Urban Institute
By John Holahan and Brenda Spillman
“The weakness of the safety net does not appear to worsen the uninsureds’ access to care. Conversely, a relatively strong safety net does not appear to improve their position relative to the insured. No matter how the uninsured are supported-whether by third-party payers, the presence of community health centers, a high level of disproportionate share payments, or local government subsidies-we find no evidence that these efforts have the ability to eliminate, or even narrow, barriers to access to the extent that insurance can.”
Comment: The Bush administration is touting proposals for expansion of health insurance coverage, such as very modest tax credits, that will have little impact on decreasing the numbers of uninsured. Instead, their emphasis has been shifted to supporting the health care safety-net through programs such as increased funding for community clinics. (Even the seriousness of this commitment can be questioned in light of the 33% reduction in funding resulting from the elimination of the Medicaid upper payment limit for safety-net institutions.)
This study challenges the assumption that strengthening the safety-net system will provide a substitute for the lack of insurance coverage. The relative strength of the safety-net does not alter access to care. In sharp contrast, insurance coverage, or the lack thereof, dramatically impacts access to health care.
Although this study demonstrated that weaknesses in safety-net systems can be compensated for by the remainder of the health care community, it is important to note that there may be an as yet unidentified threshold at which safety-net systems can collapse resulting in further impairment of access for the uninsured. So it is important to maintain the integrity of the safety-net system until we finally resolve the deficiencies in our methods of funding health care.
But the bottom line is that we must make every effort to provide comprehensive health care insurance for everyone. We now know that the only way that we can do this equitably, and still afford to pay for it, is through a single payer system. Let’s start the planning process today!