Important questions surround the issue of access to medical insurance coverage.
Who are the uninsured and why do they lack coverage? Is basic health care a fundamental right? Why does a nation with the world's most sophisticated health resources fail to offer even basic coverage to many of its citizens? Can we afford to solve this problem?
Nationally, the Robert Wood Johnson Foundation estimates that some 43 million Americans lack health insurance coverage -- an increase of 2 million over the past two years. The sheer numbers of the uninsured seem so overwhelming as to defy solutions.
But, perhaps this problem is not as unmanageable as it seems. Perhaps there is already enough spent on health care each year to provide at least basic coverage for everyone. A closer look at just who comprises the ranks of the uninsured may provide some guidance.
An analysis developed by the national Blue Cross and Blue Shield Association reveals that one-third of the nation's uninsured, or more than 14 million Americans, are eligible for existing government-subsidized insurance programs such as Medicaid and SCHIP (the State Children's Health Insurance Program) but for a variety of reasons, are not enrolled in one of them.
Another 13 million or more of the uninsured, representing 32 percent of those without coverage, are part of households with annual incomes above $50,000. Many in this group may be able to afford health insurance but, again for various reasons, choose to go without health care coverage.
That leaves 15 million or more uninsured individuals who can be further broken down into two groups. About 6 million -- 14 percent of all of the uninsured -- have gone without health coverage for less than two years. They include those, for example, who are temporarily between jobs as well as recent college graduates.
Most of those remaining, representing about 20 percent of the total uninsured, may have jobs but do not make enough money to purchase health insurance.
Understanding just who makes up the ranks of the uninsured becomes important because it suggests some possible solutions. For instance, through intensive outreach efforts, more eligible seniors, the poor and the disabled could be enrolled in existing medical assistance and other government-funded programs.
Targeted educational campaigns could be used to convince the uninsured who can afford basic coverage of the health and financial risks they are taking. Additional tax credits and incentives could be offered to encourage small employers to offer health insurance for their workers and their families.
To make coverage more affordable, regulatory restrictions could be modified to enable insurers to offer options that allow greater flexibility in cost sharing between employers and their employees. Maryland legislators, for instance, took a positive step in making insurance more affordable during the 2004 legislative session when they passed a lower-cost, limited health benefit plan for small groups.
Making sure that each health care dollar is wisely spent could also increase the numbers of the insured. For example, taken as a group, the uninsured have a lower quality of health care that leads to poorer overall health and ultimately results in greater cost of care when they do get sick.
There may, in fact, already be enough spent in our national health care system to provide basic care for everyone. A 2003 Juran Institute study determined that, of the $1.4 trillion spent on health care in the U.S. in 2001, an estimated $420 billion -- or 30 cents of every $1 spent -- was wasted due to misuse and overuse of resources, inefficiencies and poor quality of care. Eliminating this waste would be enough to purchase nearly $9,800 in health coverage for each uninsured American.
Bringing the uninsured into structured health plans with the capability and experience to provide efficient, effective care also could have a dramatic impact on the nation's health care spending, while improving the nation's overall health status. Public and private health insurers are able to reduce patient care costs without compromising quality.
Many insurers are moving aggressively to control costs. For example, two CareFirst BlueCross BlueShield programs combined to reduce health costs for many members by about $62 million last year.
The company saved an additional $28 million for its customers through voluntary programs targeted at 33,000 members with chronic diseases such as cancer, diabetes, asthma and heart disease.
Economic benefits aside, concerns for the good health and well being of all Americans should be enough to marshal broad public interest in the challenge posed by the 43 million people who go daily without the security of health care coverage.
William L. Jews, president and CEO of CareFirst BlueCross BlueShield, can be reached at (410) 998-5772.
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