Term Paper: Non-Insured Individuals

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Non-Insured Individuals

According to an article that appeared last September in USA Today, a record number of Americans lacked health insurance. Wolf (2010) cited a report from the Census Bureau that showed 50.7 million uninsured, a figure representing nearly one in six U.S. residents. The Centers for Disease Control reported the figure was three million more than the previous year, although there was a decline in the number of uninsured children (Wade, 2011). In response to the growing problem, President Obama signed the Patient Protection and Affordable Health Care Act (PPACA) in 2010, structured to implement much-needed changes in the system over a number of years, with most changes to take place before 2014.

There are several reasons for the increase in the number of uninsured, mostly tied to the economy and the deep global recession that followed 2008's mortgage crisis. Many people lost their jobs due to the recession and with job loss came loss of benefits, including health insurance. A number of companies dropped employee health insurance benefits in an effort to cut costs and prevent the businesses from failing. Likewise, families opted out of insurance plans for much the same reason, to cut costs. As the economy continues its slow recovery, these numbers are expected to change, but it will not happen overnight. The U.S. has been devastated by the recession and it will likely take years to recover. PPACA is structured to make recovery, at least with respect to health care, a little easier for the average American.

Another problem, as noted by the Kaiser Family Foundation, is the rising cost of medical care. According to the Foundation's report, workers pay 47% more than they did in 2005 for family coverage; their employers pay 20% more (Wolf, 2010). Even as people move off the unemployment rolls and into jobs, health benefits cost more for them and for their employers. During tough economic times, individuals take any jobs they can find, and some jobs may not have any benefits at all. Further, Gulley (2011) noted that Americans find themselves uninsured for other reasons, including divorce, disability determination, or because they are in waiting periods for public coverage or for benefits from a new job to take effect.

Who are the uninsured? Statistics from 2008 reported 10.8 million non-Hispanic whites, 19.1 million African-Americans, and 30.7 million Hispanics (Gorin, 2010). Since the late 1990s, the government has continually expanded coverage for children, and at present it is estimated there are approximately 8.2% of children who are uninsured. People in the south and west are less likely to be insured, as are adult males under the age of sixty-five. As Wade (2011) further points out, "In the U.S., people's insurance coverage is linked to their jobs." The demographics of the uninsured mirror the demographics of the unemployed, underemployed and the poor.

The Centers for Disease Control defines health disparities as "preventable differences in the burden of disease, injury and violence, or opportunities…experienced by socially disadvantaged racial, ethnic, and other populations, groups, and communities (cited in Gorin, 2010). The adverse impacts on uninsured populations are significant.

There are two broad categories of uninsured, those who experience short-term gaps and those who are chronically uninsured. Both categories can have devastating consequences. There are individuals who experience gaps in coverage, due to job loss, divorce, or other non-permanent circumstances; they can get sick or be injured at times when they do not have insurance. Either they do not seek care or they face financial ruin by undergoing treatment they cannot afford. AllNurses.com cites inability to pay large medical expenses as a leading cause of personal bankruptcy.

Short-term "gap" coverage can be pricey. COBRA is a federal law that covers private- and public-sector group health plans, providing coverage to workers and their families during transitional phases for eighteen months or, in some cases, even longer. Although the goal of the law is to alleviate hardship on workers when they leave a job, premiums can be up to 102% of what a worker contributed as an employee (Doheny, 1999). COBRA is more affordable than coverage one may buy as an individual, but costs may still be too steep for many. Other short-term plans are available from a variety of providers, albeit with several caveats. They may not cover pre-existing conditions. They are designed to cover unexpected illness and accidents, not preventive care.

The greater issue, even more urgent than the problem of gap coverage, is health insurance for the chronically uninsured. Barring injury or major illness, these individuals cannot avail themselves of routine and preventive care. Something as easily treated as strep throat can turn into something much more serious when an individual finds the cost of a doctor's visit, lab test, and prescription antibiotic prohibitive because he or she does not have health insurance. Without preventive care, individuals do not undergo yearly physicals; they may not have routine procedures such as mammograms or colonoscopies, or simple tests such as those for cholesterol, blood sugar levels, or high blood pressure. The results of any of these tests, even if they reveal a problem, are often not of major concern to individuals who have insurance. With early detection, elevated cholesterol, diabetes, high blood pressure, cysts, or polyps are all treatable conditions. Unfortunately, they can be very serious and even fatal if left unchecked.

People who are chronically uninsured cannot benefit from physician-directed programs such as smoking cessation or nutrition counseling. Both these programs can be very beneficial to long-term health; failure to stop smoking or lose weight as needed can have potentially fatal consequences. These are just two more ways that the rights of poor individuals are denied. Without adequate healthcare, the chasm between "haves" and "have-nots" widens in America.

The consequences affect not just the uninsured, but society as a whole. As Cobb and Davis (2007) point out, poor health affects adults' performance at work and children's performance in school. Poor performance at work translates to increased absenteeism and lower productivity rates. Poor performance at school affects achievement, test scores, and graduation rates -- in turn affecting employability and earning power. Workers whose performance is sub-par may be fired; individuals can lose any benefits they had and can put further strain on state and federal systems that provide support to the needy. When children do poorly in school, they are shaping the rest of their lives. If they are unemployable or employed in low-paying jobs, they may not have benefits and may also need to rely heavily on government services. They will not contribute much in taxes. Society suffers as a whole as the consequences of inadequate health care perpetuate from generation to generation. O'Neill and O'Neill (2009) found that roughly one-third of America's chronically uninsured are high school dropouts, compared to about seven percent of the privately insured population. This demonstrates, once again, that the cycle of poverty -- and resulting lack of insurance -- is difficult to overcome.

Opponents to the federal plan argue that it takes away states' rights to handle the issue in the way they see fit. Utah's Governor Gary R. Herbert testified before Congress earlier this year, stating "Utah has repeatedly demonstrated we can find Utah solutions to Utah problems, particularly in the area of health care." Former Massachusetts Governor Mitt Romney has argued along much the same lines, particularly now that he is contemplating a run for the White House. In 2006, Romney, then governor, signed into law a bill requiring everyone in Massachusetts to buy health insurance. Options were made available to the poor, while residents who could afford to buy health insurance (anyone aged 27 or older who makes more than three times the federal poverty level, about $32,500 annually) faced penalties. The penalties recently increased from $93 per month to $101 a month. Persons aged eighteen to twenty-six making more than $35,000 annually also face penalties for failure to purchase health insurance, though the penalty amounts are approximately one-third less. Romney has responded to critics by insisting the solution was right for Massachusetts but probably not right for the nation as a whole. He believes every state should decide for itself, as Massachusetts did, the best solution for the problem ("Uninsured in Mass., 2010).

In 2004, Isaacs and Schroder described "class" as the "ignored determinant of the nation's health" (cited in Gorin, 2010). While they conceded that class can be difficult to define, the fact remains that it is divisive with respect to health care access, although it has received essentially little attention compared to disparities along racial and ethnic lines. Yet, as has been shown, the two are often intermingled. Melnick (2008) noted that hospital prices to the uninsured have risen steadily -- this affects the poor, no matter who they are. "The uninsured… have multiple disadvantages that are associated with poor health" (O'Neill and O'Neill, 2009). The passage of health care reform, so-named Obamacare, is structured to rectify this.

The Patient Protection and Affordable Care Act (PPACA) reflects a growing consensus that health… [END OF PREVIEW]

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