Health Challenges Facing the Nation

Providing health insurance coverage for the over 43 million uninsured Americans remains a major challenge for the nation. A substantial body of research shows that there is a strong relationship between health insurance coverage and access to medical care and, ultimately, health outcomes. Though there is public support for guaranteeing coverage for more Americans, the economic downturn, coupled with rising health insurance premium costs and state fiscal constraints to expanding public coverage, pose a significant challenge for reform. This paper examines the uninsured population, the consequences of lack of insurance, and the current health insurance environment. Providing health insurance coverage remains one of the nation's pressing and persistent health care challenges. When asked to identify the top health care priorities for the nation, the public lists lack of health insurance coverage among its top priorities. In a public opinion survey conducted in the fall of 2003, one in three Americans (33 percent) rated increasing the number of Americans covered by health insurance as the most important health issue for Congress and the president to address. (1) Census Bureau data released in September 2003 show that 43.6 million adults and children--more than one in every seven Americans--were without health insurance in 2002. The new statistics reveal that this is a large and growing problem for millions of Americans. From 2001 to 2002, the number of Americans lacking health insurance increased by 2.4 million primarily due to the decline in employer-sponsored coverage. (2) Public coverage expansions helped to moderate the growth in the uninsured population, notably by providing coverage to children in low-income families, but were not enough to offset the decline in private coverage. (3) The decline in employer-sponsored coverage is likely attributable to declines in employment, shifts in employment from firms and industries where coverage is more likely to be available to ones where it is less likely to be available, and increases in health care costs. (4) The uninsured come predominantly from working families with low and moderate incomes--families for whom employer-sponsored coverage is either not available or not affordable. (5) Low-wage employees are less likely than higher-wage employees to work in a firm that sponsors a health insurance plan and are also less likely to take up coverage when offered, largely due to the cost of their share of the premium. (6) Public program expansions through Medicaid and the State Children's Health Insurance Program (SCHIP) help to fill some gaps, especially for low-income children, but the fiscal crisis in the states due to a falloff in state tax revenues is now putting public coverage at risk. (7) Unfortunately, the economic downturn, coupled with rising health care costs and fiscal constraints on public coverage, all point to continued growth in our uninsured population. THE CONSEQUENCES OF LACK OF INSURANCE The growing number of uninsured Americans is not without consequence because having health insurance affects people's access to the health care system and, ultimately, impacts their health. Leaving a substantial share of our population without health insurance threatens not only the health and economic well-being of the uninsured, but also of our nation. There is now a substantial body of research documenting disparities in access to care between those with and without insurance. Survey after survey finds the uninsured are more likely than those with insurance to postpone seeking care, to forgo needed care, and to go without needed prescription medications. Many of the uninsured fear obtaining care will be too costly. Over a third report needing care and not getting it, and nearly half (47 percent) say they have postponed seeking care due to cost. (8) Thirty-six percent of the uninsured report having problems paying medical bills, and nearly a quarter (23 percent) report being contacted by a collection agency about medical bills, compared to 16 percent and 8 percent of the insured, respectively, who encountered such problems. …