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Health Care Economics
Groups Call on Congress to Act On Growing Ranks of Uninsured
Psychiatric News
Volume 38 Number 8 page 12-12

Former Presidents Gerald Ford and Jimmy Carter put aside their political differences and united as co-chairs of "Cover the Uninsured Week," which took place March 10 to 16.

Television scriptwriters for shows including "ER" and "Law and Order: Special Victims Unit" tried to raise consciousness about the issue through story lines.

APA was an official sponsor of the week. Other support came from major organizations such as the U.S. Chamber of Commerce, American Medical Association, AARP, United Way of America, and the Business Roundtable.

Sparking this show of unanimity was harsh news about the growing number of uninsured.

As a kickoff for the week, the Robert Wood Johnson Foundation released a report on March 5 that estimated that 75 million Americans under 65 years of age were uninsured sometime in 2001 or 2002.

According to the report, which was prepared by Families USA, almost two-thirds of these people were uninsured for at least six months, and nearly one-quarter (24 percent) were uninsured throughout the entire two-year period.

Researchers combined two U.S. Census Bureau surveys: the most recent Current Population Survey (CPS) and the most recent Survey of Income and Program Participation (SIPP). They differ from the Census Bureau’s annual CPS report, which is designed to show how many people were uninsured for all of the previous year. That report, "Health Insurance Coverage 2001," found that 41.2 million people were uninsured in 2001, an increase of 1.4 million from 2000. The U.S. Census Bureau released the report last September.

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Who are the uninsured? Not surprisingly, the answer depends on whom you ask.

At a meeting sponsored by the nonprofit Alliance for Health Reform on March 21, "Dynamics of the Uninsured: Finding Ways to Cover an Ever-Changing Population," Pamela Short, Ph.D., a professor of health policy and administration at the Pennsylvania State University, said that policymakers usually rely on data that report the number of uninsured at a point in time, instead of over a period of time.

The result, she said, is that so-called "snapshot" studies understate the number of people who are going to lose their health insurance over a period of time and overstate the number of people who are uninsured long term.

Moreover, those studies affect policy deliberations. She said, "When policymakers fail to recognize that many people move in and out of coverage, it’s very easy to design programs that will cause new uninsured gaps and cost more than expected."

Short said that thinking of "uninsured" in terms of gaps of time, instead of people, leads to such questions as, "How many of the uninsured would be covered if we got people onto coverage faster and kept them on longer? How many gaps can we eliminate?"

John Holahan, director of the Health Policy Research Center at the Urban Institute, challenged a conclusion drawn from "Health Insurance Coverage 2001."

According to that report, of the 1.4 million newly uninsured Americans, over half (800,000) had incomes of $75,000 or more.

New York Times reporter John M. Broden cited that figure to substantiate a claim that the lack of health insurance coverage was becoming a problem of the middle class.

Holahan, however, told the meeting attendees that the middle to upper classes did not account for most of the growth in the number of uninsured. Instead, 1.3 million of the 1.4 million newly uninsured Americans had incomes less than 200 percent of the poverty level.

He said that there are analytical problems with "Health Insurance Coverage 2001" that resulted in the erroneous conclusion that the additions to the uninsured group had come from the middle and upper classes.

The Census Bureau determines income level by combining the incomes of everyone living in a household and assuming they all have access to that income, when, in fact, some of them might be unemployed. In addition, the report did not adjust for inflation.

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APA has signed a joint resolution with the American Academy of Family Physicians, American College of Physicians, American Medical Association, and several other organizations urging Congress to pass legislation that would provide insurance for all Americans.

APA President Paul Appelbaum, M.D., said, "Universal, nondiscriminatory health care coverage is the ultimate answer to many of the problems our patients have accessing psychiatric care. Achieving this goal is particularly important now because states are trimming Medicaid rolls and denying health care to the poorest among us.

"In Massachusetts, where I work, the state has just thrown 43,000 people off Medicaid. This situation is unconscionable and demands immediate attention from Congress."

Numerous reports about problems related to the uninsured are posted on the Web at www.kff.org.

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