There are 45 million (17%) Americans without health insurance. Uninsured and special populations are experiencing problems mostly linked to unemployment, cost of health care, low income and decreased employer-based coverage. Also, many people are unable to find health insurance because of pre-existing health conditions. For some, citizenship status may also disqualify them for benefits. One example is Personal Responsibility Act of 1996, which prevents legal immigrant population and their U.S.-born children to receive certain benefits.
These people have since experienced decreased access to health insurance, among other problems. Uninsured and special populations are more likely to suffer from illnesses at advanced stages, require more acute care and hospitalizations, and have higher mortality rates because they have poor access to health care. There are many stereotypes and myths surrounding the uninsured and special populations. Some of these are that these people are not working, choose not to have insurance, are immigrants and get free or reduced health care services.
The uninsured are most likely to be:
Eight in ten uninsured come from working families. They are mostly poor Americans who earn less than $25,000/year. 79% of all uninsured are American citizens. 29.6% of the uninsured are without high school diploma as opposed to 8.7% of the uninsured with Bachelor’s degree or higher. They tend to be people ages 18-24 (30.2%) and mostly male (16.8%).
Who are the special populations?
In 1995, it was estimated that some 19% of the insured citizens are underinsured. These people have poor access to health care and higher out-of-pocket expenses. Others who fall in the category of the special populations are children, women, and chronically ill, homeless, mentally ill, racial minorities, medically indigent and elderly.
What Has Been Done?
Starting 1965, the U.S. government began to be actively involved in financing of the U.S. health care system through the creation of the public health plans that include Medicare, Medicaid, PACE, SCHIP, MHSS, VHA, and Indian Health Services (for Native Americans), among others. The federal and state governments share responsibility for the costs of the public insurance (mostly funded through taxes). Also, the government created federal mandates for health care facilities and individual providers to serve the uninsured and special populations. These are called “safety net” providers and include public hospitals, community health centers, private clinics and local health departments. However, the United States still has millions of uninsured citizens.
Most recently (2009), the U.S. government has taken serious steps to ensure that all legal U.S. citizens have health insurance. Among many provisions of the Affordable Care Act (ACA) there will be expansion of Medicaid, government assistance to small business to cover insurance costs (with 25 employees or fewer), and various prohibitions to insurers that in the past have excluded many from health insurance plans. One provision that has caused heated debates is the health insurance mandate. It requires that all citizens must buy health insurance or pay a penalty, and that all employers must offer health insurance benefits. The question that has been most often asked is whether the health insurance mandate is constitutional?
Opponents of Health Insurance Mandate
Majority of those opposing ACA, or what they call “Obamacare,” are members of the Republican Party, with minority of Democrats. They claim that the health insurance mandate is an attack on American people’s liberty. In his article, “At What Cost to Freedom?” Robert Moffit asserts what many who oppose ACA argue: the insurance mandate is unconstitutional because according to the Constitutional Article I, Section 8, the Congress has no authority to force Americans to buy any private good or service.
The health insurance mandate imposes a penalty of 2.5% of adjusted gross income to those who refuse to accept a health plan. The opponents also claim that there is an individual mandate punishing families with $3,800 if they choose a plan not approved by the government. Also, there is a high possibility of health insurance lobbying for their favored services to be included in the approved plans. The “Obamacare,” say opponents, imposes a hidden tax where those with health insurance will be required to pay for those without a health plan. “It is a way of taxing healthy people without calling it a tax.”
Supporters of Health Insurance Mandate
Those who support the PPACA are majority Democrats. They claim that the government’s health insurance mandate is constitutional based on the Commerce Clause that allows the federal government to “expand its power in various ways by defining various activities as ‘interstate commerce.’” The government is not claiming an individual’s property, but is providing a compensation for the health premiums paid by each person (health insurance). Therefore, the health insurance requirement does not go against the Fifth Amendment’s Taking Clause that states that the government cannot take a citizen’s property without compensation for it. The supporters of ACA compare the health insurance mandate to minimum wage mandate. Just like the health insurance mandate that requires premiums paid to insurance companies, the minimum wage mandate has private beneficiaries (employees), as well.
2010 Health Care Reform
The U.S. government signed into law the Patient Protection and Affordable Care Act (PPACA) in March 2010. It reforms the private and public financing systems, assists citizens with pre-existing conditions to find health coverage, and expands access to health insurance to millions of uninsured Americans. Detailed description of the PPACA can be found at: http://www.healthcare.gov/law/index.html Some of PPACA’s provisions began right at the enactment: Medicare drug rebates increased by 23%, an independent committee called Patient-Centered Outcomes Research Institute is established to analyze the effectiveness, and Indian Health Care Improvement Act has been amended and re-authorized.
In 2010, adults with pre-existing conditions are approved for temporary health insurance coverage until the insurance exchange of 2014. Also, in the same year some prohibitions on insurers have been imposed, such as new policies cannot carry lifetime limits on essential benefits (i.e. hospital stays), individuals with pre-existing conditions cannot be denied coverage, enrollees who become ill cannot be dropped from their health coverage, insurers’ administrative and executive expenditures must be revealed, and insurers will have restrictions on enforcing annual spending caps (completely outlawed in 2014).
I chose the U.S. government as the agency that represents the uninsured and special populations component of the U.S. Health Care System because I feel it has taken major steps to resolve the problem. Obviously, the fragmented system that the U.S. has had for a long time has not worked. Being the wealthiest nation on earth, the United States has spent most on health care. Also, in comparison to other developed nations, it has the largest uninsured population. According to the Congressional Budget Office, the PPACA is expected to reduce the national deficit by about $143 billion dollars in the next 10 years, and likely $1.2 trillion deficit reduction in the decade after. The population of uninsured is expected to decrease by 33 million. Already, in 2011, according to the U.S. Census Bureau, the number of uninsured between the ages 18 and 25 has declined by 1.6%. Also, some of the small businesses have offered health insurance to their employees for the first time.
The PPACA law raises many legitimate concerns among Americans (i.e. health insurance mandate), but there are some good benefits such as prohibiting bad insurer practices that contributed to the increase of uninsured populations. One example is dropping coverage for people who become seriously ill. In the past, people have filed for bankruptcy due to significant increase in personal health care costs. In fact, it is stated that 50% of all bankruptcies filed are related to health care debt. Although PPACA is not perfect solution for all our health care troubles, I consider the government’s new health care law, PPACA, to be a major step in helping Americans afford health insurance.