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Americans Confused About the Uninsured: Report

By Todd Zwillich
Originally published by Reuters, October 11, 2001

WASHINGTON (Reuters Health) — Popular myths cloud the public’s understanding of the problem of Americans who lack health insurance, concludes an Institute of Medicine (IOM) report released Thursday.

Americans remain largely disengaged from the issue, despite the fact that 14% of the population currently lacks coverage, according to the report. Most analysts expect the ranks of the uninsured—currently numbering about 38.7 million persons—to grow as the economy slows and fewer employers can afford to subsidize coverage for their workers.

“Much of what Americans think they know about the uninsured is wrong,” said Dr. Arthur Kellerman, a professor of emergency medicine who co-chaired the expert panel that produced the document.

Many Americans may believe that uninsured persons get adequate healthcare through emergency rooms or charity care at hospitals. The report cites several studies to the contrary, including one showing that uninsured people are less than half as likely as the insured to get needed care for serious medical conditions.

Studies also show that the public perceives the uninsured to be mostly young, healthy people who lack coverage by choice. But only 3 million persons between the ages of 18 and 44 fit that description, while 11 million more go without insurance because their employers offer coverage that is too expensive to purchase on an individual basis, according to the report.

Kellerman stressed that recent immigrants comprise only a fraction of the uninsured population, and that 80% of uninsured persons are employed or live in a house with someone who has a full-time job.

IOM is using the report to set the stage for a series of reports expected over the next 18 months. The reports will address the social, economic and healthcare costs of having nearly 40 million Americans without any healthcare coverage.

The reports will come as Congress continues to grapple with solutions to the problem. Some proposals involve tax credits to help uninsured workers purchase coverage, while others give credits to employers to help them buy policies for their employees. Many Democrats favor expanding access to government insurance programs like Medicaid and the State Children’s Health Insurance Program (SCHIP).

Meanwhile, President Bush has moved to expand the role of federally funded community hospitals in caring for people without coverage.

“A multi-faceted approach to this is likely,” Cindy Mann, senior fellow at the Kaiser Commission on Medicaid and the Uninsured, told Reuters Health in an interview.

Committee member Shoshanna Sofaer said that until a fix is found, academic and private hospitals, community health centers, charities and taxpayers will continue to bear the cost of healthcare for uninsured persons.

“That’s, however, a patchwork quilt that can easily fall apart at the seams,” said Sofaer, a professor of healthcare policy at Baruch College in New York City.

But the problem is expected to worsen as a faltering economy raises unemployment rates and dwindling profit margins strain employers’ ability to subsidize coverage for workers. Even employer-sponsored coverage may be out of reach for many full-time workers, Kellerman said.

“Does your job offer health insurance? If it does, can you afford 25% of the premium as a copay? I’ve got to pay rent. I’ve got to buy groceries to feed my kids,” he said.

The panel is expected to make policy recommendations, but not before its final report in Summer 2003. IOM president Dr. Kenneth Shine said lawmakers were unlikely to have finished their long struggle with the uninsured problem before then.

“If the Congress will solve the problem of the uninsured within the next 2 years, we’ll send up hosannas,” he said.