Posts Tagged ‘uninsured’

Commonwealth Fund Tackling Better Care for Uninsured, Minorities

Tuesday, October 18th, 2011

A new strategy report issued by the Commonwealth Fund Commission on a High Performance Health System  has the goal of creating a road map to improve healthcare for the uninsured, minorities and low-income Americans.

The commission, which looks for opportunities to enhance the delivery and financing of healthcare, recommends three broad strategies for achieving that improved care in the report, Ensuring Equity:  A Post-Reform Framework to Achieve High Performance Health Care for Vulnerable Populations.  The recommendations seek to assure the safety net’s stability and stimulate higher performance; strengthen delivery systems for susceptible populations; and coordinate healthcare delivery systems with public health services and community resources.

“Our current economic situation has increased the number and proportion of people who are vulnerable, leaving even more families at risk of suffering from our healthcare system’s inequities,” said Dr. David Blumenthal, chairman of the commission, and Samuel Their, professor of medicine and professor of health care policy at Massachusetts General Hospital/Partners HealthCare System and Harvard Medical School, Boston.

According to the report, there is a significant divide between vulnerable populations and their more secure counterparts in rates of receiving recommended screening and preventive care, control of chronic diseases, and hospital admissions for conditions that may be preventable with good primary care and community health outreach.  By way of example, only four of 10 low-income adults receive all recommended screenings and preventive care, compared with six of 10 higher-income adults.  Approximately three of 10 (29 percent) uninsured adults diagnosed with diabetes do not have it under control, twice the rate of the insured (15 percent).  Black adults are hospitalized for heart failure at rates (959 per 100,000) that are more than twice the rate for Hispanic adults (466 per 100,000); that’s nearly three times the rate for white adults (349 per 100,000).

“This policy framework builds on the great strides we expect to be made for vulnerable populations once the Affordable Care Act takes full effect in 2014,” said Commonwealth Fund Executive Vice President for Programs Anthony Shih, M.D. “By addressing crucial issues like access to care, affordability, quality improvement, and better coordinated care, these recommendations seek to assure that the uninsured, those with low incomes, and racial and ethnic minorities see the full promise of health reform and experience a truly equitable healthcare system.” 

“The Affordable Care Act is a big step forward in terms of addressing the significant needs of vulnerable groups and the healthcare providers who serve them,” said Commonwealth Fund President Karen Davis. “However, the inequity in our healthcare system is significant and” as defined in the Commission’s report, “more work must be done to close that gap and assure that we have a healthcare system that provides all of us with access to high quality healthcare.”

The Affordable Care Act: A Tale of Two Studies

Monday, May 23rd, 2011

A study of medical bills under the Patient Protection and Affordable Care Act (ACA) determined that most households will be able to afford premiums and related expenses after paying bills for food, child care, transportation and other necessities, according to the Commonwealth Fund. The mission of The Commonwealth Fund is to promote a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society’s most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults.

Approximately 8.5 to nine percent of American families living closest to the poverty line could not afford basic necessities and typical medical bills proposed by the health reform law.  The ACA requires individuals to purchase insurance by 2014, although with occasional exceptions.  The ACA restricts household out-of-pocket costs and subsidizes plans available through insurance exchanges to people with low-incomes.  Fewer households in high cost-of-living states could afford healthcare expenses, according to the Commonwealth Fund study.  The report included projections of spending on necessities, premiums and out-of-pocket costs for households between the federal poverty line and 500 percent of the threshold.  Those insured by safety net or state run insurance exchanges were not factored into the study.

Even with implementation of the ACA, some families across all income levels would continue to struggle to afford coverage because of steep out-of-pocket costs.  According to the report, 17 percent of families of four earning up to $44,700; approximately 25 percent of families earning between $44,700 and $67,050, would struggle with healthcare costs.  The data examines costs in 2014, the first year the ACA will be fully implemented and the start of state-based health insurance exchanges.  The law provides federal subsidies for the lowest-income people to buy insurance.  Americans with incomes between 133 and 399 percent of the poverty level are eligible for income-based tax credits.  Some low-income people will be eligible for subsidies to make up for out-of-pocket costs.  Americans who make less than 133 percent of the poverty level are eligible for Medicaid.

“The Affordable Care Act is very good news for millions of Americans who are struggling to afford health care, going without health insurance, or skipping the care they need because they can’t afford it,” said Commonwealth Fund President Karen Davis. “The new law makes health insurance and health care affordable for nearly all families, and introduces delivery system reforms that have the potential to greatly improve quality and efficiency.  If implemented well, new entities like accountable care organizations may bring even greater savings and affordability than this report predicts.”

Although the Commonwealth report is positive about the likelihood that more families will be able to afford health insurance, Craig Pollack, M.D., M.H.S., assistant professor of medicine at Johns Hopkins, and Katrina Armstrong, M.D., from the University of Pennsylvania, are not as upbeat about the ACA.  The physicians warn that as a result of certain provisions in the ACA, wealthy hospitals and physician practices might “cherry-pick” similar institutions and create Accountable Care Organizations (ACOs).  In this way, they can avoid poor and minority-heavy patient populations who will be treated elsewhere to cut costs.  ACOs encourage patients to seek care within their own network, which highlights the disparities between networks.

According to Pollack, hospitals and physician practices that treat too many minorities may be unable to join ACOs and will fall further behind in the cost and quality of care that is likely to occur in such networks.  “There is ample evidence of racial and ethnic disparities in healthcare,” Pollack said.  “Hospitals and private practices that care for greater numbers of minorities tend to have larger populations of Medicaid and uninsured patients.  These patients have less access to specialists, and their hospitals and practices tend to have fewer institutional resources than their counterparts.”

Nine Million Americans Lost Healthcare Coverage During the Recession

Monday, April 4th, 2011

The financial crisis not only robbed nine million Americans of their jobs – but also their healthcare insurance. According to a new study by The Commonwealth Fund, only 25 percent of Americans who lost employer-sponsored healthcare coverage succeeded at finding another source.  As a result, an estimated 52 million Americans did not have healthcare coverage in 2010.  Even though the federal government provides a subsidy, just 14 percent of people who lost their jobs continued their coverage through COBRA.

According to The Commonwealth Fund Biennial Health Insurance Survey of 2010, “Using data from The Commonwealth Biennial Health Insurance Survey of 2010 and prior years, this report examines the effect of the recession on the health insurance coverage of adults between the ages of 19 and 64 and the implications for both their finances and their access to healthcare.  The survey of 3,033 adults, conducted by Princeton Survey Research Associates International from July 2010 to November 2010, finds that in the last two years a majority of men and women who lost a job that had health benefits became uninsured.  Adults who sought coverage on the individual insurance market over the past three years struggled to find plans they could afford and many were charged higher premiums, had a health condition excluded from their coverage, or were denied coverage altogether because of a pre-existing condition.  Meanwhile, Americans with health insurance had higher deductibles and consequently greater exposure to medical costs.  And millions were struggling to pay medical bills, facing cost-related barriers to getting the care they need, or skipping or delaying needed care, including prescription medications, because of the cost.”

Just 50 percent of adults aged 64 or less are current with preventive care.  Fully 49 million employed Americans spent 10 percent or more of their yearly income on out-of-pocket costs and insurance premiums, a sharp increase from the 31 million reported in 2001.  Once the Patient Protection and Affordable Care Act (ACA) goes into full effect in 2014, the situation is likely to improve dramatically.  “These reforms have enormous potential to begin solving the problems identified in this report,” said Sara Collins, vice president of The Commonwealth Fund, a private foundation that promotes a high performing healthcare system that achieves better access, improved quality, and greater efficiency, particularly for society’s most vulnerable, including low-income people, the uninsured, minority Americans, children, and the elderly.

“The report tells the story of the continuing deterioration of healthcare accessibility, efficiency, safety and affordability over the past decade,” said The Commonwealth Fund president Karen Davis. “All this despite the fact that the United States spends more than any other country on healthcare.  Most recently it has failed the millions of Americans who lost their jobs during the recession and lost health benefits as well, leaving them with no place to turn for affordable healthcare coverage.  The silver lining is that the Patient Protection and Affordable Care Act has already begun to bring relief to families,” Davis said.  “Once the new law is fully implemented, we can be confident that no future recession will have the power to strip so many Americans of their health security.”

Of those people who attempted to buy an individual plan during the study’s timeframe — 19 million individuals – or 71 percent found it difficult or impossible to locate a plan they could afford and met their needs, were denied coverage or charged extra because of a pre-existing medical condition.  Adults with family incomes of less than $22,050 for a family of four were hardest hit with 54 percent having no healthcare insurance.  An additional 41 percent of families with incomes of between $22,050 and $44,100 had no coverage.  Of higher-income families, just 13 percent lacked healthcare coverage in 2010.

Conservative groups such as the Heritage Foundation are critical of the healthcare reform law.  The Washington, D.C.-based think tank wants changes made to the healthcare system to make it less reliant on government and to have individuals “own and control their own healthcare policies.”  Additionally, Heritage believes that the healthcare law will increase government spending.  “Of course there’s some people who will benefit from the law, but just focusing on individuals with benefits is misleading,” said Brian Blase, a policy analyst in health studies.  “You have to look at the law in its totality.”

Majority of Baby Boomers Under 65 Will Be Covered by Healthcare Reform

Tuesday, December 21st, 2010

Approximately 8.2 million of the 8.6 million uninsured baby boomers (Americans between the ages of 50 and 64) will have access to healthcare coverage in 2014, thanks to the passage of the Patient Protection and Affordable Care Act.  This is just one finding of a new study by the Commonwealth Fund, entitled Realizing Health Reform’s Potential:  Adults Ages 50 – 64 and the Affordable Care Act of 2010.

According to the study, 3.5 million insured boomers will be eligible for subsidized private insurance; another 3.3 million will qualify for Medicaid; and 1.4 million will be able to access non-subsidized private insurance.  Those without coverage will include approximately 377,000 undocumented immigrants.

Unemployment drives much of the baby boomers’ need for healthcare coverage.  The Commonwealth Fund study notes that “Losses in coverage in the 50 – to — 64 age group have been driven by record high unemployment.  Approximately 2.2 million workers aged 55 and older were unemployed in November 2010.  Unemployed workers between the ages of 55 and 64 had been jobless for an average of 45 weeks, the highest unemployment duration for any group under age 65 in this time period.  As a result, the number of uninsured people in this age group climbed in 2010 as options for affordable healthcare dwindled and family budgets became more constrained.”

The Commonwealth Fund said early provisions in the health reform law that could benefit baby boomers  also include the following:

  • Create high-risk pools for people with pre-existing conditions
  • Impose a ban on lifetime coverage limits and gradually eliminate annual limits
  • Cover preventive services
  • Create an early retiree reinsurance program
  • Create a new long-term care insurance program

Healthcare Reform to Provide Coverage for Millions of Young Adults

Wednesday, October 27th, 2010

12.1 million young Americans will get healthcare coverage in 2014. When the Patient Protection and Affordable Care Act is fully implemented in 2014, approximately 81 percent of young adults aged from 19 to 29 will have healthcare coverage, according to a report from the Commonwealth Fund. In fact, young adults comprise approximately 30 percent of the 32 million Americans who will finally have healthcare coverage in 2014.

The 12.1 million young adults expected to get coverage include 7.2 million who will be covered by a Medicaid expansion, and 4.9 million who will buy subsidized private insurance.  The law does not cover an estimated 1.8 million undocumented young adults, who are not eligible for Medicaid or subsidized insurance.  According to the Commonwealth Fund report, the crucial time to get coverage is when young adults graduate from high school or college.  Approximately 27 percent of young adults who don’t attend college lose their insurance; another 15 percent secure a new source of coverage.  For college graduates who entered the workforce, approximately 32 percent lost their insurance while 43 percent had access to a new source.

Uninsured Americans Total 9.4 Percent of the Population in 2009

Wednesday, October 6th, 2010

The number of Americans with no health insurance climbed in 2009, along with a rising poverty rate.As Congress debated healthcare reform, the number of Americans who lack healthcare insurance climbed approximately 9.4 percent to 50.7 million people in 2009.  According to U.S. Census Bureau statistics, 16.7 percent of Americans have no healthcare insurance compared with 15.4 percent — or 46.3 million people — the previous year.

During the same time period, the poverty rate in the United States rose to 14.3 percent, the highest level since 1994. The 2008 rate was just 13.2 percent.  This means that 44 million Americans – one in seven people – are living in poverty, an increase of four million over the previous year.  Children were especially hard hit, with one in five under the age 18 living in poverty, according to the Census Bureau.

“This is the highest number of uninsured since 1987, the first year that comparable uninsured data was collected,” said David Johnson, chief of the Census Bureau’s Household Economic Statistics Division.  The report includes conclusions from the 2010 Current Population Survey Annual Social and Economic Supplement.

Census Bureau statistics reveal that the number of Americans covered by private health insurance fell from 201 million to 194.5 million in 2009 compared with the previous year.  Employment-based health insurance fell from 176.3 million covered to 169.7 million.  Meanwhile, Americans with government health insurance rose to 93.2 million from 87.4 million.

ER Usage Study Shows Interesting Results

Tuesday, August 24th, 2010

Study has unexpected results on just who uses the emergency room the most.  Twenty percent of Americans visited a hospital emergency room in 2007, the most recent year for which the National Center for Health Statistics has data.  That includes approximately 7.4 percent of the uninsured who visited the ER multiple times, as did 5.1 percent of people with private insurance.  The most frequent ER visitors were Medicaid patients, with 15.3 percent reporting two or more visits in 2007.  A total of 116.8 million ER visits were made that year.

One third of adults in fair or poor health visited the ER at least once during the year and are the patients most likely to use that facility.  Patients over 65 reported more ER visits and described it as their customary source of healthcare.  Approximately 25 percent of individuals aged 75 and older visited the ER at least once in 2007.

The big surprise?  Contrary to conventional wisdom, the uninsured were not more likely to make non-emergency visits to the ER than other groups.  Approximately 10 percent fall into the non-emergency category whether the patient had private insurance, Medicaid coverage or no insurance.  Determining who visits the ER, the frequency and for what reasons requires examining complicated interactions among multiple factors – socioeconomic level, overall health, age, health insurance, access to healthcare and others.

“Our job is to provide the best numbers to inform policy and practice,” said Amy B. Bernstein of the National Center for Health Statistics.  “If people are concerned about the use of emergency rooms and how to make their use more efficient or effective, they should have accurate information about who is actually using them – and not who they think is using them.”

“Barely Hanging On”

Tuesday, May 11th, 2010

Study finds that middle-class Americans are losing their healthcare coverage.  Middle-class Americans are losing their healthcare insurance at a faster rate than other income earners. This finding was reported in “Barely Hanging On”, prepared by the University of Minnesota’s State Health Access Data Assistance Center.  The report was commissioned by the Robert Wood Johnson Foundation as part of its yearly Cover the Uninsured Week and analyzed data from the U.S. Census Bureau and the Department of Health and Human Services.

According to the study, three million fewer middle-income Americans had healthcare insurance provided by their employers in 2008 when compared with 2000.  Two-thirds of families earning between $45,000 and $85,000 a year were insured by their employers in 2008, a seven percent drop from 2000.

The study also found that costs had risen 81 percent between 2000 and 2008.  During the same timeframe, household incomes fell 2.5 percent.  Additionally, fewer workers were offered or could afford employer-provided coverage.

“America’s uninsured crisis means that hard-working people with average incomes are being squeezed,” said Risa Lavizzo-Mourey, the Robert Wood Johnson Foundation’s president and CEO.  “The fallout from rising health insurance costs hits everyone.”

Do the Right Thing

Tuesday, October 20th, 2009

3912_healthcare-debateA political paradox in the healthcare debate lies in the fact that some members of Congress – whose constituents will benefit the most from reform legislation – oppose the bill. A study by the Urban Institute found there are 20 congressional districts where more than 30 percent of the residents lack even the most basic form of healthcare coverage.  California, Florida and Texas are home to 18 of those districts.

In three Florida districts where the uninsured comprise one-third of the population, the Republican representatives are solid in their opposition to healthcare reform.  Republican Representative Mario Diaz-Balart, whose south Florida district has 31 percent uninsured residents, bases his opposition on the belief that none of the Democrats’ proposals will cover all of his constituents.  “My constituents, they also understand that they are the ones that get stuck with the bills,” he said.

On the opposite side of the aisle, Texas Democratic Representative Henry Cuellar, whose district is in 10th place on the uninsured list, fears that cuts in Medicare will be used to pay for the expanded coverage.  Cuellar’s district includes a significant senior citizen population.

By contrast, Southern California’s districts with the most uninsured residents are Los Angeles and Orange County, home to many immigrants and low-income groups.  These areas are represented by Democrats who support healthcare reform, which would provide significant benefits to their constituents.

Walgreen’s Reaches Out to Help the Unemployed

Tuesday, April 14th, 2009

The nation’s largest drugstore chain is helping the unemployed and uninsured take good care of their health at a time when they need it the most.  walgreens23Walgreen’s, which operates 6,679 drugstores in 49 states, the District of Columbia and Puerto Rico, is offering free clinic visits to the unemployed and uninsured through 2009.

Although patients still have to pay for prescriptions, people who lose their jobs and health insurance after March 31 will be able to get free treatment at Walgreen stores with Take Care clinics for conditions such as respiratory problems, allergies, infections and skin conditions, among other ailments.  These treatments typically cost $59 or more for people with no insurance.

According to Hal Rosenbluth, chairman of the Take Care Health Systems division, the plan is an experiment; he isn’t certain how patients will respond to the program or what it will cost the company.  What’s certain is that the move is likely to generate positive attention for the clinics.  The typical Take Care patient tells eight other people about the experience, so the move could bring in significant new paying customers.  Walgreen’s operates 341 Take Care clinics in 35 markets around the country, including Chicago, Atlanta, Miami and Cleveland.

walgreens1To receive free treatment, patients must present proof that they have lost their jobs, including a federal or state unemployment determination letter and an unemployment check stub.  They will be required to sign a form stating that they have lost their jobs and health benefits.