Report: Health Care Costs, Policies and Misperceptions Can Pose Obstacles to Obtaining Insurance

Article excerpt

The high cost of health insurance, along with public policies, prevents tens of millions of Americans from obtaining health care coverage, says a new report from the Institute of Medicine of the National Academy of Science.

A dip in the number of uninsured in 1999 and 2000 can be attributed in part to a stronger economy, but an increase is expected in the future because of rising health care costs and insurance premiums, a weakening economy and a growing population.

Barriers to Coverage

"More than the state of the economy, the rising cost of health care services and insurance premiums, combined with a hodgepodge of policies and practices, undermines affordability for employers, their workers, and the public at large," said Mary Sue Coleman, co-chair of the committee that wrote the report and president of the Iowa Health System and the University of Iowa, Iowa City. "Unless health insurance is made more affordable, the number of uninsured Americans is likely to continue growing over time."

With the cost of health care services and insurance premiums increasing, more employers and consumers may view coverage as prohibitively expensive, the committee concluded. Many employers absorbed premium increases during the economic boom of the 1990s, but they are not expected to continue this trend in the current, softening economy. Many lower-wage workers pass up coverage because they cannot afford their share of the premium.

On average, workers pay 14 percent of the cost of individual coverage and 27 percent of family coverage. Over the past 20 years, private-sector employers have become less likely to cover part-time or new workers. And small business, faced with hurdles such as higher group-premium rates, frequently do not offer coverage to their employees.

About 13.6 million of the uninsured work for employers that do not offer health insurance.

Public insurance programs such as Medicaid and the State Children's Health Insurance Program (SCHIP) present their own set of issues. Stringent eligibility requirements and enrollment processes make coverage difficult to obtain and even harder to keep, the report says.

"Our system of health care coverage functions more like a sieve than a safety net, with more and more people slipping through the holes," said committee co-chair Arthur Kellerman, professor and chair, department of emergency medicine, School of Medicine, Emory University, Atlanta. "Without coverage, roughly 40 million Americans face steep barriers to care and an increased risk of serious illness. …