Third Installment of NEJM Health Policy Series Examines The Uninsured
Every U.S. citizen should have basic health insurance, Dr. Steven Schroeder of the Robert Wood Johnson Foundation writes in the third installment of the New England Journal of Medicine's Health Policy 2001 series. Schroeder notes that as health costs and insurance premiums "once again" increase "rapidly," the uninsured population also is "likely to grow." Although he notes that "the chances of a swift move toward universal coverage are slim," Schroeder outlines the issue of the uninsured and various approaches Congress has considered and is expected to address this year. The following is an excerpt of Schroeder's views on the issue:
- Almost two-thirds of the uninsured population is under age 35 and more than half are members of families with annual incomes below 200% of the federal poverty level, or less than $34,100 for a family of four;
- People without health insurance are more likely to delay "obtaining necessary, even life-saving care;"
- Many uninsured people receive care from private physicians, as well as through government-funded and private clinics and hospitals, but recent fiscal strains have limited those facilities' capacity to serve as a safety net;
- Several obstacles exist to expanding health coverage: the uninsured "are not a strong political constituency" in Congress, universal coverage could cost more than $300 billion per year, the public's lack of confidence in the federal government "inhibits" congressional debates about coverage expansion and states' uninsured populations vary widely.
- Changing tax policy through providing tax credits or expanding existing tax deductions for purchasing health coverage;
- Raising the income eligibility limit for Medicaid and the CHIP program, extending the CHIP program to low-income adults and opening Medicare enrollment for "early retirees;" and
- Reforming the insurance market to allow new forms of insurance pools that would be exempt from various state regulations.
