A new study quantifying the cost of covering the nation's uninsured added fuel to the burgeoning debate about how best to increase healthcare access, but the likelihood of any real action on the matter remains slim.
The study, released by the Kaiser Commission on Medicaid and the Uninsured last week, estimated universal coverage would cost $34 billion to $69 billion annually in additional spending, or an increase of less than 1% to healthcare's share of the gross domestic product.
Currently, about 41 million Americans lack health insurance, according to the U.S. Census Bureau. In recent weeks, several Democratic candidates have unveiled plans to reform the nation's health system, including taking steps to increase coverage to the uninsured.
Those plans include expanding public programs such as Medicaid and Medicare and adding incentives for more employers to provide coverage. Last week, Carol Moseley Braun, former Democratic Illinois senator and a presidential candidate, said she soon would be unveiling a proposal to provide universal coverage by scrapping the employer-based system and giving the federal government a larger role. Details are being ironed out.
In addition, states are increasingly taking the initiative on the uninsured issue. At least six states-California, Illinois, Maine, Maryland, Massachusetts and Wisconsin-have proposals for universal coverage.
Last week, the California State Assembly also passed a bill that would limit how much a hospital can charge low-income, uninsured patients, while Maryland's health secretary began work on a plan to provide at least basic healthcare for residents there.
Despite all the ideas being floated, Donald Young, president of the Health Insurance Association of America, expressed doubt that any sweeping proposal soon would see the light of day.
"I think the issue is squarely on the agenda," he said. "How far people will go, I don't know." At the state level, in particular, he said, reform will be difficult because of the costs involved and the deficits states are facing.
The Kaiser study, the third in a series on the uninsured, looked at how much providing coverage would cost.
"This study shows that the direct cost of providing care to the 41 million uninsured would be less than the annual inflation in health spending-8.7% in 2001-but still would require a commitment of new resources in a time of fiscal deficits," said Diane Rowland, executive director of the Kaiser Commission.
Indeed, strapped with gaping deficits, many states are looking at paring back their Medicaid benefits and dropping some optional enrollees, those who normally would not automatically qualify for Medicaid. At the same time, double-digit increases to health plan premiums have caused some employers to drop coverage or pass along increased expenses to their workers.
With the number of uninsured projected to rise to 51 million by 2006, according to the National Coalition on Health Care, a Washington-based organization advocating for affordable healthcare, national attention is focusing on finding solutions to the uninsured problem.
According to the Kaiser study, published on Health Affairs' Web site, healthaffairs.org, the country already spends $98.8 billion annually on healthcare for the uninsured. Providing coverage for the uninsured would increase spending by $34 billion under the public insurance system and $69 billion under the private system.
According to the study's authors, the disparity is because of less use of healthcare by consumers under the public system and higher payment rates by private health plans.
One of the criticisms of providing universal coverage is that it would be too expensive, especially for those who already have insurance, said Judy Feder, dean of public policy at Georgetown University. The study debunks that argument, concluding that providing universal coverage would raise healthcare's part of the GDP from 14.1% to between 14.5% and 14.9%.
"To argue you can't have insurance because my insurance is too expensive is a little selfish," Feder said.