by Robin A. Cohen, Ph.D., Brian W. Ward, Ph.D., and Jeannine S. Schiller, M.P.H. Division of Health Interview Statistics, National Center for Health Statistics
Centers for Disease Control and Prevention, June 22, 2011
* In 2010, 48.6 million persons of all ages (16.0%) were uninsured at the time of interview, 60.3 million (19.8%) had been uninsured for at least part of the year prior to interview, and 35.7 million (11.7%) had been uninsured for more than a year at the time of interview.
* In 2010, the percentage of persons who were uninsured at the time of interview among the 20 largest states ranged from 4.0% in Massachusetts to 26.1% in Arizona.
* In 2010, the percentage of children under age 18 years who were uninsured at the time of interview was 7.8%.
* In 2010, among adults aged 19–25 years, 10 million (33.9%) were uninsured at the time of interview.
* Private coverage decreased among near poor adults aged 18–64 years, from 52.6% in 1997 to 34.7% in 2010. The uninsured rate (43.0%) was higher than the private coverage rate (34.7%) for this population.
* During 2010, 25.3% of persons under age 65 years with private health insurance at the time of interview were enrolled in a high deductible health plan (HDHP), including 7.7% who were enrolled in a consumer-directed health plan (CDHP). Almost 50% of persons with a private plan obtained by means other than through employment were enrolled in a HDHP.
http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201106.htm
Comment:
By Don McCanne, MD
To no surprise, the number of uninsured continues to increase. In the 2010 survey, over 60 million individuals were uninsured for at least part of the year. Private health insurance coverage continued to decline, whereas public coverage increased, especially for children. The gains in public coverage failed to offset the losses in private coverage. Young adults continue to have the lowest coverage rates of all.
Although there is much information in this 28 page report, let’s briefly look at two notable findings:
* For “near poor” adults under 65 (100-200% of federal poverty level), more were uninsured than were covered by private plans (43.0% vs. 34.7%).
* For those under 65 covered by private plans, 25.3% are now enrolled in a high-deductible health plan (HDHP). Only 7.7% also have a health savings account or equivalent (consumer-directed health plan – CDHP).
Enthusiasts for the Affordable Care Act (ACA) would likely claim that deficiencies such as these are precisely why ACA is so important. So what will ACA do for these individuals?
The near poor will be moved into Medicaid plans. Because that is a chronically underfunded program, there is already a lack of willing providers, especially amongst specialists (plus an across-the-board lack of primary care professionals). Infusing this large number of newly qualified beneficiaries into the Medicaid program will not only provide them a “ticket-without-a-show,” but it will also further impair access for those already enrolled because of a lack of capacity amongst the willing.
The current trend of moving Medicaid patients into managed care organizations is not a satisfactory solution because the only way these business organizations can remain viable is by further reducing spending on the patients, especially since they have even higher administrative costs. Although health care prices are high in the United States, that is not true of Medicaid. Prices have already been squeezed to their bottom limit and beyond. That means that these managed care organizations have only one way left to reduce spending – cut health care services.
What about those who have high-deductible health plans? We already know of the harm caused by these HDHPs. (As an example, see: https://pnhp.org/news/2010/november/high-deductible-health-plans-foster-bad-decisions-by-rich-and-poor). We are now witnessing the rapid shift of employer-sponsored plans to HDHPs, because the premiums are lower (since they shift costs to the pockets of individuals with health care needs). The individual health insurance market has seen an even greater shift towards HDHPs since more comprehensive plans are no longer affordable for the majority of us.
Will the state insurance exchanges provide relief? No. Most plans will have a low actuarial value which will automatically require high deductibles (since they will be required to cover a basic benefit package which cannot be pared down).
The point of all this is that those who say that the increase in the numbers of uninsured isn’t important because we will be taking care of that by covering them through ACA have missed the whole point that we have been trying to make. The goal is not simply to improve the count of nominally insured individuals. The goal is to remove financial barriers to health care – for everyone. An underfunded Medicaid program and a market of private plans with intolerable cost sharing are not going to do that.
Other nations have figured out how to do it – with far less money. Surely we have enough ingenuity in this nation to accomplish the same. Come to think of it, we don’t need ingenuity. The beneficial policies of other nations are not intellectual property. We can copy them.