1. Seminar 7

2. Chapter Overview Chapter 7 provides a basic overview of the problem of uninsurance and health reform attempts to reduce the number of uninsured individuals. Chapter 7 focuses on: – Characteristics of the uninsured – Problems associated with uninsurance – Providers who care for the uninsured – Federal and state health reform

3. Uninsured Approximately 15% of the U.S. population is uninsured – Over the past several decades the uninsured rate has hovered around 12-16% of the U.S. population Even more people are uninsured at some point over a two year period

4. Uninsured - Characteristics Low-income Working Young adults (18-24) Low education level Racial or ethnic minority Immigrant Male Reside in South and West Reside in remote rural areas

5. Uninsured – Health Status If you are uninsured you – Are less likely to have a regular source of care – Are less likely to have timely care – Have less chronic disease management – Have more emergency room visits – Less likely to follow treatment recommendations because of cost – Have a higher in-patient mortality rate – More likely to be hospitalized for avoidable health problems

6. Uninsured - Cost There are a variety of ways to count the cost of uninsurance – Poorer health status Lower quality of life, more anxiety – Financial costs High cost of care for uninsured patients Cost to providers who give uncompensated or reduced rate care Cost to federal, state, and local governments to assist providers who give reduced rate or charity care to the uninsured Cost to privately insured if cost-shifting occurs – Opportunity costs Costs to individuals, providers, governments who could be spending resources on other needs – Productivity costs If productivity reduced because workers are ill

7. Uninsured – Safety Net Providers Safety net providers are those who serve a disproportionately high number of uninsured and publicly insured patients – “Core” safety net providers also have a policy of serving patients regardless of ability to pay Common safety net providers – Public hospitals – Community health centers – Local public health agencies

8. Health Reform There have been numerous health reform attempts in the U.S. – All attempts at national health reform to crate universal or near-universal coverage have failed – Some successes at the state level

9. Health Reform – Difficulty of Reform in the U.S. National Health reform may be difficult to achieve for a variety of reasons – Individualistic culture – Dislike of big government – Lack of consensus – Federal system rules and structure make it difficult to achieve major reform – States generally home to social welfare issues – Powerful interest groups against national health reform – Path dependency

10. Health Reform – Key Failed Attempts at National Health Reform 1912 Progressive Party candidate Teddy Roosevelt supported social insurance platform that included health insurance 1915 American Association for Labor Legislation proposal for working class health insurance President Truman supported national health reform upon taking office, won re-election on national health insurance platform in 1948 President Nixon initial health reform proposal in 1969 and revised proposal in 1972 President Clinton Health Security Act in 1993

11. Health Reform – State Efforts A variety of states have addressed health reform issues A few examples: – MA passed individual mandate for all residents to have health insurance – IL passed a bill that makes health insurance available to all children – VT created a program to cover about 300,000 uninsured residents – KS and MT created purchasing pools to health small employers offer health insurance