MANAGED CARE May 2001. ©MediMedia USA
The federal government has released new estimates of the number of Americans without health insurance as of June 30, 1999 — about 42.8 million, or 15.8 percent of the population. This is virtually unchanged from the same period in 1998. Discounting those 65 or older, the share of uninsured people is 17 percent.
SOURCE: MEDICAL EXPENDITURE PANEL SURVEY RESEARCH FINDINGS #14: HEALTH INSURANCE STATUS OF THE CIVILIAN NONINSTITUTIONALIZED POPULATION, 1999. U.S. AGENCY FOR HEALTHCARE RESEARCH AND QUALITY, 2001.
No insurance translates to poor outcomes
The effects of being uninsured, in terms of health status and outcomes, were recently demonstrated in an American College of Physicians-American Society of Internal Medicine study of women without health coverage. ACP-ASIM found that delays in care can result in poorer outcomes and more costly treatments. Uninsured women ages 35 to 49 with breast cancer, for instance, have a 57 percent higher adjusted risk of death than privately insured women.
|Likelihood of uninsured women to skip treatment|
|Health care service||Times more likely than insured women|
|Never had a mammogram||2.3 times|
|Never had a Pap test||2.7 times|
|Get <80 percent of recommended prenatal care||3.0 times|
|Unable to see a physician when needed||5.3 times|
SOURCE: NO HEALTH INSURANCE? IT'S ENOUGH TO MAKE YOU SICK, ACP-ASIM, PHILADELPHIA, 2001.
So what to do about the uninsured?
Several policy experts recently have suggested scenarios tied to the budget surplus. Lynn Etheridge, of George Washington University, proposed in Health Affairs that low-income workers be given tax credits to be used to enroll in employers' health coverage, if offered, or to buy private insurance. A $1,000 tax credit would consume 30 percent of the federal budget surplus. Separately, a Commonwealth Fund task force yielded 10 proposals for the 24 million low-income Americans who work but are ineligible for public coverage. All approaches assume tax credits or premium assistance of $2,000 per person. No one proposal would cover all 24 million, though combinations of them could be more effective — and cost-effective — than using tax credits alone.
SOURCE: GLIED S, FERRY D. INCREMENTAL COVERAGE EXPANSION OPTIONS: DETAILED TABLE SUMMARIES TO ACCOMPANY OPTION PAPERS. THE COMMONWEALTH CLUB, NEW YORK, 2001.