A QUESTION OF ACCESS

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• A QUESTION OF ACCESS

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• WHAT ACCESS MEANS IN THE UNITED STATES

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• ACCESS IS RESTRICTED TO THOSE WHO HAVE HEALTH
  INSURANCE THROUGH THEIR EMPLOYERS
•  
• THOSE COVERED UNDER A GOVERNMENT HEALTH CARE
  PROGRAM.
•  

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• THOSE WHO CAN AFFORD TO BUY INSURANCE OUT OF
  THEIR OWN PRIVATE FUNDS, AND
•  
• THOSE WHO ARE ABLE TO PAY FOR SERVICES PRIVATELY.

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• Some Statistics about access

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Health Insurance Coverage in the U.S., 2006
Total 296.1 million
NOTE Includes those over age 65. Medicaid/Other
Public includes Medicaid, SCHIP, other state
programs, and military-related coverage. Those
enrolled in both Medicare and Medicaid (1.8 of
total population) are shown as Medicare
beneficiaries.


SOURCE Kaiser Commission on Medicaid and the
Uninsured/Urban Institute analysis of March 2007
CPS.
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Uninsured Rates Among the Nonelderly, by State,
2005-2006
NH
VT
ME
WA
ND
MT
MN
MA
OR
NY
ID
WI
SD
RI
MI
CT
WY
PA
NJ
IA
NE
OH
IN
NE
DE
IL
NV
WV
UT
VA
MD
CO
KY
CA
MO
KS
NC
DC
TN
SC
OK
AR
AZ
NM
GA
MS
AL
TX
LA
AK
FL
HI
gt20 (10 states)
18-20 (9 states)
US Average 18
13-17 (18 states DC)
lt 13 (13 states)
SOURCE Kaiser Commission on Medicaid and the
Uninsured and Urban Institute analysis of the
March 2006 and 2007 Current Population Survey.
Two-year pooled estimates for states and the US
(2005-2006).
8
Childrens Access to Care, by Health Insurance
Status, 2006
NOTE MD contact includes MD or any health care
professional, including time spent in a hospital.
Data is for all children under age 18, except
for dental visit and unmet dental need, which are
for children age 2-17. Respondents who said usual
source of care was the emergency room were
included among those not having a usual source of
care. All estimates are age-adjusted. SOURCE
Kaiser Commission on Medicaid and the Uninsured
analysis of National Center for Health
Statistics, CDC. 2007. Summary of Health
Statistics for U.S. Children NHIS, 2006.
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Characteristics of the Uninsured, 2006
Family Work Status
Age
Family Income
Part-Time Workers 11
55-64 9
0-18 20
No Workers 18
35-54 32
19-34 39
1 or More Full-Time Workers 71
Total 46.5 million uninsured
The federal poverty level was 20,614 for a
family of four in 2006. SOURCE Kaiser
Commission on Medicaid and the Uninsured/Urban
Institute analysis of March 2007 CPS.
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Health Insurance Coverageof the Nonelderly by
Poverty Level, 2006
NOTE The federal poverty level (FPL) was 20,614
for a family of four in 2006. Data may not total
100 due to rounding. Nonelderly defined as age
0-64. SOURCE Kaiser Commission on Medicaid and
the Uninsured/Urban Institute analysis of March
2007 CPS.
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The Nonelderly Uninsured,by Age and Income
Groups, 2006
Total 46.5 million uninsured
Low-income includes those with family incomes
less than 200 of the federal poverty level.
SOURCE Kaiser Commission on Medicaid and the
Uninsured/Urban Institute analysis of March 2007
CPS.
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Number of Nonelderly Uninsured Americans, 2004 -
2006
Uninsured in Millions
46.5
44.4
43.0
SOURCE Kaiser Commission on Medicaid and the
Uninsured/Urban Institute analysis of March CPS
for each year.
13
Uninsured Nonelderly vs. All Nonelderly,by Race
and Ethnicity, 2006
Multiracial (1)
2
Am. Indian (1)
Asian
1
Black
Hispanic
White
46.5 Million
260.0 Million
NOTES American Indian category includes Aleutian
Eskimos. Data may not total 100 due to
rounding.SOURCE Kaiser Commission on Medicaid
and the Uninsured/Urban Institute analysis of
March 2007 CPS.
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Health Insurance Coverage ofNonelderly Adults,
2006
181.8 Million Nonelderly Adults
SOURCE Kaiser Commission on Medicaid and the
Uninsured/Urban Institute analysis of March 2007
CPS.
15
Adults' Health Insurance Coverage by Household
Type, 2006
Number
Adults, living together
28.9 M
19.6 M
Adults, living alone
53.7 M
Married, no children
7.2 M
Other with children
13.1 M
1 parent with children
59.3 M
2 parents with children
NOTES Other households with children include
families with at least three generations in a
household, plus families in which adults are
caring for children other than their own (e.g., a
niece living with her aunt). Adults includes all
individuals aged 19 to 64. Data may not total
100 due to rounding.SOURCE Kaiser Commission
on Medicaid and the Uninsured/Urban Institute
analysis of March 2007 CPS.
16
Access to Employer-Based Coverage by Family
Income, 2005
(Family Income lt100 FPL)
(Family Income 400 FPL)
NOTE The Federal Poverty Level (FPL) was 16,090
for a family of three in 2005. SOURCE Garrett B.
and L. Clemens-Cope. Changes in
Employer-Sponsored Health Insurance Coverage
2001-2005. Kaiser Commission on Medicaid and the
Uninsured report 7599, Dec. 2006
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• FLORIDAS UNINSURED

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• FLORIDA HAS THE 3rd LARGEST UNINSURED POULATION
  IN THE NATION

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• 17.8 OF FLORIDAS NON-ELDERLY POPULATION DOES
  NOT HAVE HEALTH INSURANCE COVERAGE

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• IN 2008, 18.8 OF FLORIDAS CHILDREN WERE
  UNINSURED

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• 43 OF FLORIDIANS AGES 21-24 DO NOT HAVE HEALTH
  INSURANCE

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• ETHNIC GROUPS WITHOUT HEALTH INSURANCE
• HISPANIC 32
• BLACKS 31
• WHITES 19

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• EARLY RETIREES ARE A RAPIDLY GROWING GROUP OF
  UNINSURED FLORIDIANS. FEWER EMPLOYERS ARE
  PROVIDING HEALTH BENEFITS FOR EARLY RETIREES.

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• 75 OF FLORIDAS UNINSURED ARE EMPLOYED.

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• THE VAST MAJORITY OF EMPLOYERS ARE SMALL AND ARE
  LESS LIKELY TO PROVIDE HEALTH CARE INSURANCE.

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• WHY ARE PEOPLE LOSING HEALTH CARE INSURANCE?

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• WHEN HEALTH CARE COSTS RISE FASTER THAN WAGES
  THERE IS A DECREASE IN INSURANCE COVERAGE. LOW
  INCOME WORKERS CANNOT AFFORD TO BUY HEALTH CARE
  INSURANCE.

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• COST OF HEALTH INSURANCE PREMIUMS IS THE PRIMARY
  REASON PEOPLE DO NOT HAVE HEALTH INSURANCE
  COVERAGE. BECAUSE OF COST INCREASES, EMPLOYERS
  ARE SHIFTING MORE OF THE COST OF COVERAGE TO
  EMPLOYEES.

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• WHEN PREMIUM COSTS RISE, EMPLOYERS OF ALL SIZES
  ARE LIKELY TO SWITCH FROM CONVENTIONAL COVERAGE
  TO MANAGED CARE PLANS, RESTRICT HEALTH PLAN
  ELIGIBILITY (NO COVERAGE FOR PART-TIME OR
  TEMPORARY WORKERS), AND INCREASE COST-SHARING
  REQUIREMENTS.

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• SOME EMPLOYERS ARE ELIMINATING COVERAGE FOR
  DEPENDENTS OR SHIFTING THE ENTIRE COST TO THE
  EMPLOYEE.

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• MORE EMPLOYERS USE CONTRACT OR PART-TIME
  EMPLOYEES WHO ARE NOT ELIGIBLE FOR COVERAGE.

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• WELFARE REFORM IS MOVING PEOPLE OFF WELFARE AND
  INTO JOBS. IN MANY CASES, THEY TEND TO MAKE TOO
  MUCH INCOME TO QUALIFY FOR MEDICARE. THE JOBS
  THEY TAKE DONT ALWAYS OFFER INSURANCE.

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• IMPLICATIONS OF BEING UNINSURED

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• MOST PEOPLE WHO LACK HEALTH CARE COVERAGE RECEIVE
  LITTLE OR NO PREVENTATIVE CARE. THEY ARE LESS
  LIKELY TO FILL A PRESCRIPTION OR RETURN FOR
  FOLLOW UP CARE.

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• THE EMERGENCY ROOM BECOMES THE SOURCE OF PRIMARY
  CARE

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• HEALTH CONDITIONS THAT GO UNMANAGED CAN RESULT IN
  SERIOUS CONDITIONS REQUIRING HOSPITALIZATION.

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• EMERGENCY ROOM CARE REPRESENTS 7 OF ALL PATIENTS
  ADMITTED TO FLORIDA HOSPITALS.

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• IMPLICATIONS FOR THE FUTURE

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• THE 1998 STATE LEGISLATURE PASSED THE FLORIDA
  KID CARE PROGRAM
• ENROLLING THEM REMAINS A CHALLENGE.

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• INCREASES IN HEALTH INSURANCE COSTS WILL RESULT
  IN MORE PEOPLE BEING UNABLE TO AFFORD COVERAGE.

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• HOSPITALS, FACING LOWER PAYMENTS FROM MEDICARE,
  MEDICAID AND MANAGED CARE COMPANIES, WILL
  STRUGGLE TO ABSORB THE COST OF CARING FOR THE
  UNINSURED.

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• PROGRAMS FOCUSING ON PRIMARY AND PREVENTATIVE
  CARE FOR THE UNINSURED POPULATIONS WILL BE THE
  KEY TO MANAGING THE COST OF CARING FOR THESE
  PATIENTS.

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• TAX INCENTIVES TO ENCOURAGE INDIVIDUALS WILL
  RESULT IN MORE AFFORDABLE COVERAGE.
• SPECIAL FUNDING MUST BE AVAILABLE TO THE SAFETY
  NET HOSPITALS, I.E., THOSE HOSPITALS WHO SERVE A
  DISPROPORTIONATE AMOUNT OF UNINSURED PATIENTS.

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• Key Points to Remember
• Most of the uninsured either work or come from a
  working family.
• There is a higher incidence of un-insurance in
  the low-income, younger adults, and minority
  populations.
• Most of the uninsured are U.S. citizens

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• Loss of health care delivery capacity
• Less effective control of communicable diseases.
• Losses to the communitys economic base.

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• Being uninsured effects the emotional health of
  individuals and families by
• Creating a fear of being denied health care or
  being bankrupt by illness
• Forcing individuals to choose which medical
  services to utilize.

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• Internal Costs to individuals, families, and
  business firms
• Greater morbidity and premature mortality
• Developmental losses for children
• Family financial uncertainty and stress,
  depletion of assets.

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• Lost income or uninsured breadwinner in ill
  health.
• Workplace productivity losses (absenteeism,
  reduced efficiency on the job)
• Diminished sense of social equality and
  self-respect.

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• End of Lecture for August 29th
• 2011, 6th Period
• Questions?
• Discussion?