By Ron Pollack,
Executive Director, Families USA*
The reports from our nation's economic front appear rosy. Unemployment is at an all-time low. Incomes are rising. The poverty rate has declined. Interest rates have plummeted. The federal budget is in surplus for the first time in decades. And, thus, with increased financial security and steady jobs, it seems like the best of times for America's families.
To those buoyed by all the good economic news, two recent unheralded reports will come as an icy, sobering shower. The first, from the Census Bureau's Current Population Survey, tells us that the number of Americans without health insurance is growing rapidly. In 1997, there were 43.4 million people without insurance, an increase of approximately 1.7 million from the year before. A decade earlier, fewer than 32 million Americans lacked health insurance. Each and every year this decade, the number of people without insurance has gone up.
The second Census Bureau report is no less shocking. This report found that approximately 71.5 million people lacked health insurance for at least one month during the most recent three-year period examined by the Bureau. As a result, nearly three out of every ten Americans experienced a significant period without health insurance, most losing coverage for over five months.
Significantly, the overwhelming majority of people without health insurance coverage are in working families. They are the breadwinners, spouses, and children of families for whom work, not welfare, is the norm:
- They are the young couple with children, with dad working full time but his employer doesn't offer health care coverage. They put off their daughter's doctors' visits, hoping that the ear infection or fever won't turn more serious.
- They are the family whose breadwinner was laid off several months ago and cannot afford to pay for COBRA coverage. The medical attention for mom's abdominal pain is deferred until it becomes severe and possibly life threatening.
- They are the low-wage worker whose employer offers health insurance, but the premiums, deductibles, and co-payments are unaffordable. If and when that worker's family gets health care, it is normally in an emergency room.
For a surprisingly large and growing portion of America, insecurity about health care is a daily fact of life. In the country with the most advanced medical technology in the world, tens of millions of people are scared that their family won't get the health care they need when they need it.
The National Center for Health Statistics confirms that they have good reason to be scared. Long-term uninsured children receive less than half the number of doctor visits, and only 42 percent the number of inpatient hospital care days, than insured children. Comparing those uninsured and insured children who are in fair or poor health, they found that uninsured children are: five times more likely not to have a usual provider of care; four times more likely to have needed medical or surgical care and been unable to get it; almost five times as likely to have needed dental care and been unable to get it; four-and-one-half times as likely to have needed prescription medicines or eyeglasses and been unable to get them; and more than one-and-one-half times as likely to be missing all or some of their immunizations.
This problem will only get worse in the years ahead. America's rosy economic picture cannot be sustained forever. When the economic downturn occurs, and when more people join the ranks of the unemployed or become part-time workers, the number of uninsured families will undoubtedly increase. Similarly, health care costs are projected to accelerate making health care more expensive and less affordable for everyone.
It is remarkable that the most recent increases in the number of uninsured occurred during years when health care costs slowed down. But health care spending has already begun to escalate, and that trend is very likely to continue. In 1997, health care spending amounted to $1.1 trillion. In ten years, the Department of Health and Human Services projects that annual health spending will almost double, reaching $2.1 trillion.
As costs increase, businesses will feel growing pressures to reduce the level of health care coverage for their employees. Businesses have already converted to managed care to keep costs down. The results are one-time savings that cannot be duplicated. Already, HMO and managed care premiums are rising sharply. Now, businesses seeking protection from accelerating health care inflation will turn to a tried and true way of keeping corporate health care costs down passing along those costs to their employees.
Inevitably, employees and retirees will be asked to pay larger and larger portions of their health insurance premiums, deductibles, and co-payments. And, as those costs get passed on to working families, and grow faster than general inflation and wages, increasing numbers of people will be priced out of health care coverage. During the last surge in health costs, such a shifting of costs occurred and resulted in a large decrease in employer-provided health coverage.
As the numbers of people without health coverage grow, it is high time that we reflect on several questions: At what point will we, as citizens of the richest nation on the planet, agree that too many people are uninsured? How many additional tens of millions of people need to experience a loss of health coverage before we act? Why are we, the most technologically advanced and medically proficient country in the world, virtually the only industrialized nation without health coverage for all of our people?
Certainly, as other countries have showed, there are alternative ways to achieve improved health care coverage. We can build on our employer-based health care system by requiring or inducing more of such coverage. We can require individuals to purchase health insurance while providing subsidies for those who can't afford it and regulatory protections for unhealthy and disabled persons. We can build on existing public sector programs such as Medicare, Medicaid, and the new Children's Health Insurance Program or create new ones.
Each of those solutions can work, but each of them requires sacrifices from portions of the American population. Thus, it is not the health plan mechanics that are missing, but the public will. In these economic best of times while numbers of uninsured Americans continue to rise, it is time to start the job.
* Ron Pollack is the executive director of Families USA, the national organization for health care consumers. Mr. Pollack served as the only consumer organizational representative on the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry.
