On March 9, the House Ways and Means Subcommittee on Health heard testimony on the problems faced by the uninsured in America.
Noting that over 43 million Americans are uninsured on any given day, Chair Nancy Johnson (R-CT) stated, “This Subcommittee understands the importance of addressing this problem because those without health coverage often go without health care…Indeed, the uninsured are more than three times as likely to delay care and to leave a prescription unfilled. Without affordable health insurance, these Americans and their families risk not only their health but their financial well-being.”
Ranking Member Pete Stark (D-CA) bemoaned the fact that “year after year” the subcommittee has held hearings on the uninsured, yet the number of uninsured Americans continues to rise and Congress has not taken action. He also questioned the Bush Administration’s policy on the issue, contending that the administration supports national health insurance for Iraq, but does not support universal coverage in the United States.
Douglas Holtz-Eakin of the Congressional Budget Office (CBO) provided characteristics of the uninsured population. He said that people with less education, those with low incomes, and Hispanics are more likely than other populations to be uninsured. In addition, working families make up a majority of the uninsured. “Some 43 percent of the people who were uninsured all year in 1998 were in families in which at least one person worked full time all year, and 47 percent were in families in which at least one person worked part time or for a portion of the year,” he stated. Mr. Holtz-Eakin offered a number of reasons why so many Americans are uninsured, including rising premiums and high unemployment rates. “In a recent analysis,” he stated, “CBO found that health insurance coverage rates declined significantly among people who received unemployment insurance (UI) benefits for at least four consecutive months in 2001 or early 2002. Some 82 percent of such workers had health insurance coverage before they began receiving UI benefits, but only 58 percent had coverage by the final months of those benefits.” Mr. Holtz-Eakin pointed out that it would be very expensive for Congress to achieve 100 percent coverage and suggested, “Policymakers could consider policies aimed at expanding insurance coverage in conjunction with policies to strengthen the system through which the uninsured receive medical care — for example, through increased funding of community health centers and public hospitals.”
Diane Rowland of the Kaiser Family Foundation also offered a number of statistics on the uninsured population in the United States, including:
Ms. Rowland pointed out that Medicaid and the State Children’s Health Insurance Program (SCHIP) have greatly reduced the number of uninsured children in the United States, but warned that states’ budget crises threaten the stability of the programs. Nonetheless, she argued, “Maintaining the coverage now provided through Medicaid and SCHIP and building on that foundation to extend coverage to more of the low-income uninsured population provides both a tested and cost-effective approach to reducing the number of uninsured Americans. But, like all solutions to the uninsured, this too requires additional resources and given the fiscal straits of the states, undoubtedly means a greater commitment of federal support to address this national problem.”
Testifying on behalf of the Center for Studying Health System Change, Len Nichols discussed the shortcomings of universal health coverage. He disputed the assertion that universal coverage would eliminate poor health status among vulnerable populations, including low-income individuals, children, racial and ethnic minorities, people living with chronic conditions, the near-elderly, and people suffering from psychiatric and substance abuse disorders. Dr. Nichols stated, “As an example of troubling disparities, taken from AHRQ’s [Agency for Healthcare Research and Quality] recent healthcare disparities report, black women have lower rates than white women of cancer screening and higher rates of diagnosis in late stage and consequently death rates. These death rates apparently persist even after controlling for education and income. They also appear to persist after controlling for insurance. This suggests that insurance alone cannot solve the problems faced by vulnerable populations.”
During the question and answer session, Rep. Johnson asked the panel why so many children, approximately 25 percent of the uninsured population, have no health coverage when most would be eligible for Medicaid or SCHIP. Witnesses explained that in states where these programs cover both children and their parents, such as in Wisconsin, the participation rates are much higher. They could only guess as to why parents would not choose to provide health insurance for their children even if they themselves would not be covered. Witnesses also pointed out that many of the uninsured children live in rural areas where they do not have access to community health clinics.
Rep. Jim McDermott (D-WA) focused his comments on association health plans (AHPs), which would allow small businesses to come together to form associations for the purpose of purchasing health insurance at more affordable group rates. He expressed his concern that the AHPs could choose who would be covered, and would be able to bypass state mandates covering specific diseases such as breast cancer and diabetes. The witnesses argued that physicians currently find a way to make the required treatment covered by health insurance, and would continue to do so under the AHPs. They noted that there were a few exceptions, including certain fertility treatments and maternity care.
