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The Working Uninsured

The Working Uninsured

How do lives unravel? For working people, it often begins with a measure of bad luck and accelerates with the loss of health insurance.

And so it goes for Risé Horton. “We had health coverage [in 2006], but my husband had a heart attack in February, lost his job, and so we lost coverage,” says Horton, a team lead quality inspector with Quality Industrial Services in Lordstown, Ohio.

Horton’s employer, an inspection service for auto-parts maker Delphi, doesn’t offer health insurance. “It’s absolutely horrible,” she says. “We can’t go to the doctor as much as we need to. And with my husband having a heart attack, he has to take medications that cost us quite a bit each month.”

Why Are So Many Americans Uninsured?

So why are approximately 47 million Americans uninsured, while millions more endure the tribulations of being underinsured?

There are many reasons that legions of us fall through the cracks of our patchwork healthcare system.

Small companies say they can’t afford to offer health insurance to their workers. Indeed, only 62 percent of small firms offered health benefits in 2008 versus 68 percent in 2001, according to the Kaiser Family Foundation's 2008 Employer Health Benefits Survey. Millions of other workers are between jobs or recent graduates and don’t yet have access to group rates. Health advocacy group Families USA reported that 86.7 million Americans under 65 -- one in three -- were uninsured at some point during 2007 and 2008; of those, four out of five belonged to working families.

But low-wage workers are the least likely to have access to insurance through their employers. Some 65 percent of higher-paying companies (those where less than 35 percent of employees earn $20,000 or less) offer health insurance, according to a study by the Kaiser Family Foundation. By contrast, among companies that pay lower wages to 35 percent or more of workers, only 42 percent offer a health plan.

And in the wake of years of double-digit percentage increases in premiums, access to a group policy in no way guarantees affordability. “If you’re a worker for a company that offers insurance, you might or might not be able to afford coverage, depending on the amount of the premium that you have to pay,” says Bianca DiJulio, a policy analyst with the Kaiser Family Foundation’s Health Care Marketplace Project.

For Millions More, Insurance Doesn’t Provide Enough Coverage

Millions more Americans -- the underinsured-- have some insurance, but with gaps that could bankrupt them or force them to choose between health and solvency. Nearly 16 million US residents ages 19 and 64 were underinsured in 2003, according to a study published in 2005 in Health Affairs.

It’s not that the underinsured’s claims are being denied. Employees whose only choice is a high-deductible plan can incur thousands of dollars in out-of-pocket expenses annually, which could tip some into bankruptcy. Being uninsured or underinsured can also cause people to skimp on treatment. A 2003 Kaiser survey reports that uninsured adults were twice as likely as insured adults to cut pills, not fill a prescription or skip medical treatment due to cost.

What about Medicaid, the government insurance program for low-income Americans? Very few working adults without children are eligible.

Insured Americans Pay for Costly, Ineffective Care of Uninsured

But wouldn’t it be prohibitively expensive to finance the healthcare of additional tens of millions of people? This question doesn’t acknowledge that the uninsured are already getting care that’s medically ineffective and financially inefficient. These patients receive very little preventive care, often visit pricey emergency rooms for the wrong reasons and, when they become acutely ill, require costly care at the expense of the insured and taxpayers.

“At the end of the day, you have to balance your books, so you have to cost-shift -- whether it’s the price of aspirin or surgery,” says Dr. Ralph deVere White, director of the University of California Davis Cancer Center. Better preventive care for the uninsured could actually reduce some of these costs, though it would require a big up-front investment.

Some consumer advocates say the federal government should be the single payer for all Amercans’ healthcare. Other stakeholders believe private insurance and market forces should play a role in rescuing the tens of millions who have no insurance or too little.

Universal access to healthcare doesn’t require a single-payer system, but could entail a government guarantee that those who can’t obtain affordable private insurance will get insured somehow.

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