Healthcare Policy: An Overview of the Uninsured and Underinsured in America

An alarming number of people in the United States today do not have health-care coverage. Many of these people live in urban areas and their income is below the official government poverty line. However, some of them make up to 200% of the government poverty amount, and not all of these uninsured and underinsured individuals are inner-city minority individuals.

According to a recent press release put out by the Kaiser family foundation, 75% of individuals in the United States who don't have health insurance or who recently had a gap or lapse in their health insurance were working families. These people can work full-time or part-time, and some of them are the husband or wife of someone who is working.

These people are not uninsured because their health problems do not allow companies to provide them with insurance, or because they don't want to be. Rather, they are uninsured and underinsured because the money that they make at their job simply does not pay enough for them to be able to purchase health insurance.

Sometimes this is because their company does not offer health insurance, and this is especially true for part-time and seasonal workers. Sometimes employers offer health insurance but the cost of the deductible is so high that the workers cannot afford to have that much removed from their paycheck each week. Many of the workers who cannot afford health care through their employers make too much for Medicaid. Because of this, they are caught in the middle. They don't make enough money to pay for quality health insurance, but they make too much money for the state to pay for health care for them.

Because of this many people in this country are uninsured and this can be very dangerous when a trauma or unexpected illness strikes. Most affected by a lack of insurance are families who make less than $35,000 per year. These low-wage earning, working families tend to have problems with medical bills, and some of them even go without needed prescriptions or doctor visits because they know that they simply cannot afford to spend money on doctors when that money might put food on the table for their children.

In contrast to the working families, the elderly individuals in this country who are covered by Medicare are usually satisfied with their insurance coverage. They have more serious health problems but very few of them have problems getting health care. Only 7% had problems getting health care in the year that the study was conducted. Forty percent of adults under age 65 had difficulty receiving care, and 42% of working-age adults who had no insurance at all had trouble getting care. Those who received Medicare were much happier with their health insurance and more pleased with their doctors than those individuals who rely on Medicaid or have health-care coverage tied in with their jobs.

Special Report prepared for the Commonwealth Fund by some individuals at the center for health policy research at George Washington University indicates that many of the issues in the Kaiser family foundation study are very accurate. The report adds to the information given in the Kaiser family foundation study by stating that over half of the individuals who live in underserved areas are in inner cities. Many of these individuals seek treatment at places that are required to provide service to poor patients such as community health centers, family planning clinics, and AIDS providers.

Often, children's hospitals and providers of school health services, as well as mental health and substance abuse providers, will also help poor and underserved communities, although they are not legally obligated to do so. The report does indicate that those who are in the minority population have more trouble with income and health insurance than their white counterparts. Numbers for the year 1992 show that one-third of African-Americans and nearly one-third of Hispanic-Americans were poor, compared with only 11% of white individuals. This totaled up to 36% of African-American children and almost 39% of Hispanic children being poor, compared with only 16% of white children. To make matters worse, children of ethnic minority are far more concentrated in higher poverty areas.

This means that not only are there very many minority children in cities that are poor, but they are congregated within the same area where there is little hope of access to decent medical care. Studies have shown that minority individuals...

This is likely because of their little income and trouble having access to good medical care, or work health insurance to pay for it.
Many of these people end up using hospital emergency rooms and other stat care facilities as clinics for chronic problems, instead of going to the doctor. This is because they wait until their difficulties with their health have reached a level where they need urgent care. If they had health insurance, this would likely not be as much of an issue. While it is true that some people with good health insurance and medical care do not go to doctors simply because they do not trust them or like them, many people who have health insurance will go to the doctor if they feel they really need to.

Those without medical insurance will often avoid doctors even if they know that they really should go, because they are unable to pay for it. Medicaid is facing many challenges because the population that is traditionally on Medicaid is already sicker than the population that has private insurance. Premium payments made to hospitals and other health-care facilities are also less than with traditional insurance. Medicaid is also having trouble finding a sufficient provider base. Many doctors and health-care institutions do not want to take Medicaid because they know that the individuals that are on it often need more care and Medicaid will not pay as well as private insurance does.

Many of the families on Medicaid need more than just medical care. Often they need decent housing, decent food, and mental health counseling or family counseling. Another problem with Medicaid is a short enrollment period. Many people who are on Medicaid are only on it for approximately eight months.

This complicates care somewhat because individuals that have chronic conditions often need care for much longer than that. Sometimes Medicaid is discontinued because the woman has had a baby, a child has reached a birthday, or the breadwinner of the house has gotten a small raise. These things may be just enough to push the person past the income level for Medicaid, but not really enough for them to afford insurance of their own.

A status report about the uninsured in the United States confirms some of the things that the above two documents have discussed. They use less doctor visits and more emergency room visits than those who do not have insurance. They are also more likely to be hospitalized with chronic conditions, and many of these conditions would better be controlled by consistent and reliable access to a good quality physician. Lack of health insurance carries with it an increased risk of mortality because many people ignore a condition until it gets to a critical stage before they go to a doctor.

They do this obviously because they cannot pay for it. The underinsurance is a little more difficult to discuss. According to this study, there are significant differences in what many people consider being 'underinsured.' For example, someone who has a low income and an insurance policy with a very large deductible will likely be considered to be underinsured. They cannot pay the deductible if they would need to. However, a person with a high income and the same policy would not be considered underinsured because they have the means to pay the deductible for their insurance without having financial difficulty. This is why it is difficult to study whether people are actually underinsured. Risk factors, income, and the specific benefits of the individual's health policy must all be considered.

The underinsured are usually adults who are under age 65, and their children. Many of the underinsured are working families and quite a few of them are single parent households. Many of these individuals will purchase insurance for their children if they can afford it, and have no insurance on themselves. This is somewhat easier to do because Medicaid tends to favor children. In other words, it is easier to get a Medicaid policy for a child that it is for an adult. Only very poor families with real need and an income at or below the poverty level can get a Medicaid policy for an adult.

Usually, Medicaid covers adults with a 'medically needy-share of cost' policy and many times the deductible for this policy is so high that the adult could not pay it anyway. Once again, they are underinsured, and this stops them from going to the doctor. However, if their child is on Medicaid they will usually take their child to…