Posts Tagged ‘underinsurance’

PNHP: New Census Figures on Uninsured Show Urgent Need for National Health Care

September 14th, 2011

Number of uninsured climbs to highest figure since passage of Medicare, Medicaid
50 million uninsured shows urgency of enacting single-payer Medicare for all: national doctors group

Official estimates by the Census Bureau showing an increase of about 1 million in the number of Americans without health insurance in 2010 – to a 45-year high of 49.9 million persons, or 16.3 percent of the population, under the bureau’s revised calculation method – underscore the urgency of going beyond the Obama administration’s federal health law and swiftly implementing a single-payer, improved Medicare-for-all program, spokespersons for Physicians for a National Health Program said today.

Employment-based coverage continued to decline. The bureau said 55.3 percent of Americans were covered by employment-based plans in 2010, down from 56.1 percent in 2009. It was the eleventh consecutive year of decline, from 64.2 percent in 2000.

Read the rest of the article here.

Obama’s Healthcare Reform Law One Year Later

March 23rd, 2011

It’s been a year since President Obama and the Democrats passed the most sweeping overhaul of the nation’s healthcare system in more than 40 years. Sweeping it may have been, but for millions of Americans, this law is still inadequate. Unfortunately, the Patient Protection and Affordable Care Act (PPACA) leaves in place the unaffordable, unsustainable and grossly unfair profit-driven healthcare system.

Many Americans are still confused about the law. And one poll shows that although most people are opposed to the law, a quarter of those opposed believe it doesn’t go far enough. One of the most important provisions of PPACA, the prohibition on preexisting conditions, won’t go into affect until 2014. Meanwhile, millions of our citizens, battered by the worst recession since the Great Depression, are still going without coverage. Millions more are suffering under burdensome insurance premium increases.

A great post by Kevin Zeese of Prosperity Agenda details the problems inherent in PPACA:

Premiums are rising and coverage is shrinking a new norm is taking hold in America: ‘Unaffordable underinsurance.’ This month, the number of waivers granted to the Obama health law broke 1,000 protecting inadequate insurance plans. The expansion of health insurance to the uninsured is becoming a mirage. The Obama administration has told states they could reduce the number of people covered by Medicaid as well as reduce the services provided. And, the centerpiece of the law is under court challenge – the mandate is the first time ever the federal government has forced Americans to buy a corporate product, private health insurance – is heading to a close Supreme Court decision.

Although PPACA provides relief from some of the worst abuses of the health insurance industry, the law is nothing more than a Band-Aid covering a gaping wound. We can do much better. And we can do it without private health insurance companies. The fight for a simpler system that guarantees affordable access to health care for all has shifted to the states. California and Vermont are leading efforts to pass single payer at the state level. In Vermont, the state’s new Democratic governor has unveiled a single payer bill, and both U.S. senators support single payer. In California, State Sen. Mark Leno re-introduced SB 810 last month, and the bill is currently in committee. Even President Obama is acknowledging these state efforts by throwing his support to a federal bill that would allow states to opt out of most of PPACA’s requirements by 2014, instead of 2017.

We have a long battle ahead against the insurance industry lobbyists and their minions who would deny Americans their right to affordable health care. But progress is being made. Once PPACA’s shortcomings become more readily apparent, the public will realize that the only credible solution to our healthcare crisis is single payer.

Don McCanne, MD: Reform in Massachusetts fails to reduce medical bankruptcies

March 16th, 2011

Medical Bankruptcy in Massachusetts: Has Health Reform Made a Difference?

By David U. Himmelstein, MD, Deborah Thorne, PhD, Steffie Woolhandler, MD, MPH
The American Journal of Medicine
March 2011

Despite a marked declined in the uninsurance rate in Massachusetts since the implementation of health reform, the proportion of bankruptcies that occurred in the wake of medical problems has not decreased significantly, and the absolute number of medical bankruptcies has actually increased by one third.

What accounts for the seemingly paradoxical trends of increasing coverage yet stable, or even increasing (on a per capita basis), medical bankruptcy rates? Health costs in the state have increased sharply since reform was enacted. Even before the changes in health care laws, most medical bankruptcies in Massachusetts, as in other states, affected middle-class families with health insurance. High premium costs and gaps in coverage — copayments, deductibles, and uncovered services — often left insured families liable for substantial out-of-pocket costs. None of that changed.


The recently enacted national health reform law closely mirrors Massachusetts’ reform. That reform expanded the number of people with insurance but did little to upgrade existing coverage or reduce costs, leaving many of the insured with inadequate financial protection. Our data do not suggest that health care reform cannot sharply reduce the number of medical bankruptcies. Indeed, medical bankruptcy rates appear lower in Canada, where national health insurance provides universal, first dollar coverage. Instead, these data suggest that reducing medical bankruptcy rates in the United States will require substantially improved — not just expanded — insurance, as well as better disability insurance programs to provide income support to ill individuals and family caregivers.


By Don McCanne, MD

“Unaffordable underinsurance” is rapidly becoming the new standard in the United States. Even with subsidies, insurance premiums are ever less affordable, and for those who need health care, out-of-pocket spending creates significant financial hardships. Since reform under the Affordable Care Act closely mirrors that of Massachusetts, their current experience with medical bankruptcy portends the future of medical bankruptcy throughout the United States.

The Massachusetts experience shows that merely providing insurance coverage to the majority of the population is not enough. The quality of the insurance coverage is crucial. In 2009, 89% of Massachusetts debtors and all their dependents had health insurance at the time of filing, yet the insurance was not effective in reducing the rate of medical bankruptcy below levels that already existed before the full implementation of the Massachusetts health reform program.

Other nations with first dollar coverage do not see medical bankruptcies, even though they cover everyone at a much lower cost. We could do the same here. In fact, we most likely will once the nation understands that “unaffordable underinsurance” is rapidly becoming the new national norm – now carved in stone by the Affordable Care Act. We just need more highly skilled artisans to rework that stone.

Re-posted with permission from

Don McCanne, MD: 4.3 million more without insurance

September 17th, 2010

Income, Poverty, and Health Insurance Coverage in the United States: 2009

U.S. Census Bureau
September 2010

Health Insurance Coverage in the United States


* The percentage of people without health insurance increased to 16.7 percent in 2009 from 15.4 percent in 2008. The number of uninsured people increased to 50.7 million in 2009 from 46.3 million in 2008.

* The number of people with health insurance decreased to 253.6 million in 2009 from 255.1 million in 2008. This is the first year that the number of people with health insurance has decreased since 1987, the first year that comparable health insurance data were collected. The number of people covered by private health insurance decreased to 194.5 million in 2009 from 201.0 million in 2008. The number of people covered by government health insurance increased to 93.2 million in 2009 from 87.4 million in 2008.

* Between 2008 and 2009, the percentage of people covered by private health insurance decreased from 66.7 percent to 63.9 percent. The percentage of people covered by employment-based health insurance decreased to 55.8 percent in 2009, from 58.5 percent in 2008. The percentage of people covered by employment-based health insurance is the lowest since 1987, the first year that comparable health insurance data were collected. The number of people covered by employment-based health insurance decreased to 169.7 million in 2009, from 176.3 million in 2008.

* The percentage of people covered by government health insurance programs increased to 30.6 percent in 2009, from 29.0 percent in 2008. This is the highest percentage of people covered by government health insurance programs since 1987. The percentage and number of people covered by Medicaid increased to 15.7 percent or 47.8 million in 2009, from 14.1 percent or 42.6 million in 2008. The percentage and number of people covered by Medicaid is the highest since 1987. The percentage and number of people covered by Medicare in 2009 (14.3 percent and 43.4 million) were not statistically different from 2008.

* In 2009, 10.0 percent of children under 18, or 7.5 million, were without health insurance. These estimates were not statistically different from the 2008 estimates. The uninsured rate for children in poverty (15.1 percent) was greater than the rate for all children.

* Between 2008 and 2009, the uninsured rate and the number of uninsured for non-Hispanic Whites increased from 10.8 percent and 21.3 million to 12.0 percent and 23.7 million. The uninsured rate and the number of uninsured for Blacks increased from 19.1 percent and 7.3 million to 21.0 percent and 8.1 million.

* The percentage and number of uninsured Hispanics increased to 32.4 percent and 15.8 million in 2009, from 30.7 percent and 14.6 million in 2008.

Census Bureau press release:

PNHP press release:


By Don McCanne, MD

Highlights of the 2009 health insurance highlights:

* Uninsured increased to 50.7 million – 16.7 percent of the population

* Private insurance decreased to 194.5 million – 63.9 percent

* Employment-based insurance decreased to 169.7 million – 55.8 percent

* Medicaid increased to 47.8 million – 15.7 percent

* Uninsured children remain at 7.5 million

* Racial and ethnic disparities in coverage have compounded

Those who oppose government solutions to the health care crisis will likely pass these worsening numbers off as an expected consequence of the sputtering economy and the new age of unemployment. They will pay little heed to the fact that the numbers are still intolerable when the economy is thriving; that isn’t their concern.

Supporters of the Patient Protection and Affordable Care Act (PPACA) will no doubt be disturbed by these numbers, but it is very likely that they will make the most of them in selling PPACA by showing how it will dramatically reduce the numbers of uninsured. That is true. Many will be covered by Medicaid and by private health plans, even if far too many will still remain uninsured.

This Census Bureau report remains silent on one of the most important issues in health insurance – the numbers who are underinsured – those who will face financial hardship should medical needs arise.

PPACA is an underinsurance program. Employers will see little relief and will expand their present trend of shifting more insurance and health care costs onto their employees. Individuals buying plans in the new insurance exchanges will select underinsurance products with low actuarial values (30 to 40 percent of costs to be paid by the patient) with subsidies that are inadequate to avoid financial hardship. Many will move into the Medicaid program which has more expansive coverage, but which reimburses providers at such a low rate that far too many will not be willing to accept patients under this program. With Medicaid chasing away providers, it too has become another form of underinsurance.

Thus the touted increase in insurance enrollment under PPACA will be more than offset by the explosion in underinsurance – affecting the majority of Americans. At this point looking forward, this nefarious outcome is not obvious to most. But as underinsurance sneaks up on us, and more and more individuals are feeling the pain, they’ll be ready. Ready for what? Ready for an improved Medicare that will always be there for us – in both good and bad economic times.

The PNHP press release (link above) provides a reality-based perspective of just what these numbers mean.

Re-printed with permission from