Uninsured in the United States

From Wikipedia, the free encyclopedia

This article or section is in the middle of an expansion or major revamping. You are welcome to assist in its construction by editing it as well. Please view the edit history should you wish to contact the person who placed this template. If this article has not been edited in several days, please remove this template. Consider not tagging with a deletion tag unless the page hasn't been edited in several days.

Health care in the United States

Government Centers for Medicare and Medicaid Services Medicare Medicaid TRICARE Department of Veterans Affairs (VA) Indian Health Service State Children's Health Insurance Program (SCHIP) EMTALA Federal Employees Health Benefit Plan Private Health insurance in the United States Health Maintenance Organization (HMO) Managed Care Medical underwriting Preferred provider organization (PPO) Private consumer driven Flexible spending account (FSA) Health Reimbursement Account Health Savings Account Medical savings account High Deductible Health Plan (HDHP) Others Canadian and American health care systems compared Health care reform in the United States Single payer health care Uninsured in the United States Universal Health Care

This box: view • talk • edit

The term uninsured in the United States is most commonly used to refer to US residents who do not have health insurance coverage. In 2006, there were 47 million people in the US (16% of the population) who were without health insurance for at least part of that year, according to the United States Census Bureau.^[1] The percentage of the non-elderly population who are uninsured has been generally increasing since the year 2000.^[2]

The causes of this increasing rate of uninsurance remain a matter of political debate. Rising insurance costs have contributed to a trend in which fewer employers are offering health insurance, and many employers are managing costs by requiring higher employee contributions. Many of the uninsured are the working poor or are unemployed. Others are healthy and choose to go without it. Some have been rejected by insurance companies and are considered "uninsurable." Some are without health insurance only temporarily.

The number of uninsured Americans is one of the primary concerns raised by advocates of health care reform in the United States.

Contents 1 Who are the uninsured? 2 Causes 3 Consequences 4 Emergency Medical Treatment and Active Labor Act (EMTALA) 5 See also 6 References 7 External links

[edit] Who are the uninsured?

The US Census Bureau annually reports statistics on the uninsured. According to its most recent figures, in 2006, nearly 38 million of the uninsured were employment-age adults (ages 18 to 64), and more than 27 million worked at least part time. Approximately 62% of the roughly 47 million uninsured live in households with incomes under $50,000 (13.9 million below $25,000 and 15.3 million at $25,000 to $49,000).^[1] And 38% live in households with incomes of $50,000 or more (8.5 million at $50,000 to $74,999 and 9.3 million at $75,000 or more.

According to the Census Bureau, people of Hispanic origin were the most affected by being uninsured. Their numbers grew from 14 million (32.3% of the total Hispanic population) in 2005 to 15.3 million (34.1% of the total) in 2006. The state with the highest percentage of uninsured was Texas (24.1% average for three years, 2004-2006). New Mexico has the second highest percentage of residents without health insurance at 22%.^[3]

It has been estimated that nearly one fifth of the uninsured population is able to afford insurance, almost one quarter is eligible for public coverage, and the remaining 56% need financial assistance (8.9% of all Americans).^[4] An estimated 5 million of those without health insurance are considered "uninsurable" because of pre-existing conditions.^[5]

According to the Census Bureau, in 2006, there were 8.7 million uninsured children in the US. Another 8.3 million young adults (those aged 18-24), are uninsured, representing 29.3% of their population. Young adults make up the largest age segment of the uninsured, and are one of the fastest growing segments of the uninsured population. They often lose coverage under their parents' health insurance policies or public programs when they reach age 19. Others lose coverage when they graduate from college. Many young adults do not have the kind of stable employment that would provide ongoing access to health insurance.^[6]

A report by the Kaiser Family Foundation in April 2008 found that US economic downturns place a significant strain on state Medicaid and SCHIP programs. The authors estimated that a 1% increase in the unemployment rate increase Medicaid and SCHIP enrollment by 1 million, and increase the number uninsured by 1.1 million. State spending on Medicaid and SCHIP would increase by $1.4 billion (total spending on these programs would increase by $3.4 billion). This increased spending would occur while state government revenues were declining. During the last downturn, the Jobs and Growth Tax Relief Reconciliation Act of 2003 (JGTRRA) included federal assistance to states, which helped states avoid tightening their Medicaid and SCHIP eligibility rules. The authors conclude that Congress should consider similar relief for the current economic downturn.^[7]

[edit] Causes

This section needs additional citations for verification. Please help improve this article by adding reliable references. Unsourced material may be challenged and removed. (May 2008)

Americans who are uninsured may be so because: their job does not offer insurance; they are unemployed and cannot pay for insurance; or they may be financially able to buy insurance but may decide to take chances and see what happens without having health coverage.

Historically, most working Americans have received their health insurance from their employer. However, recent trends have shown an ongoing decline in employer-sponsored health insurance benefits. In 2000, 68 percent of small companies with 3 to 199 workers offered health benefits. Since that time, that number has continued to drop to 2007, when 59 percent offered health benefits. For large firms with 200 or more workers, in 2000, 99 percent of employers offered health benefits, and in 2007, that number stayed the same at 99 percent. On average, considering firms of all numbers of employees, in 2000, 69 percent offered health insurance, and that number has fallen nearly every year since, to 2007, when 60 percent of employers offered health insurance.^[8]

[edit] Consequences

This section needs additional citations for verification. Please help improve this article by adding reliable references. Unsourced material may be challenged and removed. (May 2008)

To strive to properly care for their health while being uninsured, people turn to a variety of resources. This includes: community or nonprofit hospitals or health clinics that charge no or reduced prices for health treatment; asking their health provider for a reduced fee for their healthcare services; turning to medical facilities, pharmacies and hospitals abroad that may charge considerably less than U.S. rates for healthcare; or, going without care altogether.

Additionally, being uninsured impacts American consumers' health in a tangible way, according to a 2008 survey: ^[9]

• More of the uninsured chose not to see a doctor when were sick or hurt (53 percent) vs 46 percent of the insured.

• Fewer of the uninsured (28 percent) report currently undergoing treatment or participating in a program to help them manage a chronic condition; 37 percent of the insured are receiving such treatment

• 21 percent of the uninsured, vs. 16 percent of the insured, believe their overall health is below average for people in their age group]

The costs of treating the uninsured must often be absorbed by providers as free care, passed on to the insured via cost shifting and higher health insurance premiums, or paid by taxpayers through higher taxes.^[10]

[edit] Emergency Medical Treatment and Active Labor Act (EMTALA)

Main article: Emergency Medical Treatment and Active Labor Act

EMTALA, enacted by the federal government in 1986, requires that hospital emergency departments treat emergency conditions of all patients regardless of their ability to pay and is considered a critical element in the "safety net" for the uninsured. However, the federal law established no direct payment mechanism for such care. Indirect payments and reimbursements through federal and state government programs have never fully compensated public and private hospitals for the full cost of care mandated by EMTALA. In fact, more than half of all emergency care in the U.S. now goes uncompensated.^[11] According to some analyses, EMTALA is an unfunded mandate that has contributed to financial pressures on hospitals in the last 20 years, causing them to consolidate and close facilities, and contributing to emergency room overcrowding. According to the Institute of Medicine, between 1993 and 2003, emergency room visits in the U.S. grew by 26 percent, while in the same period, the number of emergency departments declined by 425.^[12] Hospitals attempt to bill uninsured patients directly under the fee-for-service model, but most such people cannot pay their hospital bills, and escape into bankruptcy when hospitals seek legal process against them.

Mentally ill patients present a unique challenge for emergency departments and hospitals. In accordance with EMTALA, mentally ill patients who enter emergency rooms are evaluated for emergency medical conditions. Once mentally ill patients are medically stable, regional mental health agencies are contacted to evaluate them. Patients are evaluated as to whether they are a danger to themselves or others. Those meeting this criterion are admitted to a mental health facility to be further evaluated by a psychiatrist. Typically, mentally ill patients can be held for up to 72 hours, after which a court order is required.

[edit] See also

• Health care reform in the United States
• Health insurance
• Health insurance in the United States

[edit] References

[edit] External links