Coverage Crisis Continues; Local Advocates Take Action

Health Progress, Jul/Aug 2006 by Tieman, Jeff

Members of the Catholic Health Association should once again be proud of their contribution to Cover the Uninsured Week (CTUW). If participation is the yardstick, the Robert Wood Johnson Foundation's (RWJF) fourth annual advocacy campaign-featuring more than 3,000 events around the country-was a success.

Catholic health care organizations, in partnership with other providers and advocacy organizations, convened press conferences, enrollment fairs, health screenings, public meetings, and other events to help vulnerable populations get coverage and to highlight the intolerable situation of 46 million people living without health insurance in our wealthy nation.

Unfortunately, despite the well-intentioned efforts of RWJF and its national partners, including CHA, research released in connection with CTUW indicates that health coverage in the United States has only become a larger problem since RWJF started its campaign in 2003. For instance, one study found that uninsured individuals are in poorer health than adults with insurance and that access disparities between the two groups exist in every state.

According to the study, entitled "The Coverage Gap: A State-by-State Report on Access to Care," 41.1 percent of adults without health insurance reported being unable to afford to see a doctor when needed.1 By comparison, only 9.2 percent of insured adults reported the same.

Uninsured adults are also less likely to have a personal doctor or health care provider and are more likely to report that they are in "poor" or "fair" health compared with their insured counterparts, according to the study, which was commissioned by RWJF and prepared by the University of Minnesota's State Health Access Data Assistance Center.

Failing to adequately address the problem of the uninsured ultimately contributes to greater costs for everyone. The RWJF study also found that uninsured adults are significantly less likely to receive preventive services that can identity conditions before they require serious-and expensive-medical intervention. For instance, 22.8 percent of insured women said they have not had a mammogram in the past two years. More than twice as many uninsured women-50.8 percent-did not have one over the same period.

It has been clear for some time that not having insurance adversely affects health. In fact, the Institute of Medicine (IOM) concluded back in 2002 that 18,000 people die every year because they do not have adequate insurance coverage." That amounts to 49 people a day, a statistic that has proven to resonate with the public. Public opinion research continues to validate the strength of certain messages that will, one hopes, help move the public toward demanding a real solution.

"I have worked in health care and health policy long enough to know that usually Congress won't act until the people do," said Louis Sullivan, MD, who was secretary of the Department of Health and Human Services under President George H.W. Bush.3 "We need millions of Americans to call for change in order to get real action from Washington."

MASSACHUSETTS POINTS THE WAY

As RWJF points out in a new resource it calls State of the States: Finding Their Own Way, state and local leaders are not waiting on Washington to resolve the crisis of 46 million Americans lacking health insurance.4 They are taking action on their own.

Currently, Massachusetts is perhaps the most discussed example of this. In passing legislation that will attempt to cover at least 95 percent of the state's residents, the state's leaders agreed to move beyond partisan differences to get something done. The Massachusetts law and its provisions are as yet untested, but the specifics are less important than the spirit in which the law was written-with broad bipartisan cooperation and in partnership with advocacy groups all across the political spectrum.

"For the first time in any state, every person is required to have insurance it they can afford it," said Rep. Salvatore DiMasi, speaker of the Massachusetts House of Representatives, in a briefing convened by Families USA and held at the National Press Club in Washington, DC. In addition to mandating that all state residents who can afford to carry health insurance do so by July 2007, the new law calls for expanding coverage for children up to 300 percent of the federal poverty level; subsidizing coverage for low-income, uninsured individuals and families; and offering low-cost plans to small businesses with 50 or fewer employees.

"The law represents a curious amalgam of conservative and progressive approaches," said John McDonough, executive director of Health Care for All, a Massachusetts group that advocates health reform on the premise that medical care is a right. Another speaker at the Press Club briefing, John Holahan, a researcher for the Urban Institute, lauded Massachusetts's "opportunity to get to universal coverage."

Advocates and state lawmakers alike agreed that Massachusetts's accomplishment can be a model for other states. Even if the policies developed there do not work in other settings, the basic Massachusetts concept illustrates the tact that solutions are indeed attainable.