Health Disparities Among the Uninsured in America

Introduction: The Scale of the Uninsured Crisis

Statistics show that approximately 47 million Americans lack medical coverage, and another 38 million have inadequate health insurance. What these statistics imply is that one-third of Americans are insecure and unsure about whether they could 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 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 often do not have a primary care physician, which means they neither seek out medical care when they are supposed to, nor turn up for preventive care such as 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 ultimately passing those extra costs on to the insured population and the already-overburdened taxpayer.

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 avoid medical bills, which is why they do not seek care when they need it; instead, they postpone treatment — waiting for their conditions to worsen to the point that they must receive the most costly care in the emergency room. It costs far more to treat a condition in the emergency room than in a doctor's office. Most uninsured people receiving emergency room treatment are often unable to pay for the care they receive; and given their large numbers, the government is frequently unable to match the expenses, leaving the taxpayer to bear the ultimate cost.

Emergency rooms are intended to handle trauma, urgent health conditions, and sudden illnesses. The uninsured, however — having no access to other primary sources of care — impact the emergency department's ability and finances to handle the most serious cases, overburdening local trauma systems, causing longer waiting times, and consequently lowering the quality of emergency care for everyone else.

Just as the uninsured are unlikely to seek treatment when they should, they are also less likely to attend preventive care appointments and routine check-ups. They often fail to catch conditions early, partly because they are unaware of their health status and partly because they fear the medical bills that would follow. Conditions such as diabetes, cancer, and hypertension have significantly varied outcomes, but these outcomes can be monitored and managed if the conditions are detected early enough. Prevention is always better than cure, and it costs far less to treat pre-cancer, pre-hypertension, and pre-diabetes than to treat the full-blown disease.