A QUESTION OF ACCESS

WHAT ACCESS MEANS IN THE UNITED STATES

ACCESS IS RESTRICTED TO THOSE WHO HAVE HEALTH INSURANCE THROUGH THEIR EMPLOYERS   THOSE COVERED UNDER A GOVERNMENT HEALTH CARE PROGRAM.

THOSE WHO CAN AFFORD TO BUY INSURANCE OUT OF THEIR OWN PRIVATE FUNDS, AND   THOSE WHO ARE ABLE TO PAY FOR SERVICES PRIVATELY.

Some Statistics about access

Health Insurance Coverage in the U.S., 2006 Total = 296.1 million NOTE: Includes those over age 65. Medicaid/Other Public includes Medicaid, SCHIP, other state programs, and military-related coverage. Those enrolled in both Medicare and Medicaid (1.8% of total population) are shown as Medicare beneficiaries. SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2007 CPS.

Uninsured Rates Among the Nonelderly, by State, 2005-2006 NH VT ME WA MT ND MN MA OR NY ID SD WI MI RI WY CT PA IA NJ NE OH NE IN NV IL DE WV UT VA CO MD CA KS MO KY NC DC TN OK SC AR AZ NM GA MS AL TX LA AK FL HI >20% (10 states) 18%-20% (9 states) US Average = 18% 13-17% (18 states & DC) < 13% (13 states) SOURCE: Kaiser Commission on Medicaid and the Uninsured and Urban Institute analysis of the March 2006 and 2007 Current Population Survey. Two-year pooled estimates for states and the US (2005-2006).

Children’s Access to Care, by Health Insurance Status, 2006 NOTE: MD contact includes MD or any health care professional, including time spent in a hospital. Data is for all children under age 18, except for dental visit and unmet dental need, which are for children age 2-17. Respondents who said usual source of care was the emergency room were included among those not having a usual source of care. All estimates are age-adjusted. SOURCE: Kaiser Commission on Medicaid and the Uninsured analysis of National Center for Health Statistics, CDC. 2007. Summary of Health Statistics for U.S. Children: NHIS, 2006.

Characteristics of the Uninsured, 2006 Family Work Status Family Income Age Part-Time Workers 11% 55-64 9% 0-18 20% No Workers 18% 35-54 32% 19-34 39% 1 or More Full-Time Workers 71% Total = 46.5 million uninsured The federal poverty level was $20,614 for a family of four in 2006. SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2007 CPS.

Health Insurance Coverage of the Nonelderly by Poverty Level, 2006 NOTE: The federal poverty level (FPL) was $20,614 for a family of four in 2006. Data may not total 100% due to rounding. Nonelderly defined as age 0-64. SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2007 CPS.

The Nonelderly Uninsured, by Age and Income Groups, 2006 Total = 46.5 million uninsured Low-income includes those with family incomes less than 200% of the federal poverty level. SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2007 CPS.

Number of Nonelderly Uninsured Americans, 2004 - 2006 Uninsured in Millions 46.5 44.4 43.0 SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March CPS for each year.

Uninsured Nonelderly vs. All Nonelderly, by Race and Ethnicity, 2006 Multiracial (1%) 2% Am. Indian (1%) Asian 1% Black Hispanic White Racial and ethnic minorities comprise over half of the uninsured. Minorities have higher uninsured rates than whites, in part, because they are more likely to live in low-income families and have less access to job-based coverage. 46.5 Million 260.0 Million NOTES: American Indian category includes Aleutian Eskimos. Data may not total 100% due to rounding. SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2007 CPS.

Health Insurance Coverage of Nonelderly Adults, 2006 Employer-sponsored health insurance covers the majority of adults, however the share of adults with job-based coverage has been steadily falling since 2000 while the percent who are uninsured has grown. Medicaid covers a much smaller percentage of adults than children. While states are required to offer coverage to parents at very low incomes, Medicaid coverage for parents is more limited than for children. Most childless adults are ineligible for the program, regardless of how low their incomes are. 181.8 Million Nonelderly Adults SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2007 CPS.

Adults' Health Insurance Coverage by Household Type, 2006 Number Adults, living together 28.9 M Adults, living alone 19.6 M Married, no children 53.7 M Other with children 7.2 M Fewer than half of parents in one-parent households have private coverage, compared to 77% of parents in two-parent families. Although adults in one-parent families have higher rates of Medicaid coverage than adults in other types of households, 29% of single parents remain uninsured. 13.1 M 1 parent with children 2 parents with children 59.3 M NOTES: Other households with children include families with at least three generations in a household, plus families in which adults are caring for children other than their own (e.g., a niece living with her aunt). Adults includes all individuals aged 19 to 64. Data may not total 100% due to rounding. SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2007 CPS.

Access to Employer-Based Coverage by Family Income, 2005 <100% FPL) (Family Income 400%+ FPL) NOTE: The Federal Poverty Level (FPL) was $16,090 for a family of three in 2005. SOURCE: Garrett B. and L. Clemens-Cope. Changes in Employer-Sponsored Health Insurance Coverage: 2001-2005. Kaiser Commission on Medicaid and the Uninsured report #7599, Dec. 2006

FLORIDA’S UNINSURED

FLORIDA HAS THE FOURTH LARGEST UNINSURED POULATION IN THE NATION

ALMOST ONE-FOURTH OF FLORIDA’S NON-ELDERLY POPULATION DOES NOT HAVE HEALTH INSURANCE COVERAGE

THE NUMBER IS EXPECTED TO CONTINUE TO INCREASE

IN 1997, 20% OF FLORIDA’S CHILDREN WERE UNINSURED

43% OF FLORIDIANS AGES 21-24 DO NOT HAVE HEALTH INSURANCE

ETHNIC GROUPS WITHOUT HEALTH INSURANCE HISPANIC – 32% BLACKS – 31% WHITES – 19%

EARLY RETIREES ARE A RAPIDLY GROWING GROUP OF UNINSURED FLORIDIANS EARLY RETIREES ARE A RAPIDLY GROWING GROUP OF UNINSURED FLORIDIANS. FEWER EMPLOYERS ARE PROVIDING HEALTH BENEFITS FOR EARLY RETIREES.

75% OF FLORIDA’S UNINSURED ARE EMPLOYED.

THE VAST MAJORITY OF EMPLOYERS ARE SMALL AND ARE LESS LIKELY TO PROVIDE HEALTH CARE INSURANCE.

WHY ARE PEOPLE LOSING HEALTH CARE INSURANCE?

WHEN HEALTH CARE COSTS RISE FASTER THAN WAGES THERE IS A DECREASE IN INSURANCE COVERAGE. LOW INCOME WORKERS CANNOT AFFORD TO BUY HEALTH CARE INSURANCE.

COST OF HEALTH INSURANCE PREMIUMS IS THE PRIMARY REASON PEOPLE DO NOT HAVE HEALTH INSURANCE COVERAGE. BECAUSE OF COST INCREASES, EMPLOYERS ARE SHIFTING MORE OF THE COST OF COVERAGE TO EMPLOYEES.

WHEN PREMIUM COSTS RISE, EMPLOYERS OF ALL SIZES ARE LIKELY TO SWITCH FROM CONVENTIONAL COVERAGE TO MANAGED CARE PLANS, RESTRICT HEALTH PLAN ELIGIBILITY (NO COVERAGE FOR PART-TIME OR TEMPORARY WORKERS), AND INCREASE COST-SHARING REQUIREMENTS.

SOME EMPLOYERS ARE ELIMINATING COVERAGE FOR DEPENDENTS OR SHIFTING THE ENTIRE COST TO THE EMPLOYEE.

MORE EMPLOYERS USE CONTRACT OR PART-TIME EMPLOYEES WHO ARE NOT ELIGIBLE FOR COVERAGE.

WELFARE REFORM IS MOVING PEOPLE OFF WELFARE AND INTO JOBS WELFARE REFORM IS MOVING PEOPLE OFF WELFARE AND INTO JOBS. IN MANY CASES, THEY TEND TO MAKE TOO MUCH INCOME TO QUALIFY FOR MEDICARE. THE JOBS THEY TAKE DON’T ALWAYS OFFER INSURANCE.

IMPLICATIONS OF BEING UNINSURED

MOST PEOPLE WHO LACK HEALTH CARE COVERAGE RECEIVE LITTLE OR NO PREVENTATIVE CARE. THEY ARE LESS LIKELY TO FILL A PRESCRIPTION OR RETURN FOR FOLLOW UP CARE.

THE EMERGENCY ROOM BECOMES THE SOURCE OF PRIMARY CARE

HEALTH CONDITIONS THAT GO UNMANAGED CAN RESULT IN SERIOUS CONDITIONS REQUIRING HOSPITALIZATION.

EMERGENCY ROOM CARE REPRESENTS 7% OF ALL PATIENTS ADMITTED TO FLORIDA HOSPITALS.

IMPLICATIONS FOR THE FUTURE

THE 1998 STATE LEGISLATURE PASSED THE “FLORIDA KID CARE PROGRAM” ENROLLING THEM REMAINS A CHALLENGE.

INCREASES IN HEALTH INSURANCE COSTS WILL RESULT IN MORE PEOPLE BEING UNABLE TO AFFORD COVERAGE.

HOSPITALS, FACING LOWER PAYMENTS FROM MEDICARE, MEDICAID AND MANAGED CARE COMPANIES, WILL STRUGGLE TO ABSORB THE COST OF CARING FOR THE UNINSURED.

PROGRAMS FOCUSING ON PRIMARY AND PREVENTATIVE CARE FOR THE UNINSURED POPULATIONS WILL BE THE KEY TO MANAGING THE COST OF CARING FOR THESE PATIENTS.

TAX INCENTIVES TO ENCOURAGE INDIVIDUALS WILL RESULT IN MORE AFFORDABLE COVERAGE. SPECIAL FUNDING MUST BE AVAILABLE TO THE “SAFETY NET” HOSPITALS, I.E., THOSE HOSPITALS WHO SERVE A DISPROPORTIONATE AMOUNT OF UNINSURED PATIENTS.

Key Points to Remember Most of the insured either work or come from a working family. There is a higher incidence of un-insurance in the low-income, younger adults, and minority populations. Most of the uninsured are U.S. citizens

Loss of health care delivery capacity Less effective control of communicable diseases. Losses to the community’s economic base.

Being uninsured effects the emotional health of individuals and families by: Creating a fear of being denied health care or being bankrupt by illness Forcing individuals to choose which medical services to utilize.

Internal Costs to individuals, families, and business firms Greater morbidity and premature mortality Developmental losses for children Family financial uncertainty and stress, depletion of assets.

Lost income or uninsured breadwinner in ill health. Workplace productivity losses (absenteeism, reduced efficiency on the job) Diminished sense of social equality and self-respect.

End of Lecture for August 31st 2009, 6th Period Questions? Discussion?