New Study Examines the Current Spending on Health Care for the Uninsured
A newly published study from the Kaiser Family Foundation examines the current spending on care for the uninsured and projects additional medical spending if the population had health insurance coverage.
The study finds that the uninsured will spend $30 billion out-of-pocket for health care in 2008 while receiving $56 billion in uncompensated care, three quarters of which will be from government sources.
The study is an update of a previous Kaiser study and also projects the additional cost to the nation’s health care system if all the uninsured were covered by insurance. If everyone were covered, overall costs would increase by $123 billion dollars, or an additional five percent of national health spending. The analysis does not assess how much a universal coverage plan would cost the government, which would vary depending on the details of the approach.
For more see here.
News Alert: New US Data on the Uninsured
Increases in the number of Americans with government health insurance — especially coverage from State Children Health Insurance programs – helped lower the overall uninsured rate in the United States in 2007 to 45.7 million from 47 million in 2006, according to U.S. Census Bureau figures released today. However, the percentages of Americans with employer-based insurance continued to fall. The 2007 numbers do not take into account the effects of economic downturn that has overtaken the country since late last year.
The percentage of women with no health insurance was 13.9 percent in 2007, down from 14.2 percent in 2006, but still higher than the rate in any other year since 1999 (which is as far back as the Census Bureau’s current set of historical tables go). The un-insurance rate in 2007 was far higher for women of color (Black women, 17.9 percent; Hispanic women of all races, 28.9 percent; and Asian-American women 15.7 percent) than for white non-hispanic women (9.6 percent).
Census bureau spokesman David Johnson acknowledged at a press conference today that the decline in the number of uninsured Americans could largely be attributed to increases in the number of children receiving coverage under government health insurance programs. The State Children’s Health Insurance Program (SCHIP) has been the subject of an ongoing battle between the administration and those members of Congress and Governors who want to increase the numbers of children covered by SCHIP.
“The numbers released today show the potential power of public insurance programs to provide desperately-needed coverage to uninsured Americans,” said Lois Uttley, Director of the MergerWatch Project and co-founder of Raising Women’s Voices for the Health Care We Need (RWV). She pointed out that women also benefit significantly from public health insurance programs.
The percentage of women who relied on government health insurance of any type (Medicaid, Medicare or military insurance) in 2007 was 29.8 percent, compared to 25.7 percent for men. A higher percent of women relied on Medicaid than did men (14.2 percent for women, compared to 12.2 percent for men), and the same was true for Medicare (15.4 percent of women had Medicare coverage, compared to 12.2 percent for men.)
Cindy Pearson, Director of the National Women’s Health Network and another Raising Women’s Voices co-founder, noted with concern that in 2007, 58.7 percent of women had employment-based private health insurance, down from 59.1 percent in 2006. The 2007 rate was the lowest for women in the nine years reported by the Census Bureau today. The highest rate for those years was in 2000, when it was 63.1 percent. The percentage of men with employer-sponsored insurance was 60 percnet in 2007, also at its lowest level since 1999.
“This decline in employer-sponsored insurance rings a real alarm bell, warning us that fewer and fewer women and men are able to get health insurance from their employers,” Pearson said. She added that since 2007, the economy has been slipping, and many Americans may have lost employer-sponsored health insurance in recent months.
The new Census data show continuing disparities in coverage that affected low-income people and people of color in 2007. While the percentages of Blacks and Hispanics without health insurance declined from 2006 to 2007, their rates of uninsurance were still dramatically higher than for non-Hispanic whites. The uninsurance rate for Blacks fell from 20.5 percent in 2006 to 19.5 percent in 2007, and the rate for Hispanics fell from 34.1 percent in 2006 to 32.1 percent in 2007. However, both groups had rates significantly higher than the uninsured rate for whites, which was 10.4 percent in 2007, down from 10.8 percent in 2006.
“Once again, we have seen strong evidence of health disparities in our country,” said Byllye Avery, founder of the Black Women’s Health Imperative and another co-founder of Raising Women’s Voices. “We must be committed as a nation to make health coverage a basic human right, and ensuring that everyone has access to health care.”
HSS Regulations: The Latest
The Department of Health and Human Services has proposed a new set of regulations that could make it easier for health providers to refuse to give women the health care services and information we need. The Wall Street Journal covers the story:
The Bush administration has proposed stronger protections for health-care workers who refuse to participate in abortions, issuing a sweeping regulation that could also undercut access to birth-control pills and other forms of contraception.
The new rules, which could take effect after a 30-day comment period, threaten state governments with a cutoff in federal funding if they force medical personnel to perform, assist in or refer patients to abortion services.
For the full story see The Wall Street Journal Online.
In July, a draft of these regulations, which would potentially allow contraception to be defined as abortion, was leaked to the media. The formal release of the regulations last Thursday reflects some changes to that draft. Washington Post Coverage says:
WASHINGTON (Reuters) – Health officials released a controversial regulation on Thursday to protect health professionals who do not want to provide abortions or certain other health care services.
The regulation could strip federal funding from employers or institutions that fire a doctor, nurse, pharmacist or other health professional who refuses to provide abortion care or information.
But it no longer defines some types of contraception as abortion, after family planning groups complained an earlier draft would have defined abortion to include birth control pills and the intrauterine device or IUD.
For the full article, see the Washington Post Online.
And for additional news and commentary, please see RH Reality Check’s ongoing coverage.
Ob/Gyn Group Urges Routine HIV Tests for All Women
FRIDAY, Aug. 1 (HealthDay News) — Minority women are at higher risk for HIV/AIDS, and doctors need to make a special effort to encourage them to be tested for HIV.
That’s the new recommendation released Thursday by the American College of Obstetricians and Gynecologists (ACOG).
“Rates of infection among African Americans — and also among Hispanics — are much higher than among white women. Sixty-four percent of women with HIV are black, even though blacks only make up about 13 percent of the U.S. population,” Dr. Heather Watts, a liaison member to ACOG’s Committee on Health Care for Underserved Women, said in an organization news release.
For the full article see: http://health.usnews.com/articles/health/healthday/2008/08/01/obgyn-group-urges-routine-hiv-tests-for-all-women.html
Provider Ignorance and Biases Turn Lesbians Patients off Healthcare
By Pamela Merritt for RHRealityCheck
When seeking medical care, LGBT people are often confronted with a system that denies our existence or insults who we are. From medical forms that ask for a patient’s marital status to doctors who refuse care to lesbians who seek to parent to medical ignorance of intersex conditions, even LGBT people with health insurance struggle to get the healthcare services they are paying for and need.
The lesbian community faces unique challenges when accessing health care, from widespread provider misperception about STI risks for women who partner with women to doctors who tailor their medical advice to stereotypes they have of lesbians’ lives and needs.
For the full article see: http://www.rhrealitycheck.org/blog/2008/08/01/provider-ignorance-bias-turn-lesbian-patients-off-health-care
California Governor Plans New Push for Omnibus Health Care Reform Effort
By Fredrick L. Pilot
SACRAMENTO, Calif.–Once the state has enacted a budget for the fiscal year that began July 1, the Schwarzenegger administration will go back to the drawing board on a comprehensive overhaul of California’s health care financing system, a top administration official said Aug. 15.
Jennifer Kent, deputy legislative secretary for Gov. Arnold Schwarzenegger (R), told a panel that the administration will incorporate lessons learned after omnibus reform legislation, which Schwarzenegger co-authored with then-Assembly Speaker Fabian Núñez (D), was killed in the Senate Health Committee in late January amid concerns the state could not afford the plan.
Chief among them is an appreciation of the views of various groups holding large stakes in any proposed reforms including payers, medical providers, and consumer and labor organizations, Kent told a Sacramento panel discussion titled Where does California Healthcare Policy Go From Here?, hosted by the University of California and the California Medical Association.
“We learned a lot of lessons of what’s important to these groups,” Kent said.
“After the budget is done, we’re going to begin the brainstorming process,” Kent said.
Most legislative seats are up for election in November and a new two-year legislative session begins the following month.
Kent said while the administration developed a number of incremental “building block” reform proposals this summer, legislators have shown little interest in taking them up this year.
Status Quo Unsustainable
The status quo is unsustainable, Kent noted. Continued dissatisfaction among key stakeholder groups with the current health care finance system and rising medical costs are likely to bring the system to a crisis point in the near term, possibly leading to a dramatic collapse of some component of the system, Kent predicted.
“We’re at this tipping point where something has to break,” Kent said. “I think it’s going to be some kind of crack and then it will be, ‘OK, we’re done.'”
One possible harbinger that appears to back Kent’s prognostications is a white paper issued Aug. 14 by the Sacramento-based consumer group Health Access California. The paper concluded that Medi-Cal cuts proposed in the administration’s revised budget issued in May to tamp down ballooning deficit spending would force more uninsured and low-income Californians to seek medical care in hospital emergency departments. Those higher costs for emergency room care will be passed on to those with insurance, boosting employer-based health insurance by 22 percent in 2009 at an estimated additional cost of more than $290 per family, the paper concluded.
Peter Harbage, who authored the paper, Adverse Reaction: Proposed Health Budget Cuts Would Lead to Increased Health Insurance Premiums, co-authored a December 2006 report by the Washington-based New America Foundation (NAF) that estimated 10 percent of California health care premiums can be attributed to cost-shifting to pay for care delivered to medically uninsured residents of the state.
The administration cited those findings to support its original health care reform proposal of January 2007 that would have required all Californians to obtain health insurance through their employers or through individual policies and by expanding access to state health insurance programs such as Medi-Cal and the Healthy Families program.
At that time, Schwarzenegger argued that eliminating what he termed a “hidden tax” for care of the medically uninsured would reduce overall health insurance costs and make coverage more affordable and accessible.
Administration Committed to Reform
Kent said Schwarzenegger remains committed to accomplishing health care reform during the remainder of his term, which ends in January 2011, based on the three fundamental principles of his 2007 proposal: cost containment, prevention, and consumer protection.
However, panelist Sara Rogers, a policy consultant to state Sen. Sheila Kuehl (D), took issue with two of the Schwarzenegger reform principles, cost containment and prevention.
Prevention is limited by peoples’ predisposition to medical conditions beyond their control and the difficulty of creating incentives to encourage individuals with low socioeconomic status to modify their lifestyles and better manage medical conditions that can become chronic and costly to treat, Rogers said.
In addition, Rogers said, cost containment incorrectly assumes a competitive market for medical services exists. It does not, Rogers explained, because market demand for medical services is inelastic since people will seek medical care at any price they can afford when they or their family members need medical treatment and medications.
‘Fragility’ in Individual Market
Kent said the administration is concerned about “fragility” in the troubled individual health insurance market, which covers about 9 percent of medically insured Californians, and would like to see payers adopt improved underwriting practices.
Managed care plans and insurers who participate in this market segment have come under intense scrutiny during the past year from regulators, legislators, and the courts over the practice of unilaterally rescinding coverage when policyholders submit costly claims, contending they hoodwinked plans and insurers by lying or omitting material information on their medical histories at the time they applied for coverage.
“We would like to see plans more aggressively police who they let in,” Kent said. “The plans have to have responsibility on the front end to do due diligence.”
Study: Uninsured population grows with immigration
The uninsured population is increasingly made up of immigrants, according to a study released today by the Employee Benefit Research Institute.
The nonpartisan research organization, which doesn’t take policy positions, tracked the increase in the uninsured population over the last 12 years. Native-born Americans still account for the majority — three-fourths — of the persons without health insurance, but the percentage of immigrants in those ranks has grown from 18.8 percent in 1994 to 26.6 percent in 2006.
Over the same 12-year period, the percentage of native-born uninsured dropped from 81.2 percent to 73.4 percent, EBRI said.
In raw numbers, that means 12.3 million immigrants and 34.1 million native-born U.S. residents had no health insurance in 2006, the end of the study period.
EBRI drew from Census data to compile the study. It did not differentiate as to the legal or illegal status of immigrants, so it’s impossible to use the data to draw conclusions about undocumented residents.
The study found that slightly more than 46 percent of foreign-born noncitizens in the U.S. were uninsured in 2006. That compared to an uninsured population of 19.9 percent of foreign-born who had become U.S. citizens and 15 percent of native-born citizens.
The longer an immigrant had resided in the United States, the more likely they were to be insured, the study found. But immigrants also were more likely to be in low-wage jobs that didn’t provide health benefits.
PUBLIC HEALTH & EDUCATION | ACOG Releases New Recommendations on HIV Screening for Women
Physicians need to make an increased effort to encourage minority women to get tested for HIV because they are at greater risk of contracting the virus, according to new recommendations issued by the American College of Obstetricians and Gynecologists, HealthDay/U.S. News and World Report reports (HealthDay/U.S. News and World Report, 8/1). A separate recommendation by ACOG also says that ob-gyns should routinely screen all women ages 19 to 64 for HIV regardless of individual risk factors. Targeted screening is also recommended for women who are outside this age range but at high risk of HIV/AIDS.
The recommendations, issued by ACOG’s Committee on Gynecology Practice, are published in the August issue of the journal Obstetrics and Gynecology. The committee also recommends “opt-out” testing, in which patients are told that HIV tests will be given as part of routine care, unless they decline. Neither specific signed consent nor HIV prevention counseling is required under opt-out testing. According to an ACOG release, some state and local laws are not consistent with the opt-out testing and might require additional counseling or informed consent requirements.
Immigrants Facing Deportation by U.S. Hospitals
JOLOMCÚ, Guatemala — High in the hills of Guatemala, shut inside the one-room house where he spends day and night on a twin bed beneath a seriously outdated calendar, Luis Alberto Jiménez has no idea of the legal battle that swirls around him in the lowlands of Florida.
Shooing away flies and beaming at the tiny, toothless elderly mother who is his sole caregiver, Mr. Jiménez, a knit cap pulled tightly on his head, remains cheerily oblivious that he has come to represent the collision of two deeply flawed American systems, immigration and health care.
Eight years ago, Mr. Jiménez, 35, an illegal immigrant working as a gardener in Stuart, Fla., suffered devastating injuries in a car crash with a drunken Floridian. A community hospital saved his life, twice, and, after failing to find a rehabilitation center willing to accept an uninsured patient, kept him as a ward for years at a cost of $1.5 million.
Birth Trauma: Stress Disorder Afflicts Moms
Amid the debate over how to effectively manage maternal mental-health disorders, a new type of postpartum illness is gaining attention: post-traumatic-stress disorder due to childbirth.
PTSD is most commonly associated with combat veterans and victims of violent crime, but medical experts say it also can be brought on by a very painful or complicated labor and delivery in which a woman believes she or her baby might die. Symptoms can include anxiety, flashbacks and a numbness to daily life. Even as medical advances have resulted in many more lives saved during high-risk births, extreme medical interventions can leave a mother severely stressed — especially if she feels powerless or mistreated by health providers.PTSD is much less common than postpartum depression, which has become better-understood by the public as celebrities like actress Brooke Shields and former CIA agent Valerie Plame have spoken out about their experiences. The National Institute of Mental Health estimates that postpartum depression affects 15% of mothers.
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