to all, there are still many difficulties in actually implementing reform. These challenges include getting additional funding, creating more desirable plans, and ensuring participation.

LITERTURE REVIEW

HISTORY

As early as 1945, seventy-five percent of Americans favored national health insurance. Harry Truman tried to create a national health insurance system, but his attempts were futile, as special interests feared that national insurance would lead to racially integrated hospitals. Professor Jill Quadagno shows how medical care has evolved over the years. By the 1960’s, Medicare and Medicaid became dominant forces in the health care delivery system. In the early 1970’s, national health insurance became more prominent. By the early 80’s, TEFRA ushered in HMO’s, which Dr .Quadagno believes marked the beginning of a period of unforeseen premium growth.

THE CURRENT STATE OF HEALTHCARE

Currently, the United States is the only major industrialized nation without universal health insurance. The US has a mixed public-private system of health insurance, which is comprised of the Federal Medicare program (covering people aged 65 and over and those who have been disabled for two years or more), State Medicaid programs (covering children from low income families and in some states their parents), voluntary employer based private insurance (covering many working families), and individual insurance (purchased by individuals who do not qualify for any of the above programs).

One in five Americans, or 59 million people, reported not getting or delaying needed medical care in 2007. The breakdown of these 59 million people includes more than 23 million people reporting going without needed care and approximately 36 million people who delayed seeking care. Other research shows that tens of millions more Americans go without health coverage for shorter periods of time.

As most elderly people are covered by Medicare, nearly all the uninsured are under age 65. Children are more likely to have coverage than non-elderly adults, as after age 25, the prospect of being uninsured gradually declines with age.

As the overall U.S. population experienced increases in unmet need and delayed care between 2003 and 2007, children were no exception. Low-income children encountered the greatest increase in unmet needs among all children and access to healthcare declined more for people in fair or poor health than for healthier people.

The likelihood that a child is uninsured has fallen from 13.9 percent in 1998 to 11.7 percent in 2006. This is highly correlated with the education level of the family head, and the firm size of the family head, and varies with the industry, occupation, work status, and work hours of the family head.

An estimated 5 million uninsured children are eligible for Medicaid or SCHIP but are not enrolled. SCHIP was created in 1997 to provide coverage for children who live in families with incomes that exceed Medicaid eligibility caps but cannot afford private coverage. Like Medicaid, it is financed by a combination of federal and state funds. Because of SCHIP, millions of children can now see a doctor when they are sick and get the health care they need.

Despite the success of SCHIP, there are still 8.7 million children living without health insurance. This number amounts to more than the total number of kids enrolled in the first and second grades in the United States public school system. To aid in helping these children, Congress must continue to fund SCHIP and make it stronger.

THE IMPACT OF A LACK OF HEALTH INSURNCE

The United States scores best in the world for patient participation in treatment decisions, respect for patients, respect for confidentiality, clean surroundings, and provision of prompt care. Despite all of this, the U.S. consistently scores at or near the bottom on infant mortality, life expectancy, and the proportion of the population with health insurance coverage. The hidden consequences of failure to ensure universal coverage in the US are well documented. The Institute of Medicine estimates that 18,000 lives are lost annually as a consequence of gaps in coverage.

The negative effects of the lack of insurance often impacts communities as a whole. The Institute of Medicine, “it is both mistaken and dangerous to assume that the prevalence of uninsurance in the United States harms only those who are uninsured.” The cost of uncompensated care provided to the uninsured was an estimated $34 billion