Millions of Americans continue to go without health care coverage. After two years of declines, the number of uninsured Americans increased by 1.4 million in 2001, with over 41.2 million Americans " 14.6% of the population " lacking health insurance. The increase is due in large part to the drop in those covered by employer-based plans.
More Americans may become uninsured: The strong economy and low unemployment rates of the 1990s helped more Americans gain health insurance coverage. But the weak economy, increasing joblessness, and rising health care costs have reversed that movement. If those conditions continue or worsen, the ranks of the uninsured will swell. One estimate puts the number at 46 million nonelderly Americans by 2005, and 53 million by 2010, given the current rate of growth.
Health insurance premiums paid by employers increased an average of 11% in 2001 and 12.7% in 2002, far beyond the rate of inflation. With estimates as high as 15 percent in 2003, we could be facing annual double-digit increases for the foreseeable future. If that occurs, some employers - particularly small employers - could discontinue providing health insurance coverage to their workers entirely, while others will pass the increased costs on to their employees, causing many workers to forgo coverage.
While uninsured families may qualify for coverage under Medicaid or the State Children's Health Insurance Program (SCHIP), most states are currently experiencing severe fiscal crises, and their state Medicaid budgets are unable to absorb large increases in the number of uninsured. Forty-nine states have already passed or proposed cut-backs in public health care programs for the poor in 2003 two-thirds of the states are on their second round of cuts. And, federal funding for the SCHIP program will decrease temporarily in FY 2003 through 2005, placing additional pressure on state health care budgets.
Who are the uninsured? By and large, it is working Americans or their family members.
- 84% of the nonelderly uninsured are from working families " 62% are in families with at least one full-time worker " and more than one-half are in low-wage families with incomes below 200% of the federal poverty level.
- More than 8 million children are uninsured " and 84% of them live in households headed by a working adult.
The prospects for Congressional action: The last Congress focused on three health care issues -- a patient"s bill of rights for HMO participants; adding a prescription drug benefit to Medicare; and incremental efforts to expand health care coverage to the uninsured but little was achieved in any of these areas. Many believe the 108th Congress will pursue a more serious health care agenda, and at the very least will pass some kind of Medicare prescription drug benefit. There will also be pressure on Congress to take action this year to expand coverage for the uninsured. But the worsening budget situation and the cost of the war on terror and the impending war in Iraq will leave little if any new resources available for new health care initiatives by Congress. Any successful proposals are likely to be relatively modest there is also disagreement over what form these modest efforts should take. Proposals under consideration include giving health insurance tax credits to individuals who purchase their own insurance, expanding public health programs, or a bill with elements of both.
Tax credits: The President's FY 2003 budget proposed funding for refundable tax credits to allow low-income households to purchase health coverage in the open market. The maximum dollar value of the credit would be $1,000 for individuals, and $3,000 for families. Individuals with incomes below $15,000 would be eligible for the full credit, which phases out at $30,000. Families with annual incomes below $30,000 would be eligible for the full amount of the credit, which phases out at $60,000.
Expanding existing programs: Many in Congress prefer to expand coverage by increasing enrollment in public health programs such as Medicaid and SCHIP, and by subsidizing the purchase of COBRA coverage for unemployed workers.
Other legislative proposals: Congress could take action on Medical Savings Accounts; expanded funding for community health centers; and restoring access to SCHIP and Medicaid for legal immigrants. While they may not be acted on, there will also be proposals for broader health care reform.
The USCCB has consistently worked for access to affordable and adequate health care for all. (See USCCB statements Health and Health Care and A Framework for Comprehensive Health Care Reform).
The USCCB is working with other Catholic organizations to place the issue of comprehensive health care reform at the top of the national agenda. The Catholic Health Association (CHA), in consultation with the USCCB and others, has put forward its framework for health care reform, Continuing the Commitment: A Pathway to Heath Care Reform.
What You Can Do
- Contact your Senators and Representatives and urge them to take action to help uninsured Americans, and to start taking steps toward achieving affordable, accessible and adequate health care for all by insisting on resources for health care programs in the fiscal 2004 budget plan.
- Take steps to make sure your community is aware that covering the uninsured remains a serious and growing problem. The USCCB and the Catholic Health Association of the United States are participating in a public awareness campaign called Covering the Uninsured Week. The week-long series of events from March 10-16, 2003 is intended to increase awareness of the crisis of the uninsured. Check out the USCCB and CHA websites for more information on how to participate in your area.
- Contact USCCB, CHA, CCUSA and other community resources to learn about what bills are active in Congress and whether they will truly help more uninsured people gain health coverage
For More Information
USCCB: Kathy Curran, 202-541-3188, firstname.lastname@example.org; www.usccb.org
CCUSA: Lisa Smith, 703-549-1390, x160, email@example.com; www.catholiccharitiesusa.org
CHA: Alyssa Keefe, 202-721-6311, firstname.lastname@example.org; www.chausa.org