By James E. Dalen
Arizona Republic
Feb. 28, 2009
Due to the recession, more than 2 million Americans lost their jobs in 2008 and millions more are expected to lose their jobs in 2009.
The consequences of increasing unemployment will be much more serious in the United States than in other western countries. Our country is unique in that most of its citizens, at least 175 million, have employment-based health insurance. In most cases, loss of job means loss of health insurance.
The situation is most serious for the employee who is the only breadwinner for his or her family. Private health insurance for family coverage may be available, but is very expensive, especially for someone who is out of work.
If the employee is older or, if anyone in the family has a “prior condition,” insurance may be unavailable or have an extraordinary price tag. COBRA, a federal program that allows one to continue their employment insurance is available but also is very expensive.
Some estimate that less than 25 percent of those losing their jobs will be covered by COBRA. Many unemployed families will turn to Medicaid to provide health care. Arizona and many other states are facing budget deficits because of the recession. It is very unlikely that they will be able to increase the number of their citizens covered by Medicaid (AHCCCS in Arizona).
What happens to those who are unable obtain alternative health insurance and remain uninsured?
Not much will happen to the young invincibles, those healthy Americans age 19 to 29. Many of them only seek health care in case of accidents. Few seek primary care, and very few require medications on a regular basis.
The outlook for the family without health insurance is very different. Multiple studies have shown the uninsured are much less likely to have regular medical care or to seek care for illness.
Ongoing preventive care becomes a luxury that the uninsured cannot afford. If they do seek care, they use emergency rooms. Our already overcrowded emergency rooms will become even more over burdened as the number of uninsured Americans increases.
The health consequences of being uninsured are most severe for the nearly half of our citizens who have a chronic condition such as hypertension, diabetes, asthma, cancer and heart disease. These conditions require ongoing medical care and usually require daily medications to prevent complications that may lead to hospitalization, disability or even death.
In a study of patients with chronic conditions, one third of the uninsured with chronic conditions had an unmet need for prescription drugs, compared with 10 percent of insured.
When Americans lose their jobs and their health insurance, their health will suffer. The Institute of Medicine has reported that the annual mortality of the uninsured is 25 percent higher than for the insured.
In addition to jeopardizing the health of our citizens the loss of health insurance by the millions losing their jobs will further escalate U.S. health-care costs. Emergency-room visits will increase, and hospitalizations that could have been prevented with ongoing preventive care will increase. The increase in uninsured patients will further challenge the financial viability of many of our hospitals.
In the many countries that ensure access to health care to all its citizens, whether employed or not, increasing unemployment will not jeopardize the health of their citizens and will not escalate health-care costs.
Maybe the U.S. should consider national health insurance that is not dependent on employment!
James E. Dalen, M.D., MPH, is dean emeritus at University of Arizona College of Medicine.