Groups come together to speak up for uninsured

An organizational partnership tells physicians, the public and lawmakers it's time to find real-world solutions to the problem of the uninsured.

By Joel B. Finkelstein, amednews staff. March 24/31, 2003.

Washington -- Advocates for the uninsured are in the kitchen, cooking up ideas to expand access to health care. Now they are calling on doctors to come to the table to finalize the menu.

In the past two years, nearly 75 million people have gone without health insurance for a matter of months to years, according to a report released at the launch of the "Covering the Uninsured" initiative earlier this month.

Who are the uninsured
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"This is a problem that is much more common than we understood," said Risa Lavizzo-Mourey, MD, president of the Robert Wood Johnson Foundation, which sponsored the report.

One in three Americans younger than 65 went without insurance for all or part of the past two years.

Nearly four out of five people without health insurance were in working families. And, uninsured patients often forgo or delay care, sometimes putting off going to the doctor until minor illnesses become acute, according to the report. The statistics have serious implications.

"The recent downturn in the economy means even more Americans are finding it difficult to find necessary care, including preventive services," said AMA President Yank D. Coble Jr., MD. "As a result, an already overburdened health care system is forced to bear even higher costs to care for these patients."

75 million people have been uninsured at some time during the last 2 years.

Another study showed people who don't have health insurance during any given year receive, on average, half as much care as those with insurance. Research has also demonstrated that people without insurance are sicker and die younger.

"Living without health insurance is itself a serious health risk," said Dr. Coble, speaking at Washington, D.C.'s Union Station, during the event kicking off the initiative.

Covering the Uninsured is a partnership of 16 national organizations, including the American Medical Association, The California Endowment, W.K. Kellogg Foundation and the Robert Wood Johnson Foundation.

The group is asking physicians, patients, businesses and lawmakers to come together to discuss the problem and agree on real-world solutions.

To jump-start this conversation, the coalition organized a week-long series of public forums held in March across the country.

At a town-hall meeting held in Washington, D.C., internist Kristen Schaefer, MD, who works with low-income and uninsured patients at Mary's Center for Child and Maternal Health in that city, grilled Mayor Anthony Williams about what he was doing to better support physicians who serve the community's health care needs.

Nearly 80% of people without health insurance in the last 2 years were in working families.

Dr. Schaefer told the mayor, "We need access to prescription drugs and integrated networks of specialists" for patients.

Williams admitted that the city was struggling with specialist issues, but said that if more physicians got involved in these forums, local officials would have a better understanding of their needs.

The call for physician involvement was also heard on Capitol Hill, during a hearing to discuss failures of the current health care system.

"There is plenty of blame to share, but blame is not the point. Developing a simultaneous approach to waste, uneven quality and uneven access is the point," Len Nichols, PhD, vice president of the Center for Studying Health System Change, told the Senate Special Committee on Aging.

"We cannot get out of our morass without the enthusiastic participation of providers, health plans, employers, governments, and citizens/workers/patients," Dr. Nichols said.

It takes a community

Meanwhile, a recent Institute of Medicine study showed that the increasing number of uninsured Americans is having a ripple effect at the local level.

"Every American should be concerned not only about the adverse consequences of the uninsured themselves ... [but also] about the consequences of uninsurance for the health care system, the hospitals, the doctors, the health care providers, the emergency medical service system or ambulance system that they ... may depend upon," said Arthur Kellermann, MD, professor and chair of the Dept. of Emergency Medicine at Emory University School of Medicine in Atlanta.

$35 billion is lost each year in uncompensated care.

Dr. Kellerman and colleagues found that, in communities with a high proportion of uninsured people, resources were stretched thin.

"The nation's more than 41 million uninsured people are not isolated individuals, they're members of communities," said Dr. Kellermann. "The financial strain of treating large numbers of people without health insurance can hurt the viability of local governments and local health care providers."

A recent Kaiser Family Foundation study concluded that physicians and hospitals are forced to rely on a poorly targeted patchwork of subsidies to support their uncompensated care, which amounts to about $35 billion a year.

The study also showed that private physicians provide around $5 billion a year in uncompensated care. Behind hospitals, physicians would benefit most from direct payments for the care they currently provide for free.

"Physicians ... account for more than half of the private subsidies that underwrite the cost of uncompensated care," the study's authors write. "They too would benefit substantially from expanding insurance coverage to all Americans."

How to achieve this expanded coverage is the question that the Covering the Uninsured partnership is urging doctors and other stakeholders to start discussing now.

"This is a complex problem -- a problem that will not be solved overnight," said Dr. Coble. "But this is a problem that must be solved soon. It is essential for us to fight disease, disability, and despair. Our nation's health depends on it."

ADDITIONAL INFORMATION:

Who are the uninsured

Children and younger adults account for the biggest chunk of people without insurance.

       Uninsured  Percent of
Age    (millions) age group 
-----  ---------- ----------
0-17      20.2      27.9%
18-24     13.5      49.6%
25-44     27.1      32.7%
45-54      8.4      21.2%
55-64      5.4      20.8%

Source: Robert Wood Johnson Foundation report, "Going Without Health Insurance: Nearly One in Three Non-Elderly Americans"