Healthcare in America: Health Insurance

In the United States, people without health insurance and other vulnerable populations depend on a loosely organized health care safety net for access to care. Three factors threaten to overwhelm this safety net: the increasing size of the uninsured segment of out population; the slowly dwindling financial assistance for subsidized care providers; and intensified competition for Medicaid patients under managed care.

Can't Afford to Get Sick: A Reality for Millions of Working Americans, a study by the Commonwealth Fund found that many under the median income of $35,000 go uninsured without obtaining necessary care having poor health and trouble paying their health care bills. The same study showed that two of five workers earning less than $20,000 are not offered or eligible to participate in employer provided plans.[1]

Nationally, from 1990 to 1994, the uninsured population grew from 13 percent to 15 percent while the percentage of people obtaining coverage through their employers dropped. Without any future Medicaid coverage expansions, it is estimated that the percentage who are uninsured will grow to 24 percent by 2002.[2] As Claude Earl Fox, M.D., M.P.H., acting administrator of the Health Resources and Services Administration, stated, "Widespread access to primary health care for uninsured, underserved people simply cannot be achieved without more health centers and outreach such as the voucher programs."[3]

The 1994 National Access to Care Survey by the Robert Wood Johnson Foundation examined the likelihood of having a usual source of care, inability to obtain needed care, and number of physician visits for persons with private insurance, Medicaid coverage, and no insurance. Medicaid participants were found to be half as likely as the uninsured and twice as likely as the privately insured to report difficulty with health care. Access for those on Medicaid closely resembled that of the privately insured than that of the uninsured.[4]

A basic issue in health care access is insurance. However, as Joan Jacobs, a policy analyst at the Office of Minority Health states, "We have to look at the fact that when there is coverage or when care is available, many Americans still aren't getting it. Access to insurance doesn't necessarily mean access to care, or even high-quality care for that matter." 1 Other barriers include fear of infection, fear of economic loss, cultural insensitivity, and linguistic barriers.[5]

References:
1. Meadows M. The Problem of Accessing Health Care. Closing the Gap: A Newsletter of the Office of Minority Health, US Dept. HHS. Washington D.C.: Sept. 1999.
2. Larkin H. Employed But Uninsured: Why Business is Cutting Back on Health Insurance. Advances. Winter, 1996; 1: 1-2.
3. HRSA Press Office. HHS Expands Access to Health Care with $18.2 Million for New Health Centers and Voucher Programs. Oct. 6, 1997.
4. Berk ML and Schur CL. Access To Care: How Much Difference Does Medicaid Make? Health Affairs. May - Jun 1998.
5. Landers SJ. Commission looks at ways to reform Medicare. Am Med News. 1999; 42: 1.