The evidence keeps piling up, even if Congress seems to have no motivation to act quickly.
Against a backdrop of impending Medicaid cuts, three studies released last week again put the focus on the plight of the uninsured and ways to shrink their numbers. But in a year when Washington lawmakers are fixated on Social Security, federal court appointments and the Middle East conflict, the studies are likely to gather dust along with earlier findings.
One report issued by a healthcare research group, the Commonwealth Fund, found that by using tax credits or expanding public insurance programs -- both ideas have been proposed by lawmakers -- the number of uninsured in some states would be reduced by more than 20%. Another study by the organization said that U.S. employers paid $31 billion for the healthcare costs of their workers' dependents in 2004.
A third study from Families USA quantified the cost borne by the insured for the healthcare of those without insurance. According to the consumer advocacy group's study, families with employer-sponsored health coverage will pay on average an extra of $922 this year to cover the unpaid expenses of healthcare for the uninsured. By 2010, the study said, the extra premium costs across all states will average $1,502.
Last week, the consequences of rising healthcare costs in the U.S. were brought into stark relief when General Motors Corp. announced it will cut at least 25,000 jobs by 2008, partly because of the high cost of healthcare. GM is the country's largest private purchaser of healthcare and expects to spend $5.6 billion this year on healthcare for its workers and retirees.
As cuts of up to $10 billion from the Medicaid program loom, representatives from both the Commonweath Fund and Families USA used their studies as lobbying points to spare the program.
"The report underscores the importance of strengthening and protecting programs such as Medicaid," said Ron Pollack, executive director of Families USA. Otherwise, the government risks increasing the ranks of the uninsured, making healthcare more expensive for everyone, Pollack said.
Karen Davis, president of the Commonwealth Fund, said its study on tax credits and expansion of public health insurance programs indicates that a one-size-fits-all approach is not the answer to the problem and that states should be given the freedom to tailor solutions to their own needs. The study, she said, will hopefully spark discussions that if Medicaid were cut, the savings would go to states to help them finance their uninsured programs rather than to finance tax cuts.
According to the U.S. Census Bureau, 45 million Americans went without insurance during 2003, a figure that is anticipated to grow in the coming years. Despite that and the fact that legislators periodically have introduced bills aimed at reducing the number of uninsured, Congress has taken no major step on the issue since the State Children's Health Insurance Program was created as part of the Balanced Budget Act of 1997.
"This has been a burning problem with the public, but it hasn't been a burning issue with public policymakers," Davis said.
Part of that is blamed on sheer differences of opinion about the best approach. While conservative factions on Capitol Hill and elsewhere have been pushing for private market solutions, liberal proposals to increase coverage put the federal government front and center. As the problem worsens, however, ideological walls among the stakeholders show signs of crumbling. A working group of about 24 disparate organizations, such as the American Hospital Association, the U.S. Chamber of Commerce, the Service Employees International Union and Families USA, have been quietly meeting to reach agreement on a set of proposals to expand health insurance coverage to more Americans.
Last week, Pollack declined to give much detail about the meetings but said the organizations are willing to make concessions on what they think are the best possible solutions to the problem. And that's a welcome sign that something constructive may come of the proceedings.
Also at the news conference last week announcing the Families USA report, Sen. Gordon Smith (R-Ore.) said he and Sen. Ron Wyden (D-Ore.) are crafting bipartisan legislation regarding the uninsured, though he declined to provide many details, saying only that they are looking at ways to provide catastrophic coverage.
"We are seeking a rational way in which to provide medicine in this country," Smith said.
The Commonwealth report studied strategies proposed earlier by both Republicans and Democrats. Among the findings: Providing a tax credit of up to $1,000 for low-income individuals and up to $3,000 for low-income families would allow states to reduce their number of uninsured by up to 20.5%. A proposal to give small employers a tax credit to cover 25% of their employees' monthly health insurance would lower the number of uninsured in some states by up to 4.7%.
Researchers also estimated that expanding the Medicaid program to cover individuals earning less than 133% of the federal poverty level would decrease the number of the uninsured by more than 18% in some states, and allowing the SCHIP to cover parents whose children are eligible for the program would lower the number of the uninsured by up to 10.3% depending on the state.
In a separate Commonwealth report, the group found that U.S. employers spent $31 billion last year on dependent coverage for Americans' healthcare costs on top of the $150 billion they spent on healthcare for their own workers. According to the study, nearly 36 million Americans did not receive health coverage through their own employers, of which 16 million received health insurance through dependent coverage. While 22 million people lack coverage because their employers did not offer such benefits, 11.2 million declined to accept the coverage offered by their employers.