The safety net is tattered
Kaiser Commission on Medicaid and the Uninsured
November 4, 2005
Covering the Uninsured - Growing Need, Strained Resources
In 2004, America’s 46 million uninsured received about $41 billion dollars in uncompensated care - care that was not paid for either by the uninsured themselves or by another identifiable source. Most of the care received by the uninsured is provided through the informal network of hospitals, clinics, and health centers, referred to as the “safety net,” which is supported by federal, state, and local government as well as private sources. About half of all safety net funds come from the federal government, but they still comprise less than one percent of overall federal spending.
After adjusting for medical inflation and using constant 2004 dollars, total federal spending on the safety net increased by only slightly more than one percent between 2001 and 2004. Because the number of uninsured grew by nearly 5 million people, federal spending actually decreased from $546 to $498 per uninsured person over this time - a decline of 8.9%.
The federal commitment to the health care safety net has not kept pace with the growth in the uninsured, and future federal funding appears unlikely to reverse this trend. Most federal safety net spending flows through Medicare and Medicaid, both of which are under severe budgetary pressures. If safety net resources continue to decrease as the number of uninsured increases, the amount of care provided to the uninsured will be jeopardized, with further consequences on their health and the health of the country.
The Uninsured and Their Access to Health Care
Charitable physicians and the safety net of community clinics and public hospitals do not fully substitute for health insurance. Lack of health coverage matters for millions of uninsured Americans - affecting their access to care, health status, job decisions, and financial security, as well as exacting an indirect toll on society in terms of more disability, lower productivity, and increased burden on the health care system.
http://www.kff.org/uninsured/upload/The-Uninsured-and-Their-Access-to-Health-Care-Fact-Sheet-6.pdf
Five New Reports Profile the Growing Uninsured Population and Portray the Health Care Safety Net as Increasingly Strained:
http://www.kff.org/uninsured/kcmu110405pkg.cfm
Comment: Lacking the “insurance ticket” that authorizes access to the private health care delivery system, the uninsured must depend on the safety net. When you consider that premiums for employer-based coverage for an individual averaged $3481 in 2003, it is difficult to imagine that the current safety net federal spending of $498 will pay for much care for the uninsured who typically have greater needs than the higher-income, healthier work force.
Since programs for safety net funding are considered to be welfare programs, the weak political voice for the uninsured is always drowned out by the strong political voices calling for fiscal restraint. Safety net institutions will never receive adequate funding until they are included in a single, universal risk pool.
We will always need community health centers and public hospitals. But to fund them adequately we will need to establish a program of comprehensive, universal health insurance, with everybody in, nobody out.