The hospital community and some Democratic governors last week used a new study on the uninsured to bolster their case that the growing problem will make it harder for providers to meet their community obligations.
As many as 82 million people were uninsured at some point during 2002 and 2003, according to the study, conducted by the healthcare consumer group Families USA. One out of three people under 65 had no insurance for all or part of the two-year period, the study concluded.
On any given day in 2002, according to the U.S. Census Bureau's widely cited estimate, 43.6 million people were uninsured. Families USA also used census data for its study, although it focused on how many people were uninsured for at least part of 2002 or 2003, to arrive at its figure. Advocates for the uninsured said last week that the same numbers can be crunched and displayed in different ways to make various points. Four out of five uninsured are in working families, said Ron Pollack, executive director of Families USA, adding that he hopes the study will bring more attention to the issue and "catapult it to the top of the national agenda."
"This is a major concern for governors," said Iowa Gov. Tom Vilsack, a Democrat. The Families USA report, he said, "underscores that the economy is not as strong as we think it is" and that the uninsured will increasingly affect patients' access to services if hospitals and doctors do not get more federal help. Vilsack and other governors appearing with Pollack at a news conference last week urged Congress and the Bush administration to restore Medicaid matching funds that are set to expire at the end of June.
Intergovernmental transfers, a book-keeping maneuver that states use to increase their Medicaid funding from Washington, would be reined in under President Bush's 2005 budget proposal, which calls for $24 billion in Medicaid cuts that would come in part from making it harder for states to use the transfers.
Those transfers "are real money and affect real people in real ways," Vilsack said.
According to Families USA, the states with the most uninsured were California and Texas, where 11.9 million and 8.5 million residents, respectively, lacked insurance for more than six months during the two-year period.
Some Republicans questioned the study and its methodology. Taking a yearly average and doubling it "simplifies and doesn't do justice to the enormity of this problem," said Greg Crist, a spokesman for the House Republican conference. "All Families USA wants to do is look at the symptoms. We want to treat the root cause of this." He pointed to association health plans, tax credits and health savings accounts as examples of effective, targeted approaches to a problem for which there is no "silver bullet legislation."
For hospitals, the study offers further evidence of how it will become increasingly difficult to screen and stabilize any patient who comes into the emergency room as required by federal law, said Carmela Coyle, senior vice president for policy at the American Hospital Association.