Health Care: It's All About Access

Access: noun, The right or opportunity to use or benefit from something.

Jeanne M. Lambrew, Senior Fellow at the Center for American Progress and an associate professor of public affairs at the Lyndon B. Johnson School of Public Affairs at the University of Texas, is a specialist in health care and policy. She conducts research on the uninsured, Medicaid, Medicare, and long-term care. On March 5, she delivered a stirring and fact-laden testimony before the United States House of Representatives on the subject of health care access. (Full text of the testimony along with a downloadable PDF version is available on American Progress.)

One wonderful thing about the Lambrew testimony is her ability to put things into realistic terms. For example, we often hear the statistic "47 million uninsured Americans" quoted throughout the media and the web (including here on this blog), but her testimony provides illustrations of just how much of the population that represents:

Nearly one in five of all Americans reports needing health care but not being able to access it due to cost. This largely results from lack of health insurance. About one in six Americans lacks health insurance at any point in time. To put this into perspective, 47 million uninsured Americans is double the number of people with diabetes. It is also more the number of people who live on the entire west coast of the United States or in Canada (Figure 1). This estimate does not capture all the people affected by gaps in coverage. Looking over a two-year period, a government study found that 82 million – one-third – of all non-elderly Americans experienced a gap in coverage (Figure 2). Research suggests that access for people with short gaps in coverage is more similar to the long-term uninsured than insured population.

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The entire testimony is well worth the read. As you can see from the slideshow above, she covers a lot of ground dispelling misconceptions such as the demographics of the uninsured. (Did you realize that four out of five uninsured are not below the poverty line, but rather are from working families?) She covers economic and racial disparities, analyzes trends that have contributed to to these "grim statistics," and examines the differences the issue takes on as you cross state lines.

She closes with three comments on approaches to reform which I will summarize here:

1. The paramount importance of addressing coverage and cost issues together.


2. To be effective, any solution must be national in scope. 50 different reform efforts would add hopeless complexity to an already complex situation.


3. The perfect should not be the enemy of the good. Purism should not be stressed over pragmatism.
   

My own summation of this moving and erudite assessment of our current health care "non-system" is that it is well worth the read. Drop us a line and let us know what you think about it.

SOURCE: "Access to Health Care: Testimony Before the House Committee on Appropriations, Subcommittee on Labor, Health and Human Services, and Related Issues" 03/05/08
photo courtesy of Ben Zvan, used under this Creative Commons license

Veto II: The Sequel?

On Thursday the U.S. House of Representatives passed a revised version of the SCHIP legislation that President Bush vetoed the last time it came through Congress. The final tally was 256-142, enough to pass but shy of the two thirds majority needed to override another veto. (Ten members of the California delegation did not vote due to the wildfires in their home districts.)

While the Democrats refuse to alter the scope of the proposed plan (covering 10 million children at a cost of $35 billion over five years), there are a number of alterations when compared to the previously vetoed attempt. Matt Canham at the Salt Lake Tribune enumerates some of the changes:

The latest bill would:

• Cap income eligibility at three times the poverty level or about $60,000 a year for a family of four. The old bill would allow the president to agree to waivers to cover those making more than that.


• Phase out the adults covered by CHIP in one year instead of two.


• Require the Social Security Administration to verify that all participants are citizens, bolstering provisions barring undocumented immigrants.


• Require the Government Accountability Office to create a report detailing the best ways to avoid "crowd out," where those with private insurance drop it in favor of this government program.

The White House and House Republicans were not impressed by the concessions, calling them "cosmetic."

Depending on how long it takes for this revised bill to negotiate the Senate it could be on the President's desk as early as next week. Several media sources report administration officials as saying President Bush is solidly opposed to the stiff increases in tobacco taxes which would fund the program. Most of these sources agree that a second veto is highly likely once this reaches the executive branch. If that occurs an override vote is likely to occur near November 16, the date on which temporary funding for the program expires.

Stay tuned.


SOURCE: "CHIP Revision Passes House" 10/26/07
photo courtesy of Superturtle on Flickr, used and remixed under this Creative Commons license. Image Remix by George Williams