New U.S. Census Bureau data showing that the number of uninsured increased sharply in 2009 will make it harder to roll back the Patient Protection and Affordable Care Act, which many in Congress want to repeal or water down.
As number of uninsured rises, effort to repeal healthcare overhaul gets tougher
In its estimates on income, poverty and health insurance for 2009, the Census Bureau estimated that 50.7 million went without health insurance, up 9.5% from last year's total of 46.3 million, the highest number of uninsured on record since the bureau began collecting comparable data on the uninsured in 1987.
And, the percentage of the population not covered by insurance rose to 16.7%, also the highest on record since 1987, and up from 15.4% in 2008.
The data, coming amid a severe economic recession, bolstered the case of those who support the bill amid an election season in which Democrats are likely to lose seats, if not control, of the two branches of Congress.
“It seems to me that the new numbers clearly emphasize the need for health reform,” said Dan Hale, executive vice president for community benefit and public affairs with Trinity Health, Novi, Mich. “Across our system we've seen dramatic increases in the number of uninsured, dramatic increases in the need for charity care and amount of bad debt. All of that is consistent with what these numbers tell us.”
Politicians in favor of the law also jumped on the data. “The health reform law will make a difference for tens of millions of people without insurance who will finally be able to afford quality health coverage,” Rep. Pete Stark (D-Calif.), who chairs the House Ways and Means Health Subcommittee, said in a written statement. For Republicans aiming to repeal health reform, “I have a message for them: You're on your own,” Stark said.
Nonetheless, the political effort to repeal the healthcare law will continue. Rep. Michael Burgess (R-Texas), who chairs the Congressional Health Care Caucus, thinks the law should be repealed despite the increase in uninsured and replaced with better solutions. “The healthcare law does nothing to help job creation, and benefits for the uninsured in the law are still years away,” said Burgess, who has introduced two alternative bills to address the problem.
Democrats will say that the bureau's findings prove that the new health reform plan was sorely needed, said Joe Antos, health policy expert at the conservative American Enterprise Institute. Yet, “there's already pressure among the Democrats to be able to say, ‘Here's what we've actually done for you.' And that's a very difficult thing to fill the blank on this year, because there's hardly anything by design that could have been done for anybody this year. And that's probably going to be an issue in the congressional elections” this November, he predicted.
Aside from the political repercussions, representatives of the hospital industry say they're banking on those reforms to make a dent in the uninsured numbers, especially in 2014, when a number of major coverage options go into effect, such as insurance exchanges, a vast Medicaid expansion and subsidies for low-income people to purchase health insurance through the exchanges.
“The economic downturn has affected everyone so it is not surprising that more people are without insurance and are facing more financial difficulties. Down the road, the passage of the healthcare reform law is expected to provide more than 32 million more Americans with health insurance,” Richard Umbdenstock, president and CEO of the American Hospital Association, said in an e-mail.
According to the latest available figures from the AHA, hospitals spent $36.4 billion on uncompensated care in 2008, which is the combination of charity care and bad debt.
“Clearly the economy has made a bad situation worse,” said Chip Kahn, president of the Federation of American Hospitals. The uninsured data from the Census Bureau “cries out for the coverage that we all look forward to in 2014,” he said.
Yet, Hale of Trinity said it's important to note “that these reforms with regard to coverage in large measure really don't kick in for another four years.” As these numbers continue to escalate, “even if they stay at these levels it puts pressure on our hospital and charity-care system to meet the care that's needed,” coupled with the fact that hospitals and physicians in particular are not experiencing increasing rates of reimbursement, and in some cases, are experiencing decreases, he said.
Physician leaders are still divided on their support of the overhaul. The American Medical Association was among those that supported the law while selected member and physician specialty groups did not (Aug. 23, p. 18). “It is disappointing, though not surprising, to see a rise in the number of uninsured Americans during 2009, due in large part to the recession and the loss of employer-sponsored insurance,” Cecil Wilson, president of the AMA, said in an e-mail.
“The Census Bureau's finding that the United States has more uninsured persons than ever before—50 million of us—demonstrates why we can't turn back from providing all Americans with access to affordable coverage, as the Affordable Care Act would begin to do,” Fred Ralston, president of the American College of Physicians, said in an e-mailed statement. “Improvements can and should be made in the law, but we can't abandon the millions of our fellow Americans who have to choose between paying their rent and groceries and getting needed medical care—simply because they don't have access to affordable insurance,” he wrote.
A vocal opponent of reform that continues to be after the release of the numbers is the Medical Association of Georgia. “The trend of uninsured will continue” under the law, said David Cook, executive director and CEO. Employers are going to drop coverage with the exception of the biggest employers, premiums will increase as the insurance industry prepares to implement the bill, and rising premiums will cause many small employers to change coverage, Cook said. In addition, there “will be no way to sustain the Medicaid expansions” planned for 2014, he said.
Health insurers largely stayed quiet on the issue. Officials for Aetna, Kaiser Permanente, UnitedHealth Group, and WellPoint declined to comment or didn't return calls requesting comment.
Robert Zirkelbach, spokesman for America's Health Insurance Plans, responded to the data by saying that the industry “is doing everything we can to implement all these reforms … to minimize disruption and mitigate the impact on cost” for consumers.
Zirkelbach said that premium rates were based on a variety of actuarial factors, including the rising cost of medical care, changes in the risk pool and changes in benefit packages. “The basic of economics is when you add additional benefits to a policy it's going to incur additional costs.” The bottom line is in order to make healthcare more affordable, “we need to do more to address underlying costs of medical care,” he said.
Robert Greenstein, executive director of the Center on Budget and Policy Priorities, said the numbers of uninsured would have been substantially greater in 2009 if not for Medicaid and CHIP, “which covered more people as the number of people lacking employer-based insurance swelled.”
In his view, the findings underscore the relevance of the recently enacted health reform law, “which substantially expands coverage for people who cannot obtain insurance through an employer. Had health reform been in place in 2009, the number of people without health insurance would have risen far less.”
Similarly, Commonwealth Fund President Karen Davis said in a statement that, “These numbers illustrate the harsh toll the recession has taken on millions of Americans' access to healthcare and highlight the urgent need for Affordable Care Act provisions that will provide affordable options for middle-class families if they lose coverage through their jobs.”
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