Health Care for the Uninsured
February, 2005
Millions of Americans continue to go without health care coverage. In 2003, the number was 45 million Americans 15.6% of the population, or almost one out of six -- an increase of 1.4 million from the year before. This is the largest number of Americans reported to be without insurance since the Census Bureau began issuing data on the uninsured data in 1987. At the same time, over two million more people relied on Medicaid for their health insurance in 2003 than in 2002 without the Medicaid safety net, many of those people would have been add to the ranks of the uninsured. The increase in the uninsured is due in large part to the drop in those covered by employer-based plans. The picture is even worse for people in more vulnerable communities: 19.4% of African-Americans, 32.7% of Hispanics, and 34.5% of immigrants do not have health insurance.
More Americans may become uninsured: The strong economy and low unemployment rates of the 1990s helped more Americans gain health insurance coverage. But a sluggish job market in the years since then, declining employer coverage and rising health care costs reversed that movement. If those conditions continue or worsen, the ranks of the uninsured will swell.
Employers saw a fourth year of double-digit increases in their 2004 health insurance premiums. Premiums increased an average of 10.9% in 2001, 12.9% in 2002, 13.9% in 2003, and 11.2% in 2004, far beyond the rate of inflation. Many continue to expect annual double-digit increases to continue for the foreseeable future. If that occurs, some employers . particularly small employers . could discontinue providing health insurance coverage to their workers entirely, while others will pass the increased costs on to their employees, causing many workers to forgo coverage. In addition, the percentage of firms offering retiree coverage has declined substantially over time.
While uninsured families may qualify for coverage under Medicaid or the State Children's Health Insurance Program (SCHIP), most states have experienced fiscal struggles over the past years, and their state Medicaid budgets are unable to absorb large increases in the number of uninsured. Over a million people have lost coverage under these programs as a result of state budget cuts during the past two years.
Who are the uninsured? By and large, they are working Americans or their family members.
- 8 out 10 of the nonelderly uninsured are from working families 70 % are in families with at least one full.time worker - and more than one-half are in low-wage earning families with incomes below 200% of the federal poverty level.
- More than 8 million children are uninsured - and more than 80% of them live in households headed by a working adult.
What are the consequences of being uninsured or underinsured? People who lack health insurance are far less likely to receive basic health care services, and are generally in poorer health as a result. They may delay seeking needed medical care and filling prescriptions, or have trouble paying medical bills while meeting other essential needs such as food, housing and utilities. The uninsured receive less preventive care, are diagnosed at more advanced disease stages, and once diagnosed, tend to receive less care. Babies whose mothers are low-income and uninsured are 60% more likely to die in infancy. The Institute of Medicine estimates that 18,000 Americans die unnecessarily each year due to the lack of health insurance coverage.
The prospects for Congressional action: Affordable and accessible health care will be a topic of significant national attention in the coming months. However, it remains to be seen whether legislation to help significant numbers of the uninsured will become law this year. If deep cuts in Medicaid are included as part of a plan to reduce the budget deficit, this could lead to a further increase in the number of the uninsured.
Among the kinds of proposals likely to be discussed this year are: tax credits for individuals to buy their own health coverage in the open market or through state sponsored purchasing agreements; incentive to participate in health savings accounts tied to high deductible insurance; expanding existing federal health programs such as Medicaid and SCHIP; expanding funding for community health centers; and restoring access to SCHIP and Medicaid for legal immigrants.
The USCCB has consistently worked for access to affordable health care for all that reflects these principles: Respect for Life; Priority Concern for the Poor; Universal Access; Comprehensive Benefits; Pluralism; Quality; Cost Control; and Equitable Financing. (See USCCB statements Health and Health Care and A Framework for Comprehensive Health Care Reform).
The Catholic Health Association (CHA), in consultation with the USCCB and others, has put forward its framework for health care reform, Continuing the Commitment: A Pathway to Heath Care Reform in April 2000.
A subcommittee of the bishops Domestic Policy Committee, which includes leaders from CHA and Catholic Charities USA, is working on a reiteration of the principles for health care reform in todays context, and to help coordinate a united Catholic effort on the issue of health care for all.
The Conference is developing a campaign to inform the Catholic community about the uninsured and Catholic teaching on health care. Working with CHA, CCUSA, and other segments of the Catholic community, our goal will be to unite Catholics around a common message: it is unacceptable that so many people in this, the most wealthy of nations, go without access to affordable health care and to bring that message to policy makers.
- Contact your Senators and Representatives and urge them to take action to help uninsured Americans, and to start taking steps toward achieving affordable, accessible health care for all by insisting on resources for health care programs in the fiscal 2006 budget plan.
- Take steps to make sure your community is aware that covering the uninsured remains a serious and growing problem. The USCCB and the Catholic Health Association of the United States are participating in a public awareness campaign called Cover the Uninsured Week. The week-long series of events from May 1-8, 2005 is intended to increase awareness of the crisis of the uninsured. Check out the USCCB and CHA websites for more information on how to participate in your area.
- Contact USCCB, CHA, CCUSA and other community resources to learn about what bills are active in Congress and whether they will truly help more uninsured people gain health coverage
USCCB: Kathy Curran, 202-541-3188, kcurran@usccb.org; www.usccb.org
CCUSA: Sharon Daly, 703-549-1390, sdaly@catholiccharitiesusa.org; www.catholiccharitiesusa.org
CHA: Pam Smith, 202-296-3993, psmith@chausa.org; www.chausa.org