1. Universal Coverage, Health Inequalities, and the American Health Care System in Crisis (Again) Annual Meeting of the American Political Science Association September 2-5, 2004 (Chicago, IL) Rick Mayes, Ph.D. Asst. Professor of Public Policy Faculty Research Fellow Department of Political Science Petris Center on Healthcare Markets University of Richmond School of Public Health Richmond, Virginia University of California, Berkeley

2. Overview This presentation examines: 1.the characteristics of the uninsured population 2.some of the factors driving the problem, 3.various economic consequences, and 4.the current leading political proposals for addressing the problem

3. Total Uninsured: 45 million total persons (Census, 2003)

4. The Uninsured, 15.6% of the U.S. Population (Census, 2003)

5. Multiple Factors: Rise and Fall of Restrictive Managed Care

6. Correlation Between Rising Health Insurance Costs and Increases in the Number of Uninsured Individuals

7. Consequences: As the Burden of Under- and Uncompensated Care Increases, Private Payers Pay More Source:The Lewin Group analysis of data contained in AHA TrendWatch Chartbook: Trends Affecting Hospitals and Health Systems, 2001.Includes data for hospitals that reported data in the AHA Annual Hospital Survey. The correlation coefficient between Private Payer Payment-to-Cost Ratio and Medicare, Medicaid & Uncompensated Care cost shift burden is 0.753 0% 20% 40% 60% 80% 100% 120% 140% 160% 180% 200% 0%5%10%15%20%25% Medicare, Medicaid & Uncompensated Care Cost Shift Burden (in %) by State Private Payer Payment-to-Cost Ratio

8. Consequences: Care Postponed & Not Received

10. Extreme Consequences: Bankruptcy & Earlier Death Upwards of 750,000 families are bankrupted by medical debt each year, even though 80% of them have some form of health insurance (CAMS, 2003). 46% of uninsured patients have debts from previous medical care (CAMS, 2003). Uninsured women with breast cancer are twice as likely to die as women with breast cancer who have health insurance (Kaiser Commission, 2002). Men without health insurance are nearly 50% more likely to be diagnosed with colon cancer at a later, more dangerous stage than men with insurance (Kaiser Commission, 2002).

11. Leading Proposals to Address the Uninsured Fiscal Policy: Health Savings Accounts and tax credits; goal=provide health insurance coverage to approx. 10 million currently uninsured individuals (cost=$102 billion over ten years) Expand Medicare: to everyone; goal=cover all of the uninsured (cost=?? anybody’s guess) Individual Mandate: similar to car insurance, require that everyone purchase or have a health insurance policy; goal=provide health insurance coverage to virtually all of the 45 million uninsured (cost=upwards of $90 billion/per year in sliding scale government subsidies/tax credits)