By Alphonso Baldwin, Ph.D.
The Center for Studying Health System Change reports that the uninsured are less than half as likely to see or talk to a doctor, indicating that lack of insurance is a major barrier to uninsured individuals receiving needed medical care. Health insurance makes a substantial difference in the amount and kind of health care people are able to afford, as well as where they obtain care. This is an important health policy issue, as a large number of physicians do not accept patients on Medicaid or without health insurance. Additionally, the Community Tracking Study Physician Survey demonstrates a decreasing trend in the proportion of physicians who provide charity care - from 76.3% in 1996 to 68.2% in 2004-05, the latest data available.
Although most insured Americans are members of working households, traditional employer-based coverage does not always meet their needs. Employer-sponsored health insurance is voluntary: businesses are not legally required to offer a health benefit, and employees can choose not to participate. The smaller an employer in terms of employees and revenue, the greater the likelihood that health insurance will not be offered as a benefit. Two employment trends add to the problem of those facing a lack of health insurance coverage: the increase of part-time, temporary, or contract positions and the decline in access to employer-provided health insurance.
A report from Families USA placed the cost of care that Pennsylvania uninsured could not pay in 2005 in excess of $1.4 billion. The impact of health premium costs for the uninsured in Pennsylvania on private employer coverage for 2005 amounted to $277 per covered employee and $681 for employees with families.
Forty-eight million uninsured Americans are predicted to have received some $43 billion in what is known as "uncompensated health care" in 2005. The Pennsylvania Health Care Cost Containment Council defines uncompensated care as a combination of the costs of charity care, which hospitals provide for free to patients who are unable to pay for their care, and the delivery of inpatient and outpatient care to patients who pay none or only some of their hospital bills. The average statewide uncompensated care rates have remained relatively constant at about 2.1% for the last three years. However, even within a given county, the uncompensated care rate may vary greatly, and the burden of uncompensated care also varies by location and services. For example, within Region 1, uncompensated care rates in 2004 ranged from 0.76% to 9.25% among healthcare delivery systems.
Hospital uncompensated care is linked to the socioeconomic status of the communities served. An interesting observation is that, within Pennsylvania, uncompensated care rates are lower in counties that border the large metropolitan areas of Pittsburgh and Philadelphia. However, within the county of Philadelphia, the uncompensated care rate is actually higher than in any other county. The uninsured continue to cause concern within our society not only in terms of improved health status but also in terms of productivity and equitable distribution of resources. Often the uninsured individuals seek care through the emergency departments of hospitals, which is very costly, less efficient, and does not provide the benefits of ongoing care.
The ongoing debate on universal health coverage for Americans must be framed in the context of whether we choose to pay for healthcare coverage before or after the occurrence of a debilitating illness. The current uninsured picture is financially clear: we pay now, or we pay at much higher costs later.