PNHP

'Don't undermine Medicare,' panel to tell lawmakers Sept. 23

'Don't undermine Medicare,' panel to tell lawmakers Sept. 23

Economists and health professionals to testify at congressional briefing Thursday to sound alarm on Deficit Commission proposals to weaken or gut Medicare program

FOR IMMEDIATE RELEASE
Sept. 21, 2010

Contact:
Margaret Flowers, M.D., margaret@pnhp.org
Mark Almberg, Physicians for a National Health Program, (312) 782-6006, mark@pnhp.org

Media Advisory

What:
A congressional briefing to examine proposals being floated by members of the National Commission on Fiscal Responsibility and Reform and others to weaken the Medicare program, including hiking the age of eligibility to 67 or 70, increasing co-pays and deductibles, using means testing to reduce benefits, or replacing the program altogether with private vouchers.

The panelists will discuss the strengths of the present Medicare program, including its role in reducing poverty and health disparities, and why it should be strengthened. They will also argue that improving and extending the Medicare program to cover everyone is the most practicable way to provide truly universal, comprehensive and affordable care with effective cost control.

When: Thursday, Sept. 23, 2:30 p.m. to 4 p.m.

Where: Longworth House Office Building, Room 1334, Washington

Who:
Tsung-Mei Cheng, distinguished health economist and expert on comparative health systems at Princeton University
Olveen Carrasquillo, M.D., nationally recognized authority on health disparities, minority health, health services research, health policy, access to care and national health insurance, board member, Physicians for a National Health Program
Michele Evermore, legislative advocate, National Nurses United
The Honorable Raúl M. Grijalva (Honorary Host), co-chair Congressional Progressive Caucus
The Honorable Lynn Woolsey (Honorary Host), co-chair Congressional Progressive Caucus

Why:
With more than 50 million uninsured Americans, 45,000 deaths a year due to lack of health insurance, and 62 percent of personal bankruptcies linked to medical debt, it is clear that programs like Medicare serve a vital function and that even more thoroughgoing health care reform is needed and must be part of any economic recovery plan.

Sponsored by the Leadership Conference for Guaranteed Health Care, a coalition of doctors, nurses and other health care providers; labor unions; nonprofit agencies; reform advocates and faith-based organizations working to achieve comprehensive, high quality, and affordable health care coverage for everybody in the United States. The coalition specifically advocates for a publicly funded and privately delivered national health care system structured around a single-payer financing mechanism. Co-sponsors of this event include Physicians for a National Health Program, National Nurses United, Healthcare-Now, Progressive Democrats of America, All Unions Committee for Single Payer-H.R. 676, Labor Campaign for Single Payer, RESULTS, Prosperity Agenda, Code Pink, Gray Panthers, Social Security Works and Economic Experts of Color.

‘Don’t undermine Medicare,’ panel to tell lawmakers Sept. 23

Economists and health professionals to testify at congressional briefing Thursday to sound alarm on Deficit Commission proposals to weaken or gut Medicare program

FOR IMMEDIATE RELEASE
Sept. 21, 2010

Contact:
Margaret Flowers, M.D., margaret@pnhp.org
Mark Almberg, Physicians for a National Health Program, (312) 782-6006, mark@pnhp.org

Media Advisory

What:
A congressional briefing to examine proposals being floated by members of the National Commission on Fiscal Responsibility and Reform and others to weaken the Medicare program, including hiking the age of eligibility to 67 or 70, increasing co-pays and deductibles, using means testing to reduce benefits, or replacing the program altogether with private vouchers.

The panelists will discuss the strengths of the present Medicare program, including its role in reducing poverty and health disparities, and why it should be strengthened. They will also argue that improving and extending the Medicare program to cover everyone is the most practicable way to provide truly universal, comprehensive and affordable care with effective cost control.

When: Thursday, Sept. 23, 2:30 p.m. to 4 p.m.

Where: Longworth House Office Building, Room 1334, Washington

Who:
Tsung-Mei Cheng, distinguished health economist and expert on comparative health systems at Princeton University
Olveen Carrasquillo, M.D., nationally recognized authority on health disparities, minority health, health services research, health policy, access to care and national health insurance, board member, Physicians for a National Health Program
Michele Evermore, legislative advocate, National Nurses United
The Honorable Raúl M. Grijalva (Honorary Host), co-chair Congressional Progressive Caucus
The Honorable Lynn Woolsey (Honorary Host), co-chair Congressional Progressive Caucus

Why:
With more than 50 million uninsured Americans, 45,000 deaths a year due to lack of health insurance, and 62 percent of personal bankruptcies linked to medical debt, it is clear that programs like Medicare serve a vital function and that even more thoroughgoing health care reform is needed and must be part of any economic recovery plan.

Sponsored by the Leadership Conference for Guaranteed Health Care, a coalition of doctors, nurses and other health care providers; labor unions; nonprofit agencies; reform advocates and faith-based organizations working to achieve comprehensive, high quality, and affordable health care coverage for everybody in the United States. The coalition specifically advocates for a publicly funded and privately delivered national health care system structured around a single-payer financing mechanism. Co-sponsors of this event include Physicians for a National Health Program, National Nurses United, Healthcare-Now, Progressive Democrats of America, All Unions Committee for Single Payer-H.R. 676, Labor Campaign for Single Payer, RESULTS, Prosperity Agenda, Code Pink, Gray Panthers, Social Security Works and Economic Experts of Color.

Private insurers stealing from HSA accounts

Wrangling over ‘wrapping’: Insurers raise rates for employers who use cost-cutting plan

By Jay Greene
Crain’s Detroit Business
September 19, 2010
Some health insurers in Southeast Michigan are beginning to charge higher premiums to employers who offer high-deductible employee health plans and then “wrap” the plans by buying gap insurance or giving workers subsidies to cover the deductibles.
The reason? Insurers say usage of health care services is going up because employees bear little or no responsibility for health care costs.
“Often, employers go the high-deductible route and then cover the deductible by funding an employee’s (health savings account) to a point where the employee no longer has any skin in the game,” said Steve Selinsky, director of sales and marketing with BeneSys, a Troy-based third-party administrator of insurance services.
Wrapping refers to when employers increase their health plan deductible, which lowers premium costs, and then reimburse employees for all, or a part, of their health expenses falling under the increased deductible.
This differs from the original concept of high-deductible plans, in which employees were responsible for deductibles of up to $5,000, but typically $1,000-$2,500, and so had a financial incentive to eliminate unnecessary care and seek lower-cost, higher-quality treatments. John Dunn, vice president of middle- and small-group sales for Blue Cross, said Blue Cross data shows that there is a 4 percent to 8 percent difference in utilization and expenses between those plans that are wrapped and those that are not.
He said Blue Cross in January will start charging employers that wrap between 4 percent and 8 percent more to account for the expected higher utilization.
Don Whitford, vice president of sales with Priority Health, said the health plan earlier this year began charging higher rates — 12 percent to 18 percent more — for companies that wrap their high-deductible health plans.
(Jon Clement, vice president of finance of Health Alliance Plan) said HAP decided five years ago to price its high-deductible plans to assume a higher utilization rate that would accommodate employer decisions to wrap their plans.
http://www.crainsdetroit.com/article/20100919/FREE/309199985/wrangling-over-8216-wrapping-insurers-raise-rates-for-employers

As more employers are moving to high-deductible health plans to take advantage of the lower premiums, private insurers, being the market innovators that they are, were not going to stand by as they watch potential premium dollars move into health savings accounts or other options such as flexible spending accounts or health reimbursement arrangements.
From the insurers’ perspective, the high deductible is for the purpose of creating financial barriers to health care access. If the patient is forced to pay a significant amount out of pocket – the deductible – before insurance coverage kicks in, then the patient is going to forgo health care, much of it beneficial, simply because it is too expensive. Since it is less likely that the deductible threshold would be met, that reduces the chances of the insurer having to pay out any benefits at all.
The rationale of the health savings accounts, which pay health care costs before the deductibles are met, is that patients would be better shoppers since they are using their own funds from the accounts which they own, achieving the same purpose as the deductibles alone. In theory, the health savings accounts are funded by the premium savings – savings that reduce insurer revenues.
Now the insurers contend that the accounts allow patients to be spendthrifts. They insist that patients are much more likely to spend the funds if they come from a delegated savings account than they would if they came from other personal savings or current income. They are using this as an excuse to recover the premium discount for the high-deductible plans – in essence, reaching into the health savings accounts and stealing the employees’ own funds (though indirectly through higher premiums paid by the employee in payroll deductions or forgone wage increases).
Although this is yet one more addition to the litany of reasons that high-deductible plans with health savings accounts are a highly flawed method of financing health care, it is much more a further indictment of the private insurance industry which will always find a way to make another buck off of our health misfortunes.
An improved Medicare for all would eliminate these thieves.

Single payer an issue in Vermont gubernatorial election

Shumlin - Picture of Health

YouTube

“… Vermont needs a single payer system. Get the insurance companies out of the picture. Let health benefits follow you, not depend on your employer, and reward doctors for making you better. As governor, I’ll deliver real health care reform.”

Peter Shumlin, candidate for Governor of Vermont

YouTube video:

http://www.youtube.com/watch?v=8yFUbkVCsZ4

And…

Brian Dubie: Pure Vermont

YouTube

“… set priorities, reduce regulations, roll the economy so that we can continue to make opportunities happen in our state.”

Brian Dubie, candidate for Governor of Vermont


http://www.youtube.com/watch?v=ZX0euNHPQDc

And…

On the Money, Sept. 15: Dubie has $410,269 in cash; Shumlin has $61,965 on hand

By Anne Galloway
Vtdigger.org
September 16, 2010

The numbers are in, and Lt. Gov. Brian Dubie, the Republican candidate for governor of Vermont, is the winner in the money race. Dubie has raised nearly three times more money than his Democratic opponent in the last campaign finance reporting period.

Dubie’s supporters donated $150,215 to his campaign in the last month; Sen. Peter Shumlin, D-Windham, who recently emerged as the winner of a five-way Democratic primary race after a two-week recount, has raised $58,964 in the last 30 days.

http://vtdigger.org/2010/09/16/on-the-money-sept-15-dubie-has-410269-in-cash-shumlin-has-61965-on-hand/

Peter Shumlin for Governor:
http://www.shumlinforgovernor.com/

Brian Dubie for Governor:
http://briandubie.com/

Comment: 

By Don McCanne, MD

PNHP does not endorse political candidates.

Today’s message is of significance because it demonstrates once again that the single payer message can be carried beyond the party primaries and into the general election. Just as U.S. Senator Bernie Sanders (I-VT) has never abandoned the single payer message, so now Vermont State Senator Peter Shumlin is carrying the single payer message forward in his campaign for governor.

Peter Shumlin already had a track record on single payer, having been an original sponsor of S.88, a bill that would have established a single payer system in Vermont. He continued to support S.88 when it was modified to authorize a study on comprehensive reform for Vermont (Act 128), including an evaluation of the single payer model. That study is currently under way by Harvard Professor William Hsiao and his colleagues, and will be reported out in the near future.

In the money race for the campaign, Sen. Shumlin is well behind his opponent, Lt. Gov. Brian Dubie, since Democratic funds were split amongst five candidates in the primary, followed by a period of uncertainty because of a recount. This election provides the citizens of Vermont the opportunity to express their views on single payer reform, whether in support or opposed. It would be a shame if lack of funds prevented the voters from knowing that single payer is an important issue in this election.

Although we are very excited that the issue of single payer is moving further into mainstream politics, it must be emphasized that THIS MESSAGE IS NOT AN ENDORSEMENT NOR A SOLICITATION OF FUNDS FOR ANY POLITICAL CANDIDATE. Rather it is a plea for us to make every effort we can to be sure that we have a fully informed electorate.

Vermont gubernatorial candidate supports single payer

Shumlin – Picture of Health

YouTube
“… Vermont needs a single payer system. Get the insurance companies out of the picture. Let health benefits follow you, not depend on your employer, and reward doctors for making you better. As governor, I’ll deliver real health care reform.”
Peter Shumlin, candidate for Governor of Vermont
YouTube video:

http://www.youtube.com/watch?v=8yFUbkVCsZ4

And…

Brian Dubie: Pure Vermont

YouTube
“… set priorities, reduce regulations, roll the economy so that we can continue to make opportunities happen in our state.”
Brian Dubie, candidate for Governor of Vermont

http://www.youtube.com/watch?v=ZX0euNHPQDc

And…

On the Money, Sept. 15: Dubie has $410,269 in cash; Shumlin has $61,965 on hand

By Anne Galloway
Vtdigger.org
September 16, 2010
The numbers are in, and Lt. Gov. Brian Dubie, the Republican candidate for governor of Vermont, is the winner in the money race. Dubie has raised nearly three times more money than his Democratic opponent in the last campaign finance reporting period.
Dubie’s supporters donated $150,215 to his campaign in the last month; Sen. Peter Shumlin, D-Windham, who recently emerged as the winner of a five-way Democratic primary race after a two-week recount, has raised $58,964 in the last 30 days.
http://vtdigger.org/2010/09/16/on-the-money-sept-15-dubie-has-410269-in-cash-shumlin-has-61965-on-hand/
Peter Shumlin for Governor:
http://www.shumlinforgovernor.com/
Brian Dubie for Governor:
http://briandubie.com/

PNHP does not endorse political candidates.
Today’s message is of significance because it demonstrates once again that the single payer message can be carried beyond the party primaries and into the general election. Just as U.S. Senator Bernie Sanders (I-VT) has never abandoned the single payer message, so now Vermont State Senator Peter Shumlin is carrying the single payer message forward in his campaign for governor.
Peter Shumlin already had a track record on single payer, having been an original sponsor of S.88, a bill that would have established a single payer system in Vermont. He continued to support S.88 when it was modified to authorize a study on comprehensive reform for Vermont (Act 128), including an evaluation of the single payer model. That study is currently under way by Harvard Professor William Hsiao and his colleagues, and will be reported out in the near future.
In the money race for the campaign, Sen. Shumlin is well behind his opponent, Lt. Gov. Brian Dubie, since Democratic funds were split amongst five candidates in the primary, followed by a period of uncertainty because of a recount. This election provides the citizens of Vermont the opportunity to express their views on single payer reform, whether in support or opposed. It would be a shame if lack of funds prevented the voters from knowing that single payer is an important issue in this election.
Although we are very excited that the issue of single payer is moving further into mainstream politics, it must be emphasized that THIS MESSAGE IS NOT AN ENDORSEMENT NOR A SOLICITATION OF FUNDS FOR ANY POLITICAL CANDIDATE. Rather it is a plea for us to make every effort we can to be sure that we have a fully informed electorate.

My experience with British health care

It worked very well on a personal level, and is effective overall. So why the suspicion here at home?

By JOHN M. BRYSON
Minneapolis Star-Tribune, September 15, 2010

The emotional debates over health care reform in the United States last fall and again this election season are puzzling to my wife and me. We are professors who were on sabbatical leave in London from August 2009 through August 2010, so we missed last year’s debates. While in the United Kingdom we were automatically covered by the National Health Service.

For us, the NHS worked quite well. One example: The week we arrived in London we went to the NHS Choices website (www.nhs.uk), punched in our postal code and immediately got a listing of local clinics. We chose the closest one, stopped by and filled out two short forms, let the reception staff make copies of our passports and visas, and that was it: We were covered. None of this business about needing coverage by an employer’s plan, no concerns about preexisting conditions (we both have them), no rationing by what we could afford, and no excessive paperwork. All that mattered was that we were in the UK. We had a right to be taken care of by the NHS.

Another example: I badly sprained my back one evening. The next morning I was in severe pain and couldn’t get out of bed. I called the clinic, and within two minutes a doctor was on the phone. He asked if I could come in immediately, but I was in too much pain. He offered to make a house call if I could wait for a few hours. I wondered if he might do something over the phone, so he ran me through a series of questions and little exercises to make sure he understood what was wrong. He then wrote prescriptions for painkillers and a muscle relaxant. My wife picked them up, filled them at a local pharmacy (at no cost because I am over 60) and was home within the hour. I was up and walking a few hours later and was fully better in a few weeks. How many times has anyone in the United States spoken to a doctor within two minutes of calling and had the same doctor offer to make a house call?

The British have a mostly socialized health care system, meaning they handle both finance and production through the government. In the United States, we mostly socialize risk through health care insurance paid for by employer, employee, consumer and government contributions, but we also socialize much health care financing; some estimate that government pays for about 50 percent of all health care costs. We leave production mostly to businesses and nonprofits, but there is also a lot of government provision through public hospitals and clinics. The Veterans Affairs health care system is as close as we get to the NHS.

What do the British get for their money? Using 2009 figures, they spend 9 percent of GDP on health care; we spend more than 17 percent. They spend $3,150 per capita on health care each year ($2,600 of which is public money); we spend $7,500 per capita ($3,500 of which is public money). They cover everyone (even visitors from abroad); we have a long way to go. They have an average life expectancy at birth of 79.4 years; here, the average is 78.2. Their infant mortality rate is 4.8 per 1,000 live births; here, it is 6.4. Is their system perfect? No, clearly not. For example, there are issues about timely access to specialized elective care, but they also do not ration that care based on ability to pay, which we do.

Having experienced the NHS and U.S. health care systems, I think it is safe to say that no one would design our system if they could start from scratch. Ours is 50 percent more expensive than almost any other nation’s, has left way too many people out and produces many population level outcomes far worse than they should be. In addition, our system places a huge burden on company balance sheets, making it far harder for companies to compete in world markets where other nations pay for health care through taxes. I am not a health care policy analyst, but it doesn’t take one to see that we are clearly not getting what we should for what we pay. Just consider what is politically unimaginable: If we had the British system, we would have at least 8 percent of our GDP of $14.5 trillion left over — or about $1.15 trillion each year — that we could use to fix every problem with the system and still have money left to give back to employers, employees and taxpayers — and we also would have better population-level outcomes. The switch to the NHS is not going to happen, but the thought experiment does help one see the merits of moving to a system that a least guarantees health care insurance to all, that moves away from reliance on employer contributions, and that produces better overall outcomes at less cost.

John M. Bryson is a professor at the University of Minnesota.

http://www.startribune.com/opinion/commentary/103002689.html?elr=KArksc8P:Pc:U0ckkD:aEyKUiD3aPc:_Yyc:aULPQL7PQLanchO7DiUr

What a difference a year makes

By Aaron E. Carroll, M.D.
The Huffington Post, Sept. 16, 2010

Every year about this time, the census releases its yearly numbers on the uninsured. Every year, I write an op-ed or a blog post. Every year, I get a little more depressed.

It’s hard to find good news in these numbers. It’s even harder because there’s just nothing that the Patient Protection and Affordable Care Act is going to do about them this year. Or next year. Or even the next few years. And, over that time, things are going to get worse for a large number of people.

Before we even get started, let’s kill a myth. When the census reports uninsured people, they mean people who were uninsured for the entire year. Not part of the year, not on the day they were surveyed — the whole year. How do I know? Because the people who asked the question say so. The US Department of Health and Human Services, in a 2005 document entitled Understanding Estimates of the Uninsured: Putting the Differences in Context, explains that the Current Population Survey (CPS) tells us about people who were uninsured for the whole year (see Table 1). In fact, it specifically says that the CPS does not give a point in time calculation (“N/A”). It does not matter what other people “say” about it. The CPS reports uninsurance for the whole year. In this year’s report it also says:

“They were considered ‘uninsured’ if, for the entire year, they were not covered by any type of health insurance.”

Remember that when you read the rest of this. The number of people who were uninsured for at least part of the year is much higher than those who were uninsured all year. They are at risk. They often can’t get care. And we’re not measuring them at all. Nor do we take into account that so many people in the United States are under-insured. Just having insurance doesn’t necessarily mean you’re adequately covered. It doesn’t necessarily mean that you won’t go bankrupt because of illness. It doesn’t necessarily mean that you are protected. But we don’t measure under-insurance. We just don’t know.

Now that that’s out of the way, let’s hit hit the low notes on this year’s report:

The percentage of people without health insurance increased to 16.7 percent in 2009 from 15.4 percent in 2008. The number of uninsured people increased to 50.7 million in 2009 from 46.3 million in 2008.

That means that there are now more people uninsured in the United States than at any time since the passage of Medicare. Full stop. A total of 4,300,000 more people were without insurance in 2009. Remember as well, all of the 16.7% of Americans who are uninsured are less than 65 years old, because all of those older people get Medicare.

The number of people with health insurance decreased to 253.6 million in 2009 from 255.1 million in 2008.

While the percentage of people who are uninsured has gone up and down, this is the first time that the sum total of people who have insurance has gone down in 23 years. It’s also been 23 years since we’ve been looking.

The number of people covered by private health insurance decreased to 194.5 million in 2009 from 201.0 million in 2008. The number of people covered by government health insurance increased to 93.2 million in 2009 from 87.4 million in 2008.

Think about that for a second. We just passed a huge health care reform bill that, for the most part, is built on the private insurance market. And yet that market is failing us miserably. The number of people covered by government insurance increased by almost 7 million, and the number of people covered by private insurance dropped by 6.5 million. Six-and-a-half million. We’re going to build on that? Moreover, the PPACA is going to increase the number of people on Medicaid by a substantial number. That’s not until 2014. At this rate, funding Medicaid at the state (or even federal) level is going to need a large infusion of cash.

The percentage of people covered by government health insurance programs increased to 30.6 percent in 2009, from 29.0 percent in 2008.

Again, that’s the highest percentage of people on government insurance in 23 years, since we started collecting the data.

The percentage and number of people covered by Medicaid increased to 15.7 percent or 47.8 million in 2009, from 14.1 percent or 42.6 million in 2008.

Go check out the CBO report on the final PPACA bill. They estimated that in 2010, 40 million people would be covered by Medicaid and CHIP. Forty million. That’s 7.8 million less than it turns out were on Medicaid last year. How’s 2010 going from your standpoint? Is there anyone who thinks things have improved so much that that the number of people on Medicaid is going down? I think it’s possible that we’ll see 50 million people on Medicaid in 2010, which is 10 million more than the CBO thought would be on Medicaid and CHIP. And things may get worse after that.

The PPACA depends on private insurance covering a certain number of people. This will have repercussions on how much reform will cost and how much government will be involved. I can’t imagine anyone will be pleased with the changes in its outlook.

If you thought health care reform was done, prepare to be disappointed. It’s barely begun.

Aaron regularly blogs about (mostly) health policy at The Incidental Economist.

http://www.huffingtonpost.com/aaron-e-carroll/what-a-difference-a-year_b_720373.html

4.3 million more without insurance

Income, Poverty, and Health Insurance Coverage in the United States: 2009

U.S. Census Bureau
September 2010

Health Insurance Coverage in the United States

Highlights

* The percentage of people without health insurance increased to 16.7 percent in 2009 from 15.4 percent in 2008. The number of uninsured people increased to 50.7 million in 2009 from 46.3 million in 2008.

* The number of people with health insurance decreased to 253.6 million in 2009 from 255.1 million in 2008. This is the first year that the number of people with health insurance has decreased since 1987, the first year that comparable health insurance data were collected. The number of people covered by private health insurance decreased to 194.5 million in 2009 from 201.0 million in 2008. The number of people covered by government health insurance increased to 93.2 million in 2009 from 87.4 million in 2008.

* Between 2008 and 2009, the percentage of people covered by private health insurance decreased from 66.7 percent to 63.9 percent. The percentage of people covered by employment-based health insurance decreased to 55.8 percent in 2009, from 58.5 percent in 2008. The percentage of people covered by employment-based health insurance is the lowest since 1987, the first year that comparable health insurance data were collected. The number of people covered by employment-based health insurance decreased to 169.7 million in 2009, from 176.3 million in 2008.

* The percentage of people covered by government health insurance programs increased to 30.6 percent in 2009, from 29.0 percent in 2008. This is the highest percentage of people covered by government health insurance programs since 1987. The percentage and number of people covered by Medicaid increased to 15.7 percent or 47.8 million in 2009, from 14.1 percent or 42.6 million in 2008. The percentage and number of people covered by Medicaid is the highest since 1987. The percentage and number of people covered by Medicare in 2009 (14.3 percent and 43.4 million) were not statistically different from 2008.

* In 2009, 10.0 percent of children under 18, or 7.5 million, were without health insurance. These estimates were not statistically different from the 2008 estimates. The uninsured rate for children in poverty (15.1 percent) was greater than the rate for all children.

* Between 2008 and 2009, the uninsured rate and the number of uninsured for non-Hispanic Whites increased from 10.8 percent and 21.3 million to 12.0 percent and 23.7 million. The uninsured rate and the number of uninsured for Blacks increased from 19.1 percent and 7.3 million to 21.0 percent and 8.1 million.

* The percentage and number of uninsured Hispanics increased to 32.4 percent and 15.8 million in 2009, from 30.7 percent and 14.6 million in 2008.

http://www.census.gov/prod/2010pubs/p60-238.pdf

Census Bureau press release:
http://www.census.gov/newsroom/releases/archives/income_wealth/cb10-144.html

PNHP press release:
https://pnhp.org/news/2010/september/number-of-uninsured-skyrockets-43-million-to-record-507-million-in-2009

Comment:

By Don McCanne, MD

Highlights of the 2009 health insurance highlights:

* Uninsured increased to 50.7 million – 16.7 percent of the population

* Private insurance decreased to 194.5 million – 63.9 percent

* Employment-based insurance decreased to 169.7 million – 55.8 percent

* Medicaid increased to 47.8 million – 15.7 percent

* Uninsured children remain at 7.5 million

* Racial and ethnic disparities in coverage have compounded

Those who oppose government solutions to the health care crisis will likely pass these worsening numbers off as an expected consequence of the sputtering economy and the new age of unemployment. They will pay little heed to the fact that the numbers are still intolerable when the economy is thriving; that isn’t their concern.

Supporters of the Patient Protection and Affordable Care Act (PPACA) will no doubt be disturbed by these numbers, but it is very likely that they will make the most of them in selling PPACA by showing how it will dramatically reduce the numbers of uninsured. That is true. Many will be covered by Medicaid and by private health plans, even if far too many will still remain uninsured.

This Census Bureau report remains silent on one of the most important issues in health insurance – the numbers who are underinsured – those who will face financial hardship should medical needs arise.

PPACA is an underinsurance program. Employers will see little relief and will expand their present trend of shifting more insurance and health care costs onto their employees. Individuals buying plans in the new insurance exchanges will select underinsurance products with low actuarial values (30 to 40 percent of costs to be paid by the patient) with subsidies that are inadequate to avoid financial hardship. Many will move into the Medicaid program which has more expansive coverage, but which reimburses providers at such a low rate that far too many will not be willing to accept patients under this program. With Medicaid chasing away providers, it too has become another form of underinsurance.

Thus the touted increase in insurance enrollment under PPACA will be more than offset by the explosion in underinsurance – affecting the majority of Americans. At this point looking forward, this nefarious outcome is not obvious to most. But as underinsurance sneaks up on us, and more and more individuals are feeling the pain, they’ll be ready. Ready for what? Ready for an improved Medicare that will always be there for us – in both good and bad economic times.

The PNHP press release (link above) provides a reality-based perspective of just what these numbers mean.

Number of uninsured skyrockets 4.3 million to record 50.7 million in 2009

Big leap points to urgency of enacting single-payer Medicare for all: national doctors' group

FOR IMMEDIATE RELEASE
Sept. 16, 2010
 
Contact:
Quentin Young, M.D.
Olveen Carrasquillo, M.D.
Margaret Flowers, M.D.
Mark Almberg, PNHP, (312) 782-6006, mark@pnhp.org
Local physicians in almost all 50 states available for comment (See historical table of uninsured by state below).

Official estimates by the Census Bureau showing a dramatic spike of 4.3 million in the number of Americans without health insurance in 2009 – to a record 50.7 million – underscore the urgency of going beyond the Obama administration’s new health law and swiftly implementing a single-payer, improved Medicare-for-all program, according to Physicians for a National Health Program, a 17,000-member physician group.

The Census Bureau reported that 16.7 percent of the population lacked health insurance coverage in 2009, up from 15.4 percent in 2008, when 46.3 million were uninsured.

Lack of health insurance is known to have deadly consequences. Last year researchers at Harvard Medical School showed that 45,000 deaths annually can be linked to lack of coverage.

“Tragically, we know that the new figures of uninsured mean a preventable annual death toll of about 51,000 people – that’s about one death every 11 minutes,” said Dr. Quentin Young, national coordinator of PNHP. Young is a Chicago-based retired physician whose private medical practice once counted President Obama among its patients.

Young said that even if the administration’s new health law works as planned, the Congressional Budget Office has projected about 50 million people will be uninsured for the next three years and about 23 million people will remain uninsured in 2019.

“Today’s report suggests those projections are likely too low,” he said.

The jump of 4.3 million uninsured is the largest one-year increase on record and would have been much higher – over 10 million – had there not been a huge expansion of public coverage, primarily Medicaid, to an additional 5.8 million people.

The rise in the number of uninsured was almost entirely due to a sharp decline in the number of people with employer-based coverage by 6.6 million. In 2009, 55.8 percent of the population had such coverage, having declined for the ninth consecutive year from 64.2 percent in 2000.

The record-breaking number of uninsured – exceeding 50 million for the first time since the Census Bureau started keeping records – includes 7.5 million children.

The biggest jumps in the percentage of uninsured were in Alabama, Oklahoma, Ohio, Missouri, Georgia, Delaware, North Carolina and Florida. In terms of absolute numbers, the biggest increases were in California, Florida, Texas, Ohio, Georgia, North Carolina, Illinois, Alabama, Michigan and Pennsylvania. In Massachusetts, 295,000 people remain uninsured despite that state’s 2006 reform. (See link below for historical tables of the uninsured by state.)

“The only way to solve this problem is to insure everyone,” Young said. “And the only way to insure everyone at a reasonable cost is to enact single-payer national health insurance, an improved Medicare for all. Single payer would streamline bureaucracy, saving $400 billion a year on administrative overhead, enough to pay for all the uninsured and to upgrade everyone else’s coverage.”

Dr. Olveen Carrasquillo, a PNHP board member and chief of general internal medicine at the University of Miami’s Miller School of Medicine, noted that the Census Bureau was once again silent on the pervasive problem of “underinsurance.”

“Not having health insurance, or having poor quality insurance that doesn’t protect you from financial hardship in the face of medical need, is a source of mounting stress and poor medical outcomes for people across our country,” Carrasquillo said.  New research has found that about 14.1 million children and 25 million non-elderly adults were underinsured in 2007, a figure that is likely much higher today.

“The government subsidies under the new health law will not be sufficient to provide quality and affordable coverage to the vast majority of Americans,” he said. “Tens of millions will remain uninsured, underinsured and without access to care. We need more fundamental reform to a single-payer national health insurance program.”

*****
State-by-state data on the uninsured from 2006-2009 can be found here: www.pnhp.org/system/assets/drupal/docs/2010/Uninsured-by-state-2006-2009.pdf

Physicians for a National Health Program (www.pnhp.org) is an organization of more than 17,000 doctors who support single-payer national health insurance. To speak with a physician/spokesperson in your area, visit www.pnhp.org/stateactions or call (312) 782-6006.

4.3 million more without insurance

Income, Poverty, and Health Insurance Coverage in the United States: 2009

U.S. Census Bureau
September 2010
Health Insurance Coverage in the United States
Highlights
* The percentage of people without health insurance increased to 16.7 percent in 2009 from 15.4 percent in 2008. The number of uninsured people increased to 50.7 million in 2009 from 46.3 million in 2008.
* The number of people with health insurance decreased to 253.6 million in 2009 from 255.1 million in 2008. This is the first year that the number of people with health insurance has decreased since 1987, the first year that comparable health insurance data were collected. The number of people covered by private health insurance decreased to 194.5 million in 2009 from 201.0 million in 2008. The number of people covered by government health insurance increased to 93.2 million in 2009 from 87.4 million in 2008.
* Between 2008 and 2009, the percentage of people covered by private health insurance decreased from 66.7 percent to 63.9 percent. The percentage of people covered by employment-based health insurance decreased to 55.8 percent in 2009, from 58.5 percent in 2008. The percentage of people covered by employment-based health insurance is the lowest since 1987, the first year that comparable health insurance data were collected. The number of people covered by employment-based health insurance decreased to 169.7 million in 2009, from 176.3 million in 2008.
* The percentage of people covered by government health insurance programs increased to 30.6 percent in 2009, from 29.0 percent in 2008. This is the highest percentage of people covered by government health insurance programs since 1987. The percentage and number of people covered by Medicaid increased to 15.7 percent or 47.8 million in 2009, from 14.1 percent or 42.6 million in 2008. The percentage and number of people covered by Medicaid is the highest since 1987. The percentage and number of people covered by Medicare in 2009 (14.3 percent and 43.4 million) were not statistically different from 2008.
* In 2009, 10.0 percent of children under 18, or 7.5 million, were without health insurance. These estimates were not statistically different from the 2008 estimates. The uninsured rate for children in poverty (15.1 percent) was greater than the rate for all children.
* Between 2008 and 2009, the uninsured rate and the number of uninsured for non-Hispanic Whites increased from 10.8 percent and 21.3 million to 12.0 percent and 23.7 million. The uninsured rate and the number of uninsured for Blacks increased from 19.1 percent and 7.3 million to 21.0 percent and 8.1 million.
* The percentage and number of uninsured Hispanics increased to 32.4 percent and 15.8 million in 2009, from 30.7 percent and 14.6 million in 2008.
http://www.census.gov/prod/2010pubs/p60-238.pdf
Census Bureau press release:
http://www.census.gov/newsroom/releases/archives/income_wealth/cb10-144.html
PNHP press release:
https://pnhp.org/news/2010/september/number-of-uninsured-skyrockets-43-million-to-record-507-million-in-2009

Highlights of the 2009 health insurance highlights:
* Uninsured increased to 50.7 million – 16.7 percent of the population
* Private insurance decreased to 194.5 million – 63.9 percent
* Employment-based insurance decreased to 169.7 million – 55.8 percent
* Medicaid increased to 47.8 million – 15.7 percent
* Uninsured children remain at 7.5 million
* Racial and ethnic disparities in coverage have compounded
Those who oppose government solutions to the health care crisis will likely pass these worsening numbers off as an expected consequence of the sputtering economy and the new age of unemployment. They will pay little heed to the fact that the numbers are still intolerable when the economy is thriving; that isn’t their concern.
Supporters of the Patient Protection and Affordable Care Act (PPACA) will no doubt be disturbed by these numbers, but it is very likely that they will make the most of them in selling PPACA by showing how it will dramatically reduce the numbers of uninsured. That is true. Many will be covered by Medicaid and by private health plans, even if far too many will still remain uninsured.
This Census Bureau report remains silent on one of the most important issues in health insurance – the numbers who are underinsured – those who will face financial hardship should medical needs arise.
PPACA is an underinsurance program. Employers will see little relief and will expand their present trend of shifting more insurance and health care costs onto their employees. Individuals buying plans in the new insurance exchanges will select underinsurance products with low actuarial values (30 to 40 percent of costs to be paid by the patient) with subsidies that are inadequate to avoid financial hardship. Many will move into the Medicaid program which has more expansive coverage, but which reimburses providers at such a low rate that far too many will not be willing to accept patients under this program. With Medicaid chasing away providers, it too has become another form of underinsurance.
Thus the touted increase in insurance enrollment under PPACA will be more than offset by the explosion in underinsurance – affecting the majority of Americans. At this point looking forward, this nefarious outcome is not obvious to most. But as underinsurance sneaks up on us, and more and more individuals are feeling the pain, they’ll be ready. Ready for what? Ready for an improved Medicare that will always be there for us – in both good and bad economic times.
The PNHP press release (link above) provides a reality-based perspective of just what these numbers mean.