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Health Care For All

Over 45 million Americans lack health insurance and about 30 million more are underinsured.1
The increasing financial instability of the managed care industry and the rising cost of premiums and prescriptions has cast doubt on whether any American’s health care is secure. Despite the nation’s massive healthcare spending, millions are uninsured or underinsured. Sadly, the current Congress will not even attempt to repair the system’s structural flaws. And even Americans who have health insurance are carrying a greater burden. Nationwide, average health insurance premiums for workers increased nearly three times faster than their average earnings between 2000 and 2004.2 Medical bills are now the primary cause of half of all personal bankruptcies.3
Employers deny healthcare coverage to millions of their employees.
The American healthcare system is based on the assumption that employers will provide health insurance coverage to employees—but more than a third do not offer insurance. In fact, 80 percent of the uninsured come from working families.4 Seventy percent are not even offered health coverage by their employers. Of the rest, 84 percent cite the high cost of health insurance as their reason for declining coverage. Only 55 percent of low-wage workers—those who earn less than $7 per hour—have access to job-based health insurance.5
Uninsured Americans often die prematurely because they don’t receive timely medical treatment.
Annually, 18,000 Americans die prematurely because they do not have health insurance to pay for preventive care and early treatment of disease, according to a comprehensive report by the National Academy of Sciences’ Institute of Medicine. Since they receive inadequate health care and are diagnosed later, the uninsured become sicker and die sooner. One study conducted over a period of 17 years found that the uninsured were 25 percent more likely to die early than those with private insurance.6
Medical care for the uninsured drives up healthcare costs for everyone.
Hospital emergency rooms and urgent care clinics are costly and inefficient sources of primary care. Yet, the uninsured are often forced to use them for even basic health problems. Facilities that treat the uninsured provide nearly $100 billion in healthcare services each year.7 To pay for unreimbursed costs, these facilities must increase costs to public and private insurance programs, which drives up rates for everyone. A Georgia study found that the cost of private health insurance premiums would be nearly ten percent lower if every citizen in the state were insured.8
In 2003, Maine enacted an innovative plan to encourage employers to expand health coverage.
Maine’s “Dirigo” plan allows enrollees—mostly individuals and smaller companies—to participate in a buying pool. By lowering and stabilizing insurance rates, participation in the pool offers the benefits of a larger group. The Dirigo plan also expands Medicaid to cover more low-income residents and provides subsidies to middle-income families, using a sliding scale based on ability to pay.
In 2006, Maryland and Massachusetts took unprecedented steps towards health care for all.
  • In January 2006, Maryland enacted Fair Share Health Care as a part of its ongoing Health Care for All campaign. The overall plan would require small employers to make a “fair share” contribution—4.5 percent of payroll—in addition to the eight percent for large employers enacted in 2006. Other pieces of the Maryland Health Care for All campaign would expand SCHIP and Medicaid eligibility to trigger federal matching funds, give individuals and families access to group purchasing power through a small group health insurance consortium, and increase the state tobacco tax by 50 cents per pack to raise Medicaid and SCHIP provider reimbursement rates. It would also create a quasi-public insurer to provide comprehensive and affordable benefits.
  • In April 2006, Massachusetts enacted a law that requires all residents to obtain health insurance. The Massachusetts plan uses state-funded healthcare expansions, a modest tax on companies that fail to insure their employees, and a self-insurance requirement in order to cover 550,000 uninsured residents.9
The Health Care for All campaign also provides a strong organizing model.
For five years, the Maryland Citizens’ Health Initiative has built support for the concept of universal coverage, reaching out to thousands of community groups, holding dozens of town meetings, and convening a task force of health policy experts. Over 1,000 health care, business, labor and civic organizations have endorsed the Health Care for All plan.10
Americans strongly favor health care for all.
An October 2003 ABC News/Washington Post poll found that Americans prefer universal health care to the current health system by a margin of two to one. Even more revealing is the fact that Americans favor guaranteeing health insurance for all, “even if it means raising taxes.”11 In spite of the public’s clear commitment to universal health care, it remains one of the most woefully neglected policy priorities of our time.

This policy summary relies in large part on information from Families USA and the Maryland Citizens’ Health Initiative.

Endnotes
  1. U.S. Census Bureau, “Income, Poverty and Health Insurance Coverage in the United States: 2003,” August 2004.
  2. Families USA, “Health Care: Are You Better Off Today than you were Four Years Ago?” September 2004.
  3. Kenneth Thorpe and Kelly Howell, “Financing Health Care for the Uninsured in Georgia: How Much are Georgia Residents Already Paying?” Emory University, 2003.
  4. John Holohan and Arunabh Ghosh, “The Economic Downturn and Changes in Health Insurance Coverage, 2000-2003,” Kaiser Family Foundation, September 2004.
  5. Families USA, “Going Without Health Insurance,” March 2003.
  6. Institute of Medicine, “Care Without Coverage: Too Little, Too Late,” National Academy of Sciences, 2002.
  7. Institute of Medicine, “Hidden Costs, Value Lost: Uninsurance in America,” National Academy of Sciences, 2003.
  8. “Financing Health Care for the Uninsured in Georgia.”
  9. For an excellent short explanation, see Community Catalyst, “Massachusetts Health Care Reform: What it Does: How it Was Done; Challenges Ahead,” April 2006.
  10. See www.healthcareforall.com.
  11. ABC News/Washington Post poll, October 9-13, 2003.
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