Last week's announcement that 1.4 million people lost health insurance coverage in 2003 kicked Washington's politi- cal spin machines into high gear, while hospital officials expressed hope that the new data would inspire lawmakers to take action.
Politically, both parties tried to distance themselves from both the bad news and past inaction on the issue, while trying to pin blame on the other. Some members of the GOP faulted Democrats for impeding legislation to reduce costs-particularly by limiting jury awards in medical malpractice cases and expanding coverage through the passage of association health plans. Democrats, including presidential nominee John Kerry, used the data as ammunition for their argument that President Bush and the Republican- controlled Congress have paid too little attention to the nation's healthcare problems.
"While George Bush tries to convince America's families that we're turning the corner, slogans and empty rhetoric can't hide the real story," Kerry said in response to the census numbers. Along with other members of his party, Kerry pointed out that 5.2 million people have lost health insurance since Bush took office.
For hospitals and doctors, a growing base of uninsured patients means higher levels of uncompensated care-and possibly an even worse situation if employer-sponsored coverage is on a long-term downward spiral, as many last week said that it is.
According to the data the Census Bureau released as part of its annual report on income, poverty and health insurance, the number of uninsured in the U.S. reached 45 million in 2003, a 3.2% increase over 43.6 million in 2002.
The rate of uninsured among the population rose to 15.6% last year, up from 15.2% in 2002, with a decline in employer-sponsored coverage mostly responsible for the overall drop.
"The numbers are a continuation of a recent trend and most people expect it to continue," said James Mongan, president and chief executive officer of Partners HealthCare System in Boston. Mongan said Partners' costs for free care and bad debt have increased 30% year to year since 2002.
"The impact on hospitals is obvious in terms of the general deterioration of their financial picture," Mongan said.
Added the Rev. Michael Place, president and CEO of the Catholic Health Association: "Something is terribly wrong with the nation's moral and fiscal priorities. We cannot continue to calmly accept this tragedy as a national reality."
Publishing the insurance and poverty data in August represents a break with tradition, as it is typically released in October, but Census Bureau officials said they wanted to coordinate the release of the new coverage data with the annual American Community Survey, which provides broad information on social, economic and housing conditions. Also, the information is typically released to the media ahead of time so reporters can prepare stories, but this year officials released the information in a formal press conference.
Some Democrats said the Bush administration put the numbers out early to distance the bad news from the Nov. 2 election. Observers also questioned why the figures would be released on an accelerated schedule.
"If this is a break in tradition, then there can only be two explanations: happenstance, or (an) intentional (act) in order to protect the president as he seeks re-election," said Larry Sabato, director of the Center for Politics at the University of Virginia. "As far as coincidence goes, I'd say it's about the same percentage chance as those two Russian planes falling out of the sky simultaneously by chance," he said, referring to a possible terrorist incident last week.
"Normally we're not criticized for releasing data early," said Charles Kincannon, director of the bureau, declining to step on a political land mine.
Daniel Weinberg, chief of the bureau's housing and household economic-statistics division, said the census data do not show what caused the drop in employer-sponsored coverage this year but that it could be due to a "long-term trend that firms are offering less generous plans and fewer firms are offering plans."
The potential for that trend to take root concerns the provider community, where any forecast of fewer workers obtaining coverage at work translates into a less-effective health system.
"The question is: Is this a change at the economic margin, or is there a creep in decline of employer-provided coverage that is going to continue?" said Chip Kahn, president of the Federation of American Hospitals, which represents the investor-owned sector. Employers deciding not to cover their workers "could be a trend, but I don't think we know yet."
Speaker of the House Dennis Hastert (R-Ill.) last week called on Kerry to "stand up to the Democratic party's special interests" and allow for passage of legislation to reform the costly medical liability system and create association health plans. Those plans would enable small businesses to band together to purchase low-premium health plans for their workers, but that legislation has not passed the Senate. Similarly, medical liability reform-which would allegedly reduce costs throughout the system by limiting jury awards to malpractice victims-has also stalled in the Senate despite success in the House on several occasions.
"It's critically important what (Hastert) said because much of the decline in coverage is occurring in the small-group market," Kahn said. However, he added, medical liability reform and association health plans are "only part of the formula."
HHS Secretary Tommy Thompson told reporters the economy is improving and that last week's uninsured figures "do not represent the full picture because they exclude federal assistance in the form of tax credits and other aid that our society extends to people living below the poverty line."
Still, Thompson conceded, "the Census Bureau report shows that we as a nation need a comprehensive and a pragmatic approach to reducing the number of uninsured in America." At the Republican National Convention this week in New York, Bush will talk about how to reduce industry costs while giving patients and doctors more control over their healthcare, Thompson said.
Hispanics are least insured
According to the census data, 243.3 million people had health insurance coverage in 2003, an increase of 1 million over 2002. Hispanics continued last year to be the least insured of any ethnic group at 32.7%, unchanged from 2002. The proportion of children without health insurance did not change, remaining at 11.4%, or 8.4 million last year.
Hospital lobbyists and administrators said last week that they hope the continuing increase in the number of uninsured will send a signal to Congress and the president that serious action is required-and soon.
"There should be a strong focus on the coverage issue," said Mongan of Partners HealthCare. "It has tended to take a backseat in the national dialogue."
Some industry observers took positive signs from a bipartisan New York Times commentary published last week and co-authored by Senate Majority Leader Bill Frist (R-Tenn.) and Sen. Hillary Rodham Clinton (D-N.Y.).
"While there is no consensus yet on all the changes needed, we both agree that in a new system, innovations stimulated by information technology will improve care, lower costs, improve quality and empower consumers," Frist and Clinton wrote.
As providers wait for words to translate into action, the immediate outlook for the uninsured is not favorable. Recent increases in the number of people covered by public insurance programs have leveled off at the same time as employer-sponsored coverage continues its decline, said Ed Howard, executive vice president of the bipartisan Alliance for Health Reform in Washington.
"That means there's no slack-picker-upper to convert these folks who have lost employer-based coverage into publicly funded programs," Howard said. Healthcare reform, he added, "isn't easy to do. The parties are divided and have different ways of coming at it. They haven't figured out how to build from the middle or attract enough support from the other side" to reach consensus.
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