A slowdown in the uninsured population growth rate seen in last week's U.S. Census data will likely weaken the argument for universal healthcare coverage, industry observers said. And the numbers are likely to draw more attention to ways to supplement-rather than overhaul-the system, they said.
Last week, the Census Bureau released its annual statistics on the uninsured and said overall numbers increased to 45.8 million in 2004. down 1.8% from 45 million in 2003. And the percentage of the population that's uninsured rose one-tenth of a percentage points to 15.7%, a much smaller increase than seen the previous year when the increase was four-tenths of a percentage point. Despite an increase in the uninsured, the number of people with health insurance coverage also increased, by 2 million, in 2004 to 245.3 million.
"I think it's going to be hard as a practical matter politically" for members of Congress to push for universal healthcare, said Richard Pollack, executive vice president of the American Hospital Association. "What is going to happen is that we're gong to have to find ways to expand coverage."
The expansion of coverage is necessary or hospitals will increasingly continue to see patients using emergency room physicians as their primary-care doctors, he said.
Still, some will look at the numbers and say they're a positive because the rate of the uninsured was virtually stable and it showed the smallest increase since 2000. But Pollack offered a different view. "If you're saying it's stable, it's kind of like saying that patient is stable in the intensive-care unit," he said.
Michael Rodgers, interim president and chief executive officer of the Catholic Health Association, said the census findings support his association's agenda-the need to cover more people. "Our position in the past looks at a variety of approaches" to expand coverage, he said.
Rodgers and others backed the use of tax credits for individuals and small businesses as a way to reduce the number of the uninsured.
The hope is that the tax credits would counteract the drop in the rate of people in employer-sponsored healthcare programs-a problem underscored by the new census data-which many said is a product of the ever-increasing cost of healthcare.
The census numbers showed the percentage of people covered by employment-based health insurance decreased to 59.8% in 2004 from 60.4% in 2003.
The Kaiser Family Foundation released a study last week that showed only 31% who tried to purchase health insurance on their own were able to do so. Of those who tried but didn't purchase insurance, 72% said the main reason was the cost of coverage, the study showed.
Karen Ignagni, president and CEO of America's Health Insurance Plans, said insurers have done what they could to keep premiums down but increasing hospital costs make that difficult (Aug. 29, p. 8). She did point to evidence that showed the rise in premiums in 2006 to be the lowest in five years, but they're still expected to rise 12.4%, according to a preliminary analysis of HMOs by consulting firm Hewitt Associates.
Devon Herrick, a senior fellow with the research organization the National Center for Policy Analysis, said providing incentives is a way to increase coverage of the uninsured.
He said two examples of incentives are the use of tax credits, which would provide a fixed amount on money per person to put toward health insurance, and expansion of health savings accounts, which allow patients to keep or roll over money they don't use from year to year.
Herrick also cited census numbers that showed a growing segment of the uninsured are adults who make more than $50,000, with numbers increasing to 15.9 million from 14.8 million-a 7.4% increase-and he thinks offering different types of plans would attract more people to purchase plans.
"They might be more apt to buy insurance if we make health insurance a good value," he said.
One way the market may be doing this is by offering more long-term-care insurance (See Special report, p. 24). More attractive long-term-care insurance policies could deter older Americans who transfer assets to family members in order to qualify for Medicaid coverage, which covers about two-thirds of nursing home residents. The expansion of Medicaid enrollees was largely responsible for keeping the rate of uninsured down, according to the census findings.
More Medicaid patients are good news and bad news for hospitals. It's good news because it's better than treating patients with no insurance, but it's bad news because Medicaid payments largely don't cover the cost of care, Pollack said. But another concern for Pollack and others is the $10 billion in cuts that the Medicaid commission must make.
"The priority should be that the $10 billion is done in a way that it doesn't exacerbate the problem," Pollack said.