When it comes to health insurance, more Americans are falling through the cracks.
“It’s the 47-million-person question,” says Deborah Freund, a healthcare expert at the Center for Policy Research of Syracuse University.
Consider these statistics:
- Nationally, 45.7 million people were uninsured last year, according to a report from the U.S. Census Bureau.
- Many experts, like Freund, say that figure now is closer to 47 million. That’s up from about 30 million in 1987.
- The uninsured make up about 16 percent of the population — or one in six.
- In Onondaga County, nearly 50,000 people younger than 65 are uninsured, according to U.S. Census Bureau figures from 2005.
- That’s 12.8 percent — or one in eight.
And with a recent rise in unemployment, experts expect more Americans to be without insurance, because most people get it through their employer.
For people who lose their jobs, options are limited, said Karyn Schwartz, a senior policy analyst at the Kaiser Family Foundation, an independent healthcare policy research group. The programs designed to help folks keep their health insurance after getting laid off are often too expensive, she said.
About 59 percent of people who have health insurance get it through their employer, according to U.S. Census Bureau statistics. That’s more than 177 million people.
Those numbers have spurred President-elect Barack Obama to push ahead on campaign pledges of a major healthcare overhaul. Obama created a new White House Office of Health Reform and appointed as its director Tom Daschle, the former Senate majority leader from South Dakota. Daschle was also appointed secretary of health and human services.
Obama will be inaugurated President on Jan. 20. Here are some basics of his healthcare overhaul:
- Expand Medicaid, the taxpayer-funded healthcare plan for the needy, and the related program for children, to include more people.
- Require health insurance companies to cover people with poor health, the so-called “pre-existing conditions” that often are excluded for coverage.
- Require employers who don’t offer health benefits to pay into a separate national healthcare program through which employees could buy coverage. The plan would be called the National Health Insurance Exchange. It would be a type of community fund.
Key players in the debate — hospitals and doctors, insurance companies and businesses —each agree more people should have health insurance. They disagree on what should be done and how much it should cost.
The most controversial part of Obama’s plan is its “employer mandate” requiring employers to chip into the national program through which workers could buy insurance.
Area hospitals and the local medical society haven’t endorsed or opposed Obama’s plan. They say they are more united in efforts to improve the quality of healthcare and keep costs down.
For Mark Scherzer, the lawyer for the advocacy group New Yorkers for Accessible Health Coverage, Obama’s plan is the best way to get more people insured. It could make health insurance for everyone in upstate New York a reality, he said.
“It would come together into something that’s as close to what we consider universal coverage as possible,” said Scherzer.
But Obama’s plan doesn’t cover all the uninsured. It would leave about 6 percent of the non-elderly population without health insurance, according to a report from the Urban Institute, an independent research group for public policy.
For insurance companies, many of them haven’t taken a stand on the Obama plan, said Freund, of Syracuse University. She’s also a board member for the holding company of Syracuse-based Excellus Blue Cross Blue Shield.
“Insurance companies have a wait-and-see approach,” she said. That’s because the companies could become key players in the national insurance program through which workers can buy coverage.
Private insurers are staking out some ground in the ongoing debate. Excellus Blue Cross Blue Shield proposed a plan for insurance companies to administer taxpayer-funded healthcare programs.
Working with the existing system of private insurance carriers is the best route, the company said in a report issued last year. The company’s proposal would have private insurance companies doling out the tax-supported Medicaid and pooling it with private insurance for people who don’t get it through their employer.
The result would be cheaper insurance packages for the working poor, who could then afford regular checkups and avoid big hospital bills, the report said.
It would be cheaper, the insurance companies say, because they make money by pooling large groups under the same type of coverage. The bigger the group, the more likely the premiums paid by customers will add up to more than medical costs when the customers get sick. That’s why it’s more expensive for smaller employers and individuals to get insurance, experts say.
But the industry’s track record in saving money in public health care programs is questionable. In November 2008, for example, several studies found that the increase in the use of private plans had raised cost for that share of Medicare, the tax-supported health insurance for the elderly. In one study, the Medicare Payment Advisory Commission, a federal panel that reports to Congress, found that on overage the government paid 13 percent more to private health insurance to cover Medicare beneficiaries than it paid to cover those in traditional Medicare.
For businesses in Syracuse, Obama’s national health insurance plan puts an unfair tax on employers who can’t afford to offer heath insurance, a spokesman for the Greater Syracuse Chamber of Commerce said.
“It’s just another way of taxing the employers. There’s got to be a better way,” said Paul Muoio, president of the chamber’s Benefit Specialists of New York, an agency that helps businesses provide health benefits to employees.
Employers started offering health benefits in the 1950s as a way of attracting and keeping the best workers, Muoio said. But fewer and fewer companies now offer health insurance. Companies have to stop offering the benefits when they can’t afford the rising costs charged by the insurance companies, he said.
Those costs increased by 5.5 percent for small businesses in 2007, according to a report by the National Coalition for Health Care. Employers were charged an average of $12,100 for a family of four.
If an employer can’t afford those rates, they can’t afford to pay into Obama’s insurance program either, Muoio said.
A better option is to require individuals to buy health insurance, much like the way states require drivers to have auto insurance, Muoio said. It could be done by giving tax breaks or other incentives for people who don’t get insurance directly through their employer, he said.
That was a part of the healthcare plan proposed by Sen. John McCain, R-Ariz., in the presidential campaign.
For the doctors in Syracuse and the hospitals they work in, the reason for wanting more people with better insurance is simple: Getting paid.
The uninsured often end up in emergency rooms, said Gerald Hoffman, executive vice president of the Onondaga County Medical Society. The hospitals treat them, but emergency healthcare is expensive and hospitals lose money, he said.
The doctors’ association hasn’t taken a position on Obama’s plan, Hoffman said. But, he said, the American Medical Association — the country’s largest doctors’ group — wants to preserve the role of private insurance companies. That would mean a system similar to what the insurance companies are proposing, with the existing carriers administering taxpayer-funded health coverage.
To fund his healthcare plan, Obama has said it would cost between $50 billion and $65 billion a year. Spokesmen for the Government Accountability Office and the Congressional Budget Office said the government agencies haven’t researched whether that’s a reasonable estimate.
For Freund, the Syracuse University expert and insurance company board member, the biggest loose-end of Obama’s plan is a failure to tackle questions about healthcare quality.
“Nobody’s talking about quality,” Freund said. “Cost problems are related to quality.”
(Ed Jacovino is a senior majoring in newspaper journalism and anthropology.)
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