Uninsured Americans

Chapter II: REVIEW OF THE LITERATURE

The following literature review will give you reasons why we need to find solutions to the problem of the uninsured Americans adults and children. How does lack of insurance affect access to health care service and how uninsured pay for it. What can be done to decrease the number of uninsured. What can be done to decrease the number of uninsured. Census Bureau show that the number of uninsured Americans stood at 45.8 million in 2004, an increase of 800,000 people over the number uninsured in 2003 (45.0 million). The percentage of people without health insurance, 15.7 percent in 2004, was not significantly different from the 15.6 percent rate in 2003. "The number of uninsured Americans was at an all-time high in 2004, while the percentage who lack health insurance coverage showed no improvement," said Robert Green stein, executive director of the Center on Budget and Policy Priorities. "These findings are disappointing, as they follow three years of successive deterioration in health insurance coverage. It is sobering that six million more people lacked health insurance in 2004 than in 2000. Once again, Medicaid and the State Children's Health Insurance Program played a pivotal role in keeping the number of uninsured Americans from being even higher." However, Private employment-based health insurance coverage fell again in 2004, for the fifth successive year. The share of Americans with job-based coverage stood at 59.8 percent in 2004, significantly less than the share in 2003 (60.4 percent) and in 2000 (63.6 percent). Over the years, the primary cause for the decline in job-based health insurance has been escalating health care costs, which has led some employers to stop offering coverage and many others to shift more costs to employees, making it more difficult for low- and moderate-income workers to afford insurance for themselves or their families. Growth in the cost of job-based health insurance premiums continued in 2004, although the rate of growth eased modestly, falling from 14 percent in 2003 to 11 percent in 2004. [2] While many have noted the difficulties that employers face in paying for health insurance coverage, it is noteworthy that corporate profits rose by 16 percent in 2004, while employment-based health insurance coverage fell.[3]

Who Are the Uninsured?

Americans under the age of 65 lacked health insurance. National surveys consistently show that the primary reason people are uninsured is because health coverage is too expensive. Not being able to afford health insurance is a problem for many working families. The large majority of the uninsured come from families with at least one member who is working outside the home. In 2002, over 8 in 10 uninsured came from working families Ð'- nearly 70% from families with one or more full-time workers and 12% from families with part-time workers. Only 19% of the uninsured are from families that have no connection to the workforce. Even at lower income levels, the majority of the uninsured have workers in their family. Fifty-five percent of the uninsured who are poor have at least one worker in the family. (Poor is defined as less than 100% of the federal poverty level 14,348 for a family of three in 2002). Because of the high cost of health insurance, the poor and near-poor have the greatest risk of being uninsured. The uninsured rate among the non-elderly poor is more than twice as high as the national average (37% vs.17%). Were it not for the Medicaid program, many more of the poor would be uninsured. The near-poor (those with incomes between 100% and 200% of poverty) also run a high risk of being uninsured (28%) because they are not likely to be eligible for Medicaid. Nearly two-thirds of the uninsured (64%) are low-income individuals or from low-income families, making less than 200% of the poverty level, or $28,696 for a family of three in 2002. Over a third of the uninsured (36%) are poor and another 28% are near-poor. The majority of uninsured adults (59%) have gone without coverage for a period of at least two years.3 Because health insurance is primarily obtained as an employment benefit, health coverage can be disrupted when people change jobs. This, as well as other changes in income and family, can cause temporary gaps in health insurance. While most adults go without coverage for years, this varies across states and those states where more of the uninsured have short periods without coverage also tend to have lower uninsured rates in general.4

However, Adults are more likely to be uninsured than children. Adults make up about 70% of the non- elderly population, but nearly 80% of the uninsured. Most low-income children qualify for either Medicaid or SCHIP, though many eligible children are not enrolled. However, low-income adults under age 65

qualify for Medicaid only if they are disabled, pregnant, or have dependent children. Eligibility levels are generally much lower for parents than for children. Because women are more likely to qualify for Medicaid as the head of single-parent families and are also eligible when they are pregnant, low income

men are more likely to be uninsured than women through the child-raising years.

Minorities are much more likely to be uninsured than white Americans. More than a third of the Hispanic population and over a quarter of Native Americans are uninsured compared to 12% of whites. The uninsured rates among African Americans (22%) and Asian Americans (20%) are also much higher than that of whites. These differences are only partly explained by income disparities. The large majority of the uninsured (80%) are American citizens. Among the uninsured who are not native or naturalized citizens, most are legal permanent residents and/or have lived in the U.S. for at least six years.

How Does Lack of Insurance Affect Access to Health Care Services

Health insurance makes a difference in whether and when people get necessary medical care, where they get their care, and ultimately, how healthy people are. Uninsured adults are far more likely than the insured to postpone or forgo health care altogether and less able to afford prescription drugs or follow through with recommended treatments. Problems getting needed care are less common among children, who are generally healthy, but disparities in access to care between uninsured and insured children are as great as the adult differences. The consequences of reduced access to care can be severe, particularly when preventable conditions go undetected. The uninsured are up to three times more likely than those with insurance to report problems getting needed medical care, even for serious conditions. Part of the reason