Research Proposal on "Healthcare for the Uninsured"

Research Proposal 6 pages (1691 words) Sources: 4 Style: MLA

[EXCERPT] . . . .

Healthcare and the Uninsured

According to the U.S. census bureau, as of 2008, nearly 47 million Americans are without healthcare insurance, a number which represents approximately 20% of the population under sixty-five years old (Wilper et al.). This number represents an increase in almost 10 million uninsured since the year 2000, when 38.2 million individuals were uninsured. During the period between 2007 and 2008, over 90 million Americans were without healthcare coverage for some period of time (Wilper et al.; Patel & Rushefsky). Individuals who do not possess health insurance are more likely to be hospitalized for preventable conditions, including pneumonia, type II diabetes, and various forms of late-stage cancers (Patel & Rushefsky). In addition to the health impact on these uninsured individuals, there is often a concomitant monetary toll on the hospitals and eventually the federal government when the uninsured are unable to pay (Harrington, Estes, & Crawford; Kotlikoff). Responding to this problem, the United States government is considering introducing healthcare legislation which will provide a public health insurance option for United States citizens (Wilper et al.; Marmor). The goal of this public option is to inject competition within the health insurance industry, improve health standards within the United States of America, and mitigate wastefulness and preventable health-related costs. This essay will examine the issue of uninsured Americans, the demographic and socioeconomic factors related to their lack of insurance and possible solutions for improving healthcare within the United States, including the America's Affordable Health Choices Act of 2009 which is currently being considered by congress.

Uninsured Americans

The uninsured population of Americans, nearly 47 million, is comprised predominantly of poor and near-poor individuals and families, constituting roughly two-thirds of total uninsured (Patel & Rushefsky; Harrington, Estes, & Crawford). This economic group is classified by an annual income under 200% of the poverty line (Patel & Rushefsky). Over 80% of individuals lacking insurance are members of a working class family, with frequently low-wage occupations that may include service workers, laborers, and small business employees. Young adults, foreigners, and minorities are also disproportionately represented within the uninsured population, of which nearly 33% are Hispanic, 20% are African-American, 18% are classified as other, and 10% are white (Patel & Rushefsky). The high percentage of minorities who are uninsured is likely linked to prevalent economic disparities and educational attainment.

Consistent with the relationship between education and economic success with healthcare coverage, uninsured individuals are more likely to possess a lower level of educational attainment than those with insurance (Patel & Rushefsky). Approximately 70% of the uninsured population has only attained a high school education or less, while about 17% have at least some college education. Fewer than 15% of uninsured Americans have a college degree. The education level of these individuals likely contributes to their work circumstances and subsequent lack of insurance.

Due to the expansive healthcare coverage of Medicare for elderly Americans, the majority of uninsured are under the age of 65. Similarly, the State Children's Health Insurance Program (SCHIP) assists in the coverage of otherwise uncovered children (Patel & Rushefsky; Kotlikoff). SCHIP is a government program which provides healthcare coverage for children whose parents work but are incapable of affording healthcare. Of the Americans between the ages of 18 and 65 who lack health insurance, individuals within the young adult age range of 18-34 are overrepresented.

Insurance and Employment

Acquiring private healthcare insurance is cost-prohibitive for many Americans and is often characterized by high premiums and diminished benefits (Kotlikoff). As such, the majority of insured Americans possess healthcare insurance as a result of occupation-related health benefits. Related to this phenomenon is that low-income jobs are less likely to provide health-insurance benefits, and so low-income workers who do not have insurance benefits from working are also less able to afford private healthcare insurance (Kotlikoff). As a result, few Americans who are uninsured possess the means with which to attain healthcare insurance.

Since the healthcare insurance is intimately linked with employment benefits, the level of uninsured Americans also fluctuates with the degree of economic prosperity of both the nation and the state (Patel & Rushefsky). Higher levels of employment frequently correlate with decreased percentage of uninsured Americans. However, this effect is not drastic, and even during years of significant economic prosperity, levels of uninsured are not dramatically ameliorated.

Consequences of Uninsurance

Americans which lack healthcare insurance are less likely to seek preventative treatment from a primary care physician compared to insured individuals, engendering a variety of subsequent health problems for those individuals and financial burdens on hospitals as a result of increased emergency care which isn't covered (Kotlikoff). Uninsured predominantly rely on emergency rooms for acute or severe conditions which may have been preventable. An inability to pay exorbitant costs for healthcare treatment often leads to financial costs which are frequently supported by local, state, and federal authorities (Kotlikoff). Hospitals will often engage in a practice known as cost-shifting to offset the cope with this burden, where as a result insured Americans pay higher premiums and are charged more.

In addition to the financial onus placed on hospitals, the health of uninsured individuals is adversely affected as a result of entering hospitals sicker, receiving fewer treatments, and taking shorter stays (Kotlikoff; Patel & Rushefsky). Late-stage diagnoses of cancers and absence of preventative of managing treatments for chronic diseases all contribute detrimentally to the health of insured Americans. The mortality rates of uninsured Americans is higher than those with insurance by as much as 40%, according to a Harvard Medical study released in 2009 (Wilper et al.). Uninsured women are also more likely to experience birth-related problems due to a lack of pre-natal care and decreased hospital stay (Kotlikoff).

Proposed Solutions for the Insurance Problem

Three major approaches which have been suggested to deal with the problem of Americans lacking healthcare insurance are expanding the current Medicaid or Medicare programs, providing health insurance tax credit/reductions for members of lower and middle class, and the institution of a national health insurance option (Kotlikoff; Marmor; Wilper et al.).

Medicaid is a healthcare program which currently provides some assistance in covering healthcare costs of impoverished and low-resource Americans. However, since eligibility is not dependent solely on financial status, over 60% of low income Americans do not qualify for assistance (Kotlikoff). Expansion of Medicaid may be an effective approach to increasing healthcare insurance for a significant portion of the uninsured Americans. Since up to half of Medicaid is funded via local and state budgets, the difficulty with this proposition is that expansion would place significant financial stress on the locality and state, effectively preventing expansion under the current Medicaid funding system. Medicare, however, is funded entirely by the federal budget, which would mitigate the financial impact on states (Kotlikoff). Expansion to early-retirees lacking health insurance was proposed by Bill Clinton during his terms as U.S. President but never came to fruition.

Tax credits and reductions have also been suggested as potential means with which to provide low income Americans with health insurance (Kotlikoff). Both Richard Nixon and George H.W. Bush have proposed this method for dealing with the uninsured. The difficulty with this approach is that the credits and reductions which have been historically proposed are too small to cover the expenses of private healthcare insurance and were not indexed to keep up with the rapid increase in healthcare costs and resulting premiums, thus lacking viability in effectively providing and sustaining for insurance-related costs (Kotlikoff).

The third major approach, providing a National Health Insurance system, is not novel but has recently been given new consideration during President Barack Obama's administration with the congressional bill "America's Affordable Health Choices Act of 2009." The bill would permit the U.S. government to offer healthcare plans financed exclusively by the associated premiums, thereby elevating the level of competition amongst insurance providers and… READ MORE

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