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Uninsured climb to 46.6 million

The increase means more patients will delay needed care and be sicker when they do come in, doctors predict.

By Geri Aston, amednews Staff. Sept. 18, 2006.

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The number of uninsured Americans grew by 1.3 million last year, mainly due to the loss of employer-based coverage, new U.S. Census Bureau figures show. Physicians said the news exacerbates their frustrations over the human toll of the problem and the financial strain it places on their practices.

The 46.6 million people who lack coverage "don't access care in a timely manner," said AMA Trustee Ardis D. Hoven, MD, an internal medicine and infectious disease specialist in Lexington, Ky.

The first thing uninsured patients skimp on is preventive care, physicians said. "They think, 'I don't have insurance so I can't go to the doctor to get a Pap smear, a mammogram, a colonoscopy,' " Dr. Hoven said.

Mark Macumber, MD, sees the problem's impact every day. He doesn't accept insurance and charges a flat $40 fee for office visits. Virtually all of the patients at his two practices, one in Chicago and one in nearby Berwyn, Ill., lack health coverage.

"I see some very scary things," said Dr. Macumber, an assistant professor of family medicine at Northwestern University. "I see fractures, and people have taken care of it themselves."

Many uninsured patients are working poor, physicians said. They make too much to qualify for Medicaid but too little to afford insurance. Of the 37.8 million people of working age who lacked insurance in 2005, 27.3 million worked at some point that year, according to the Census Bureau figures, which approximate the number of people uninsured at some point in the year. The number of uninsured full-time workers grew from 20.5 million in 2004 to 21.5 million in 2005.

"When people think of the uninsured, they have a certain picture in their head, and it's wrong," Dr. Macumber said. They aren't totally impoverished people who can access the health care safety net. "The uninsured are people who live next to you. They're very hard working, very ordinary, and they're very scared."

The slide in employer-sponsored insurance is attributed to rising health care costs. Many employers are dropping coverage. Those who still offer it are boosting cost sharing, causing many workers to decline the benefit. Patrick Tranmer, MD, chair of family medicine at the University of Illinois, Chicago, said he also is seeing more patients with breaks in coverage when they are between jobs or moving from school to work.

Others are noticing an erosion in benefits. Dr. Macumber sees patients with insurance that doesn't cover preventive care, including well-child visits and school physicals.

Insurance access for children is a growing problem, the Census Bureau found. The number of children without coverage climbed from 7.9 million in 2004 to 8.3 million in 2005.

The dip in employment coverage is again to blame, said Diane Rowland, ScD, executive vice president of the Kaiser Family Foundation. In past years, Medicaid and the State Children's Health Insurance Program picked up this slack. But budget constraints have caused states to cut outreach to eligible families, she said.

The increase in the number of uninsured Americans has economic repercussions for physician practices.

"Physicians will continue to see these patients and provide free care," Dr. Hoven said. "We do it every day." Physicians each provide an average of $2,000 a week in uncompensated care, according to the AMA.

Doctors also will provide more discounted services and offer payment plans, said Dr. Tranmer, who is the Illinois Academy of Family Physicians' second vice president. But, he added, "practicing physicians have to pay their staffs, pay their bills and support their families."

Physicians called for political action to fix the problem but said they don't expect any immediate results. "It may have to get a little worse before it gets better," Dr. Tranner said.

Dr. Hoven said no national action is expected this year because of the politics surrounding November's congressional election. The issue likely will become a factor in the next presidential election, she said.

The AMA is promoting its solution. It includes refundable tax credits based on income, individually selected and owned health insurance, and market reforms that will create new, affordable options. If people owned and controlled their health insurance, the nation would be healthier and costs would drop, Dr. Hoven said.

Another option is a solution outside the government, Dr. Macumber said. He is trying to accomplish such change on the small scale through his practice model. "That's where I'm able to do the most."

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 ADDITIONAL INFORMATION: 

Who are these millions?

People living in deep poverty can tap into the nation's health care safety net. Working people who earn too much for public programs and not enough for private insurance go without coverage. The uninsured, one doctor says, are "the people who live next to you."

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