REFORM: Sizing up Health Reform with Kristof

It's no secret that people who lack health insurance have poorer health outcomes. In his column for the New York Times yesterday, Nicholas Kristof (who has been writing a lot about the need for health reform recently) tells the story of Sue, a 31 year old woman from Oregon:

Sue was a single mom who worked hard -- sometimes two jobs at once -- to ensure that her beloved daughter would enjoy a better life.

Sue's jobs never provided health insurance, and Sue felt she couldn't afford to splurge on herself to get gynecological checkups. For more than a dozen years, she never had a Pap smear, although one is recommended annually. Even when Sue began bleeding and suffering abdominal pain, she was reluctant to see a doctor because she didn't know how she would pay the bills.

Finally, Sue sought help from a hospital emergency room, and then from the low-cost public clinic where Dr. Harris works. Dr. Harris found that Sue had advanced cervical cancer. Three months later, she died. Her daughter was 13.

QUALITY: More Getting Primary Care From Community Health Centers

A growing number of Americans rely on federally qualified health centers for care, reports The Wall Street Journal. Last year, community health centers, as well as migrant and homeless health centers, served approximately 18 million people. That number is expected to hit 20 million this year, according to the WSJ and the National Association of Community Health Centers.


COVERAGE: The Uninsured. It Could Be Any of Us

"Every day, 14,000 Americans lose their coverage," President Obama said in his speech to Congress this month, "It can happen to anyone."

An another era, another president might have said, "Ich bin ein uninsured."

A new analysis from the U.S. Treasury shows that it can, and does, happen to anyone.

In a recent 10-year span of relative economic prosperity and job creation (1997-2006) nearly half of all Americans under age 65 were uninsured at some point. More than one in three lacked coverage for at least a year. Looking ahead to another 10-year period including our current time of economic recession and job loss, the picture is even gloomier -- at least in the absence of comprehensive health reform.

HEALTH CARE: The AARP Tries to Soothe Fears of Medi-Scared Seniors

One of the great ironies of the health reform debate is that one of the groups that is most apprehensive about the drive to cover all Americans is the group that is already covered -- America's seniors. The AARP is gearing up its efforts to soothe their fears.

Another great irony is that the Republicans now casting themselves as the defenders of Medicare have for years pursued one version after another of radically changing the very nature of Medicare -- most recently, as Ron Brownstein in the National Journal pointed out, by voting for a House GOP budget this year that would have replaced Medicare's guarantees of coverage for the elderly and disabled with a voucher. 

Here's the real story that the AARP wants to get out: All Americans age 65 and up are covered by Medicare, and that won't change under health reform.

COVERAGE: Russian Roulette in Rural America

"If anything were to happen to my wife and I, the business is sunk," Larry Harbour, a small business owner in rural Nebraska, told NPR. "It's like playing Russian roulette. Every day, we wonder when it's going to happen — if something's going to happen, are we able to afford it?"

Like millions of other uninsured and underinsured Americans, many of whom live in rural areas and have difficulty obtaining affordable and reliable coverage, Harbour and his family are one serious illness, one accident, away from financial calamity.

In the Harbour family’s case, the only health insurance plans he and his wife could find had premiums ranging from $24,000 to $40,000, on top of a $2,000 deductible. The cost was simply too great.

He said the insurance he and his wife investigated was basic, to the point where the couple would have to pay more for the insurance than they would for the health care they'd receive.

COVERAGE: Uninsured Shift Costs onto Insured, Families USA Finds

Families USA has released a report describing the costs to the insured that result from uninsured people who are unable to pay their bills. The report, entitled "Hidden Health Tax: Americans Pay a Premium," analyzes the cost-shift from the unpaid medical bills of the uninsured to those Americans with health insurance.

Key findings of the Families USA report:

  • The uninsured end up paying over a third of their medical bills out of pocket. Governments and charities pick up another quarter of the cost. 
  • The remaining 37 percent of the cost of the medical bills for the uninsured, or a stunning $42 billion, went unpaid in 2007.  
  • That unpaid portion is passed on by providers to private insurers, who pass the cost on to the insured.

Families USA estimates that the average American family pays over $1,000 a year in higher health insurance premiums due to this cost-shift. (For an individual purchasing in the individual market, it's about $368.)The Center for American Progress found similar figures in a report earlier this year.

HEALTH REFORM: More Costs of Doing Nothing

Nearly 66 million people, including many middle class families, could be uninsured a decade from now if we don't reform health care. That's the unhappy conclusion of a new report from the Robert Wood Johnson Foundation (RWJF)  and the Urban Institute.

We at New America have done quite a bit of work on the cost of doing nothing. The new RWJF research paints a similarly worrisome picture of rising costs burdening families, taxpayers and businesses, more uncompensated care stressing the safety net, and more Americans lacking insurance.

The researchers used three economic scenarios. Even the best case (and we are not living in 'best case' times) showed serious strains.

"This report makes clear that as battered as our health system has been in recent years, unless we take action, the worst is far from over," RWJF president and CEO Risa Lavizzo-Mourey, M.D., M.B.A., said in a statement. "Without comprehensive health care reform, costs will continue to skyrocket, millions more will lose insurance, and the health of Americans will suffer. Congress must act quickly and decisively to make quality

Key findings:

COVERAGE: The Working (and Formerly-Working) Uninsured

Fifty-two million—and rising? Is that the real count of the uninsured in the United States in this job-killing recession? It's the latest estimate from the North Carolina Institute of Medicine. And 52 million was the number for January, and unemployment rhas risen since then, hitting 8.5 percent in March. (April numbers are due out in a few days.)

The official US census figures are 46 million uninsured, but there's always a lag (it takes a long time to count 46 million people, even longer to count 52).

The North Carolina report was brought to our attention this week by the Center for American Progress, which looked at the uninsured in each state. As we know (even if there are wide misperceptions about this among the public) most uninsured people are not unemployed. They are the working poor or dependents of the working poor  -- although nowadays of course more of them are losing their health coverage as they lose their job.

CAP's state by state data shows that in every state, the majority of uninsured adults are employed. In several states, including Maine, Montana, and Kansas, more than two-thirds are employed.

IN THE STATES: Colorado Expands Coverage and Hospital Care

In what's been hailed as the most significant health legislation in Colorado in some 40 years, Colorado has a new law that will help cover up to 100,000 uninsured people and reduce some of the uncompensated care and cost-shifting that hurts the state's health care system and raises costs for people who are insured. It's an impressive achievement in a time of great economic pressure—one that we hope the folks here in Washington notice.

"At no increased cost to taxpayers, the Colorado Healthcare Affordability Act will allow us to provide critical health services to people who need those services the most," Gov. Bill Ritter said in a statement when he signed it into law earlier this week.

The law needs to get final approval from federal Medicaid officials. The goal is to implement it next spring. Ritter said that the law will provide coverage to about 100,000 and improve access to hospital care for the other 700,000 uninsured. (Colorado had an estimated 800,000 uninsured in 2007, that figure may be rising because of the job losses of the recession.)

QUALITY: Community Health Centers Fill Unmet Needs -- Better Than You Might Think

Community health centers (Federally Qualified Health Centers) are an aspect of the recently enacted fiscal stimulus package that hasn't gotten much attention. Perhaps that's because they mostly serve a population we often overlook. Perhaps that's because they are misunderstood—and underestimated.

President Obama earlier this month described his vision for their growth:

These health centers will expand access to care by helping people in need, many with no health insurance, obtain access to comprehensive primary and preventive healthcare services...That helps relieve the burden on emergency rooms across the country, which have become primary care clinics for too many who lack coverage, often at taxpayer expense.