Inaction Ultimately Hurts All of Us

As the health care reform legislation has become stalled in Congress, “the original motivation and rationale for the reforms appears to have become obscured, as have an understanding of what the proposals would do and who would benefit from them,” a new paper from the Urban Institute points out. In The Biggest Losers, Health Edition: Who Would Be Hurt the Most by a Failure to Enact Comprehensive Reforms?, Linda J. Blumberg, a senior fellow in the Urban Institute’s Health Policy Center, examines the groups with the most to lose should comprehensive health reform fail to pass. Those groups, primarily based on 2008 statistics, include the following:

• 13.1 million self-employed people;
• 47.8 million people employed in firms of fewer than 100 workers;
• 26.9 million non-elderly people working part-time and 20.8 million people working full-time but for only part of the year;
• 96.2 million non-elderly people in families with incomes below 200% of the federal poverty level; another 74.3 million living in families with incomes between 200% and 400% of the poverty level;
• Millions of people with significant health problems, including the highest spending 5% of the U.S. population, who account for about half of total health spending. This concentration of health care costs limits access to affordable, meaningful coverage for them as well as many others with less expensive conditions, including many older working-age adults and early retirees
• The 14.8 million people who were unemployed, as of January 2010,

“To walk away from the proposals developed, including the individual mandate, insurance exchanges, regulatory reforms of insurance markets, expanded public insurance eligibility, and premium and cost-sharing subsidies for the modest income, does even greater harm than leaving these populations in the difficult circumstances in which they find themselves today,” Ms. Blumberg noted.

Without legislative change, health care costs will continue to escalate faster than paychecks, leading to growth in the number of insured and under-insured; medical care would become an even greater financial burden; and the numbers of people seeking charity care and public coverage would overwhelm governments and the health care system, she explained. All this ultimately affects all of us.

Currently more than 90 million people have no access to employer-sponsored health insurance and 43% of these people are uninsured.

As if to underscore the Urban Institute’s conclusions, a report released on February 25 by the National Center for Health Statistics revealed that 30% of young adults ages 20 to 29 had no coverage in 2008 and were almost twice as likely as adults aged 30 to 64 to be uninsured. Young adults represent nearly 13 million people, 14% of the total U.S. population, but more than one-quarter of the estimated 45 million uninsured in 2008.

The NCHS further found that in the past 12 months 10% of young adults aged 20-29 years needed medical care and 12% needed prescription drugs but did not get them due to cost. Also in the past 12 months, 10% of young adults had two or more emergency room visits.

Young adults without insurance were less likely to have a usual source of medical care (44%) than were those with private insurance (80%) or Medicaid (84%). They also are four times as likely (21%) as those with private insurance (5%) and two times as likely as those with Medicaid (9%) to have unmet medical need.

It isn’t necessarily that these young people, or most other workers in other age groups, are uninsured by choice—they often work at low paying or part-time jobs that offer no health insurance benefits. And even if health insurance benefits are offered, with their limited incomes they can’t afford the premiums.

It’s time to act to help many millions of Americans obtain affordable and adequate health insurance coverage. Why aren't we holding legislators’ feet to the fire? As the noted linguist and philosopher Noam Chomsky said: “States are not moral agents, people are, and can impose moral standards on powerful institutions." and "To some degree it matters who's in office, but it matters more how much pressure they're under from the public."