More than 2 million Americans lost their health insurance when
they lost their jobs during the past year.
That's more than at any time since 1992 and brings the total
number of people without coverage to more than 41 million. That
number exceeds the aggregate populations of 23 states plus the
District of Columbia.
True, the number of uninsured tends to spike during economic hard
times. But the problem has been exacerbated by healthcare costs,
which are now rising at five times the rate of inflation. As a
result, experts predict that even more employers - who provide most
Americans with their insurance - will continue to cut back coverage,
if not eliminate it altogether.
"This is the top health problem in the United States, and it's
the issue of conscience in the American healthcare system," says Ron
Pollack, the executive director of Families USA, a nonpartisan
healthcare advocacy group in Washington.
But as the problem grows to what many perceive as crisis
proportions in America's middle class - the vast majority of the
uninsured are working people - so, too, does hope that after a more
than a decade of failed proposals and fierce turf battles, Congress
may find a workable compromise.
In their budget proposals, both the White House and the Senate
have earmarked more than $90 billion over 10 years to expand health-
insurance coverage. While there's no consensus on how to spend it,
there is broad agreement, particularly among the major stakeholders
in the healthcare system - from doctors to hospitals to health-
insurance companies - that something must be done, and soon, to
prevent an even greater healthcare crisis.
Employers ready for change
The business community is on board as well. As the number of
uninsured grows, the problem feeds the already-spiraling costs that
companies face in insuring workers.
"Employers see health coverage as vital to having a productive
workforce, but it's becoming more and more difficult to provide,"
says Kate Sullivan, director of healthcare policy for the US Chamber
of Commerce. "Many are seeing their health insurance premiums go up
between 25 and 40 percent for the third and fourth years in a row."
To understand the complex relationship between the number of
uninsured and overall healthcare costs, it helps to think of the
American healthcare system as one of Rube Goldberg's complex
machines - where one push of a button can set off a whole series of
unexpected events. For instance, when a person loses health
coverage, it has an indirect but very real impact on the ability of
almost all businesses to provide coverage.
Studies have shown that the uninsured tend to delay care for what
doctors would consider small problems until they reach crisis
proportions. Then they go to the emergency room, which is the most
expensive and inefficient place to get healthcare. Because the
uninsured often can't afford to pay the cost of the care, it becomes
what's called "bad debt." Hospitals simply have to absorb those
costs, and they often do it by increasing what they charge for the
services to people who do have insurance.
That's called "cost shifting" in the trade, and it, in turn,
feeds the spiraling insurance costs, which make it more difficult
for employers to provide health insurance - which ultimately
increases the number of people who are uninsured. …