Statistics show that approximately 47 million of America's population lacks medical coverage, and another 38 million has inadequate health insurance. What these statistics imply is that one-third of Americans are insecure and unsure about whether they would afford healthcare if they fell sick or needed medical help today. The State of Texas tops the list, with an uninsured population of approximately 8 million, representing 25.1% of the total (Code Red, 2006). Minority groups form a bulk of the uninsured population (Wu & Ringwalt, 2005). The impact of a large uninsured population, however, is massive -- the uninsured affect both themselves and the communities in which they live, compromising the quality of care and placing everyone at risk. They do not often have a primary care physician, which means that they neither seek out medical care when they are supposed to, nor turn up for preventive care like routine check-ups and immunizations. The consequences of delayed treatment spread far and wide; the uninsured end up in emergency rooms, incurring hospitalization costs that would easily have been avoided, and eventually passing on the extra costs to the insured population, and the already-overburdened taxpayer.
Health Disparities of the Uninsured
Uninsured people "are less likely to receive adequate care, and when they do, it comes later with serious consequences such as increased mortality and lower quality of life" (Code Red, 2006, p. 46). The uninsured shun medical bills, which is why they do not seek out medical care when they need to; instead, they postpone care - waiting for their conditions to worsen to the point that they have to receive the most costly care in the emergency room. Anyone who has been in the U.S. long enough knows that it costs way more to treat a condition in the emergency room as opposed to the doctor's office. It makes sense, therefore, that most of these uninsured people receiving ER treatment are often unable to pay for the care they receive; and given their large numbers, the government is often unable to match the expenses, and the taxpayer bears the ultimate cost.
Emergency rooms are intended to handle trauma, urgent health conditions and sudden illnesses. The uninsured, however, who have no access to any other primary sources of care, impact the emergency department's ability and finances to handle the most serious cases, overburdening the local trauma systems, causing longer waiting time in emergency rooms, and consequently lowering the quality of emergency care for everyone else.
Just like they are unlikely to seek treatment when they are supposed to, the uninsured are less likely to turn up for preventive care and routine check-ups. They often are unable to catch things on time, perhaps because they are not aware of their health conditions, but also because they have no medical coverage and are afraid of medical bills. Conditions such as diabetes, cancer and hypertension have significant diverse outcomes; but these outcomes can be monitored and kept in check if the conditions are detected early enough. Prevention is always better than cure; and it indeed costs far much less to treat pre-cancer, pre-hypertension, and pre-diabetes as opposed to the disease once it has taken root.
The existing body of literature largely focuses on demonstrating why America has such a large uninsured population; and how federal policies such as Medicaid and CHIP have affected this population.
Who are the Uninsured?
Prentice et al. (2005) express that a bulk of the insured population comes from low-income working families. Blumberg and Liska (1996) support this view, asserting that despite their low incomes, most uninsured people "do not qualify for public assistance either due to categorical ineligibility or because their modest incomes still exceed eligibility cut-offs" (n.pag). 90% of those who happen to be uninsured come from low and middle-income. It is important to note that in comparison to children, adults are more likely to be uninsured - because the latter seem to benefit more from Medicaid and Children Health Insurance Program (CHIP) (Blumberg and Liska, 1996). The authors posit that a family's work details have little to do with its insurance status as 60% and 16% of uninsured people come from families with at least one full-time worker and one part-time worker respectively. Although uninsured rates vary from state to state, states in the west and in the south have often reported higher rates. Of crucial significance is that people from minority groups are more likely to be underinsured than the majority (Wu & Ringwalt; Abdullah et al., 2009). Blumberg and Liska attribute this to the fact that whites have a high likelihood of coverage (thanks to employer-sponsored insurance) than blacks (67% vs. 48%); and even though blacks are more likely to benefit from Medicaid programs, the leverage is never sufficient to offset employee-sponsored insurance.
Why is the Uninsured Population so large?
The most obvious reason is that health insurance is expensive, and hence, most people are uninsured not because they do not deem coverage necessary, but because the cost is too high (Blankenau, 2009; Gruber, 2008). Employer-sponsored insurance is the most common form of coverage, but then a bulk of the population is either self-employed, or working for small firms that may be in no position to offer health benefits; and even for those that do, the workers may not be able to settle their share of premiums (Gruber, 2008). For instance, last year, the cost of employer-sponsored family coverage stood at $16, 351 - twenty-nine percent of which was covered by a worker's premium share; not forgetting that this premium share had risen by a massive 80% between 2003 and 2013. CHIP and Medicaid provide coverage for children in low-income families, the elderly, pregnant women, and people with disabilities; however, a large portion of the low-income population is still left out, particularly because most states do not provide Medicaid coverage to parents and low-income adults without dependents (Swartz, 2009).
The Trend in Uninsured Levels
Swartz (2008) and Gruber (2008) contend that there has been a steady increase in the number of uninsured people over the last decade or so, due to the rising cost of healthcare and the massive reductions in employer-sponsored insurance. The 2008 financial crunch led to steep increases in the number of insured people, as most people lost both their jobs and employer-sponsored coverage. Federal interventions in the form of CHIP and Medicaid, however, prevented steeper drops, leveraging eligible Americans' incomes during, and immediately after the recession. The past two years have, however, seen the uninsured rate decline because of the expanded public coverage and the stabilization of employer-sponsored insurance.
Implications of Lack of Coverage
Since they often seek medical care when their conditions have spiraled to levels requiring emergency care, the uninsured often face huge, unaffordable medical bills, which quickly translate into medical debt given their low incomes and dismal savings (Blumberg and Liska, 1996). Uninsured patients often end up paying almost 40% of their healthcare costs out-of-pocket, and consequently putting a strain on their financial and physical well-being (Blumberg and Liska, 1996). This, furthermore, is the case if they indeed seek out medical care -- the uninsured are perfectly aware that they may not afford to pay for their medical care; as such, they develop anxiety and typically delay care, or forgo it altogether (Gruber, 2008; Blumberg and Liska, 1996). Abdullah et al. (2009) analyzed data from 23 million admissions over a period of eighteen years and found that 16,787 deaths and six million hospitalizations would have been avoided had the patients been covered. To this end, the authors reported that lack of insurance coverage produces "a 60% increased risk of mortality" (p.242).
Ethical Principles Guiding the Health Disparities of the Uninsured
Medical care observers have distilled the widely-shared beliefs about caring for the sick into four major principles, commonly referred to as the principles of medical ethics -- justice, autonomy, nonmaleficence, and beneficence (Macklin, 2003). These four "provide a sound and useful way of analyzing moral dilemmas" in the practice of medicine (Macklin, 2003, p. 275). The principles of justice, autonomy, and beneficence are particularly applicable in this case.
Beneficence: it is a healthcare provider's obligation to assist people in need (Macklin, 2003). To this end, a practitioner must strive to improve the health of their patients at all times, regardless of the situation. By either refusing to attend to a patient, or offering a patient dismal care because of their insurance status, a healthcare practitioner compromises this principle, and breaches their duty towards both the profession and the patient.
Autonomy: an informed adult patient has the right to control what happens to their body by choosing, and following their own plan of life and action (Macklin, 2003). It is the obligation of the healthcare practitioner to respect those decisions. Whether to take or not to take medical coverage is a decision of the patient; it is a choice they make in a bid to control their own destiny, and fit in the societal conditions in…