2003
Primary Health Care Policy Fellowship

Increasing Access to Health Care and Health Insurance For the Working Uninsured

 

Darlene Lawrence, MD
American Academy of Physicians

Harry Lowd, III
National Rural Health Association

Scott Meit, PsyD
American Psychological Association

Mary Anne Miller, RN, MPH
Association of State and Territorial Health Officials

Laura Sessums, JD, MD
American College of Physicians/Society of General Internal Medicine

Cathryn Wright, RN, MSN, CFNP
American College of Nurse Practitioners

Increasing Access to Health Care and Health Insurance For the Working Uninsured

Problem:

Nearly 60% of the more than 41 million uninsured Americans are employed. [1] Broad national policy objectives of encouraging work compel a focus on the working uninsured to allow them to remain healthy and a productive part of the workforce, particularly during this difficult economic period.

Proposed Solution

By capitalizing on existing public/private partnerships, our two-pronged approach to this problem aims to increase access to health care and insurance. It relies on currently funded resources to achieve goals of the Department's 2003-2008 Strategic Plan [2] and President Bush's Initiative to Expand Health Centers[3] as follows:

Partner with Community HealthCorps, [4] a national Americorps service program linking medically underserved populations and communities with culturally appropriate preventive and primary care, to marshal this "army of compassion" to develop an Internet database of private health insurance resources, governmental health insurance eligibility criteria and application information, prescription drug resources and local affordable health care, especially Community Health Centers (CHCs). Local HealthCorps workers, based in public libraries, CHCs, local telephone help lines and other community agencies would utilize the database to assist the uninsured in navigating the maze of our currently fragmented system, locating accessible and affordable or free health care resources, and

Add the number of employed uninsured as a factor under "barriers" (PHS 5161, attachment D) in the Bureau of Primary Health Care (BPHC) measurement system for community health center (CHC) grants. This alteration to the BPHC needs assessment would strengthen the application for funding for CHCs in places where the uninsured employed are found in great number.

Background

The problem of the uninsured in America is a significant and growing problem. Over 80% of uninsured Americans (24 million) are part of a working family (79% are employed on a full-time basis and over 20% work part-time). [5] Lack of health insurance for working Americans increases health disparities by affecting racial and ethnic minorities disproportionally.[6] The Institute of Medicine states that Americans without health insurance receive less preventive medical care, live sicker, and die younger than other Americans. [7] For working uninsured Americans, decreased productivity, wage reductions and diminished labor force participation are additional potential consequences of their lack of health insurance. [8]

Reasons for a worker's lack of health insurance are many, but commonly include: employers' failure to offer insurance (small business, part-time worker), difficulty obtaining insurance because of self-employment, frequent job changes, and affordability. The uninsured are often not aware of the risks of being uninsured, nor the multiple private insurance products and many options for affordable or free medical care available to them. [9]

Our proposal would both increase opportunities for grant funds for CHCs who serve the working uninsured and, by providing navigational assistance, result in increased access to insurance and affordable health care for the working uninsured. According to the Institute of Medicine, medical bills are a factor in nearly half of all personal bankruptcies and the cost of unreimbursed care by health care providers is, in part, shifted to paying patients by increasing charges.[10] By reducing medical bills and the burden of charitable care by financially strapped health care institutions, this proposal could reduce the economic burden of medical care on families and communities.

  1. US Census Bureau (2002). Fact sheet on the uninsured: "Do uninsured People Work?" by Cover the Uninsured Week at http://www.coveringtheuninsured.org/factsheets/display.php3?FactSheetID=25
  2. "Goal 3: Increase the percentage of the Nation's . . . adults who have access to health care services, and expand consumer choices." HHS Strategic Goals and Objectives - FY 2003-2008 "Final Draft" - as of May 2003 available at http://aspe.hhs.gov/hhsplan/index.shtml. The objectives under Goal 3 include the following: "[c]reate new, affordable health insurance options"; "[s]trengthen and expand the health care safety net"; "[e]liminate racial and ethnic health disparities".
  3. Beginning in FY 2002, President Bush's Initiative to Expand Health Centers "will increase health care access to 1,200 of the Nation's neediest communities through new and/or significantly expanded health access points over five years." These "access points" will provide "comprehensive primary and preventive health care services in areas of high need that will improve the health status and decrease health disparities of the medically underserved populations to be served." BPHC Program Information Notice 2003-1. As a part of his Initiative, President Bush reauthorized the consolidated Community Health Center program in October, 2002, authorizing the program through 2006 and raising the authorization level to $1.3 billion. P.L. 107-251.
  4. Community HealthCorps was established in 1994 by the National Association of Community Health Centers, Inc. with funding from Americorps to expand services to medically underserved communities. Community HealthCorps members currently generally enroll for a year and serve in Federally Qualified Health Centers providing outreach to the medically underserved and helping to improve access to quality health care.
  5. See endnote 1 above.
  6. Nearly 40% of Hispanic workers are uninsured, versus 25% of black workers and only 15% of white workers. Medical Expenditure Panel Survey (MEPS) Highlights #7: Uninsured Workers - Demographic Characteristics, 1996 at http://www.meps.ahrq.gov/Papers/HL7_99-0007/HL7.htm.
  7. Care without Coverage: Too Little, Too Late. Institute of Medicine, May, 2002. See also fact sheet on the uninsured "What are the Consequences to Individual?" by Cover The Uninsured Week at http://coveringtheuninsured.org/factsheets/display.php3?FactSheetID=5.
  8. Sicker and poorer: The Consequences of Being Uninsured. Kaiser Family Foundation. (May, 2002, chapter 9 p82) http://www.kff.org/content/2002/20020510/4004.pdf . The data also supports the conclusion that poor health of a family member reduces the labor force participation of the caregiver. One study suggested that providing health insurance to for children could allow greater workforce participation by the mother (p. 85). See also Executive Summary, A Shared Destiny: Effects of Uninsurance on Individuals, Families, and Communities, Institute of Medicine, March, 2003, p. 2 (health insurance lessens disparities in access).
  9. The Uninsured: A Study of Health Plan Initiatives and the Lessons Learned. National Institute for Health Care Management. March, 2003, p. 8.
  10. Executive Summary, A Shared Destiny: Effects of Uninsurance on Individuals, Families, and Communities, Institute of Medicine, March, 2003, p. 3, 6. See also On Campus Resources Guide p. viii-ix, Cover The Uninsured Week, available at http://www.covertheuninsured.org.

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