Non-Insured Individuals According to an

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 care must focus on prevention, better management of chronic conditions, and greater attention to the health and community-based support of persons with disabilities (Gulley, 2011).

The success of PPACA, and its provisions for people who are currently or chronically uninsured, will depend on reform of public programs as well as private insurance practices to create "new pathways to coverage (Gulley) and address the problematic link between employment and insurance coverage. In other words, employment should not be the only viable option for securing affordable insurance, nor should there be "significant work disincentives for people with disabilities" (Gulley). The law should help "reduce disparities in [healthcare] access (Gorin, 2010).

A number of provisions of PPACA have already taken effect. Beginning January 1, the law provided for a 50% discount on covered brand-name drugs. This provision was designed to close the coverage gap in Medicare Part D coverage, the so-called "Donut Hole." There is a 7% discount on generic drugs. The coverage gap will be completely eradicated by 2020, according to PPACA, making it even easier for people with limited resources to get the medicines they need ("Understand the affordable care act," 2010).

PPACA allows young adults to stay on their parents' plans until they turn twenty-six, unless they are offered a plan at work. With unemployment are record highs and the job market tough on young workers who have not yet developed sufficient skills or amassed enough work experience, this provision takes care of young adults as they strive to independence from their parents.

It provides a safety net while they establish themselves in the workplace and may allow them to put money in savings, towards large purchases such as cars or starter-homes, and toward student loans. All of these expenditures will help boost the economy. PPACA makes up to 4 million small businesses eligible for tax credits to help them provide health insurance to workers. The first phase of the provision gives a credit worth up to thirty-five percent of the employer's contribution to health insurance. Small non-profits can earn up to a 25% credit.

This provision is obviously good for insured individuals, but it also helps the bottom-line of the businesses. Better financial health of individuals and small businesses is good for the economy. States can now cover more individuals with Medicaid, thanks to an increase in federal matching funds. Individuals benefit from increased access, while states and the local economies within them benefit when more services are federally subsidized.

Ultimately, health care costs will go down for everyone when individuals can access primary care, for example, instead of relying on more costly emergency-room visits. More preventive care will reduce later needs for treatments and hospitalization. PPACA also includes new laws designed to address rampant Medicare fraud. According to HealthCare.gov, current efforts to fight fraud have returned over $2.5 billion to the Medicare FY 2009 trust fund. Continued efforts are expected to recover even more funds that are wasted and obtained fraudulently through Medicare and Medicaid.

Money saved in this way can provide more for legitimate care to the people who need it. The new law also created a provision to cover early retirees, who in the past could see their savings erode when they had to purchase coverage to see them through to age sixty-five, when they would be eligible for Medicare. Funded with $5 billion, the Early Retiree Reinsurance Program provides money through employer-based programs not only for early retirees, but for their spouses and dependents.

A Pre-Existing Condition Insurance Plan (PCIP) provides new coverage options for individuals who have been uninsured for at least six months because of a pre-existing condition. States can choose whether or not to participate in the program; if they opt out, a plan will be established by the Department of Health and Human Services in that state. Before PPACA, individuals with pre-existing conditions had no alternative. Now they do. The law includes a specific provision addressing the issue of pre-existing conditions in children.

New rules prevent insurance companies from denying coverage to children under the.