From providers to politicians to business leaders, news that 2.4 million more Americans went without health insurance in 2002 drew cries of outrage and calls for immediate action-again.
Last week, the U.S. Census Bureau released the latest figures for the uninsured and the news was not good. An estimated 43.6 million Americans were uninsured last year, up from 41.2 million in 2001. That means 15.2% of the country had no health insurance during 2002, up from 14.6% the previous year.
While 1.5 million more Americans, or a total of 242.4 million, did have insurance for the year, the figures marked the second consecutive year that the total number and percentage of Americans without health insurance increased. The reaction to the news came fast and furiously.
The Catholic Health Association (CHA), St. Louis, which represents about 625 hospitals, called the figures a "national disgrace." HHS Secretary Tommy Thompson called for congressional support for President Bush's plan to help the uninsured, which includes $89 billion in tax and health credits to purchase private coverage. And the U.S. Chamber of Commerce called for passage of legislation allowing for association health plans. Under such plans, small businesses would be allowed to band together to purchase health insurance through trade associations.
In the past, news that the uninsured numbers have gone up has drawn similar immediate reactions, then died down within a few days, attracting only scattershot attention until the next round of figures was released.
But with the presidential elections a year away, the uninsured issue could become a critical one.
In a written statement, the Rev. Michael Place, president and chief executive officer of the CHA, said, "The 2004 presidential campaign must be about how we, as a nation, finally tackle this national disgrace. ... Being uninsured is an affront to human dignity."
The CHA supports expanding the State Children's Health Insurance Program (SCHIP) to families, allowing people ages 57 to 64 to buy into Medicare and creating tax credits for individuals and employers as ways to handle the uninsured problem.
The Democratic candidates and Bush have made tackling the uninsured a major component of their campaigns. The Democrats are proposing everything from expanding SCHIP to offering employers incentives to offer health insurance, to creating a government-run single-payer system, in the most radical proposal by Rep. Dennis Kucinich of Ohio.
His plan would provide universal coverage, an idea that is not drumming up much enthusiasm in Washington, even in light of the current uninsured figures.
Edward Howard, executive vice president of the Alliance for Health Reform, a nonpartisan Washington-based group that educates policymakers, said short of a continued tanking of the economy, discussion of universal coverage would never rise to a serious level of debate. The Clinton healthcare reform debacle in the mid-1990s has soured many on the idea, he said.
However, the fact that the candidates have included expansion of health coverage in their campaigns "has got to reflect some insight into voters' priorities," Howard said.
According to an official at the American Hospital Association, Americans are beginning to feel the effects of not having health insurance firsthand. "We're hearing it from every community in America," said Carmela Coyle, senior vice president of policy at the AHA. "Everyone knows someone who has had trouble accessing their healthcare because they don't have insurance."
For hospitals, caring for the uninsured has become a $22 billion-a-year responsibility, according to the AHA. Because people without health insurance often have no means to pay their healthcare bills, hospitals are forced to absorb the costs of providing services to the uninsured. The uninsured also are prone to use hospitals for primary-care services, contributing to overcrowding in emergency rooms.
"It presents hospitals with a real dilemma," Coyle said. "How can we continue to serve our communities and survive?"
The American Association of Health Plans (AAHP) said the rising number of uninsured is a symptom of rising healthcare costs.
"The administration and Congress (must) act together to preserve the safety net for America's most vulnerable while also taking on the root causes that continue to drive healthcare costs higher for working Americans and their employers," Karen Ignagni, president and CEO of the AAHP, said in a written statement.
At least two members of Congress have taken steps in reaction to the census figures. A spokesperson for Sen. Max Baucus (D-Mont.) confirmed last week that Baucus and Sen. Charles Grassley (R-Iowa) were in the process of crafting legislation that would include a provision for providing tax credits for individuals purchasing health insurance in the commercial market.
Last week, HHS also announced grants worth a total of $11.7 million to 30 states, Washington and the Virgin Islands to help them develop programs to provide health insurance to the uninsured.
To many, there was further bad news behind the numbers because the rise in the uninsured was attributed to the drop-off in the number of Americans who were covered by employment-based insurance, to 61.3% in 2002 from 62.6% in 2001.
The decline is a reflection of both growth in unemployment and in the number of employers who are passing on rising healthcare costs to their workers, who in turn are choosing to go without insurance because they can't afford it.
Legislators in at least one state, however, have moved to require employers to provide health coverage for their workers and eligible dependents. In California, a bill presented to Gov. Gray Davis would require employers with more than 20 workers to either pay for health insurance directly or to pay a fee for the employee to receive coverage from a state-run purchasing pool. The bill would go into effect in 2006 for large employers and the next year for medium-sized firms. Firms with 20 to 49 employees would not be required to participate unless a 20% tax credit is adopted first. At deadline, the governor was expected to sign the bill.
Medicaid has taken up the slack in the employer-based market nationwide. In 2002, the percentage of Americans in the program rose to 25.7%, up from 25.3% in 2001, according to the census.
Earlier this year, the Bush administration proposed giving each state a set amount of money for Medicaid. Critics attacked the plan, however, saying states that experience unexpected rises in their Medicaid rolls would be put in financial jeopardy or be forced to cut their Medicaid programs, driving up the number of uninsured.
In a conference call, Leighton Ku, a senior fellow at the Center on Budget and Policy Priorities, a nonpartisan Washington-based think tank, said the census figures only accentuate the weakness in Bush's plan.
"Had Medicaid been capped, there could've been serious problems," Ku said.