Slight drop in uninsured masks deepening problem, doctors say
For Immediate Release
Aug. 26, 2008
Don McCanne, M.D., firstname.lastname@example.org
Data released this morning by the Census Bureau showing a slight drop in the number of Americans who lacked health insurance in 2007 masks an acute and worsening problem of access to care, a national doctors' group said today. The figures also do not reflect the harmful consequences of this year's economic downturn, the group said.
Census officials reported that the number of uninsured dropped from 47 million in 2006 to 45.7 million in 2007, or by half a percentage point (from 15.8 percent to 15.3 percent)
"While any drop in the number of uninsured is welcome news, a closer look at the Census Bureau data for 2007 provides little cause for celebration," said Dr. Don McCanne, senior policy fellow at Physicians for a National Health Program.
McCanne said the number of people covered by employer-sponsored plans stayed about the same or slightly declined (0.4 percent), continuing a long-term trend of eroding coverage from this traditional source. While 64 percent of the population was covered by employment-based plans in 1999, only 59.3 percent was covered in this way in 2007.
Upon closer examination of the data, McCanne said, it is clear that last year's gain in the number of insured people was entirely attributable to an expansion of government programs like Medicare and Medicaid. The number of people covered by government health insurance programs increased by 2.7 million. Were it not for this increase, he said, the uninsured numbers would have surpassed the 2006 figure.
"The new figure - 45.7 million uninsured - is still unacceptably high," he said. "It's the second-highest figure since the 1960s, when Medicare and Medicaid were enacted into law. We still have at least 8.1 million children who are uninsured, a scandalous figure."
McCanne said the Census Bureau report is silent on another problem, which he called "the explosion in the rate of underinsurance." People are typically defined as underinsured if they spend 10 percent or more of their income (or 5 percent if they are low-income) on out-of-pocket medical expenses or if they had deductibles equal to 5 percent or more of their income.
While the number of underinsured is difficult to measure, he said, last June the Commonwealth Fund estimated that 25 million people were in this category in 2007, up 60 percent from 2003. Some health policy experts estimate the number of underinsured to be 50 million.
"Not having health insurance, or having poor quality insurance that doesn't protect you from financial hardship in the face of medical need, is a source of mounting stress, anguish and poor medical outcomes for people across our country," McCanne said.
He said African Americans are almost twice as likely to be uninsured as whites, and that Hispanics are three times more likely to be uninsured. While minorities, like whites, posted slight improvements in coverage in 2007, "such gains are of little consolation when compared to the enormity of these disparities," he said.
Several studies have shown that economic recessions, with their attendant job losses, correlate with an increase in the number of uninsured. For example, a January report by John Schmitt and Dean Baker at the Center for Economic and Policy Research suggests that in a mild-to-moderate recession health insurance coverage is likely to fall 1.4 percentage points, leaving an additional 4.2 million individuals without insurance. A more severe recession would have worse consequences.
Many economists believe a recession began in the U.S. at the end of 2007. As a result, McCanne said, it is likely that the Census Bureau figures present a misleading picture of the current situation. "The continuing high profile of the health care issue in the elections is another index of public anxiety about access to care," he said.
The growing financial difficulties of the much-touted incremental reforms in Massachusetts, he said, shows that its short-term gains in reducing the number of uninsured are in jeopardy.
McCanne said fundamental health care reform is possible. "What is really needed is a system that removes the financial burden from patients and more effectively pools our funds into a public program that is able to address costs more effectively by introducing greater efficiency and value into our health care system.
"Such a system would guarantee comprehensive health care to everyone by replacing the private insurance industry with a tax-supported government agency or agencies that would pay all medical bills, similar to the way Medicare operates today, but even better than Medicare," he said. "People would have the freedom to choose their own doctors and hospitals.
"That's a single-payer system. Such a system is embodied in H.R. 676, the U.S. National Health Insurance Act, introduced by Rep. John Conyers (D-Mich.). It currently has over 90 co-sponsors in Congress, more than any other health reform proposal."
A table showing the number of uninsured by state for the years 2004-2007 is available here. Physicians for a National Health Program has physician-spokespersons in every state who are available for comment.
Physicians for a National Health Program, a membership organization of over 15,000 physicians, supports a single-payer national health insurance program. To contact a physician-spokesperson in your area, visit www.pnhp.org/stateactions or call (312) 782-6006.