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Growth in Uninsured Outpacing U.S. Spending on
Health Care Safety Net
The south is home to more than half of uninsured
growth; immigrants not driving recent growth
Nov. 4, 2005 - At a policy briefing examining the
latest health coverage trends and the implications for the nation’s
health care safety net (Medicaid is the bread and butter of the safety
net), the Kaiser Commission on Medicaid and the Uninsured (KCMU)
highlighted five reports that profile the growing uninsured population
and portray the health care safety net as increasingly straining to meet
uninsured people’s needs. Many senior citizens, covered by Medicare, see
this trend as endangering their government health care insurance
program.
The health care safety net is the nation's system
of providing health care to low-income and other vulnerable populations.
It consists of a wide variety of providers delivering care to these
populations, including the uninsured and those covered by Medicaid. Many
of these providers have either a legal mandate or an explicit policy to
provide services regardless of a patient's ability to pay. Nursing home
coverage, for example, is not paid for by Medicare and many senior
citizens must depend on Medicaid to pay this bill.
“In the absence of providing health insurance
coverage for our nation’s growing uninsured population, some have said
that the uninsured can receive care when they need it through the
nation’s health care safety net. The new studies and personal stories
released today document the increasing burden health providers are
facing in delivering needed care,” said Diane Rowland, executive
director of KCMU.
New analysis highlighted today found that, as the
number of uninsured Americans increased by 4.6 million from 2001 to
2004, federal safety net spending per uninsured person fell from $546 to
$498 during the same period. After adjusting for inflation, total
federal spending for care for the uninsured increased by 1.3 percent
from 2001-2004 while the number of uninsured increased by 11.2 percent.
These trends resulted in an 8.9 percent decline in spending by the
federal government per uninsured person. See Figure below.
 The
analysis of federal spending on the health care safety net, authored by
Jack Hadley and colleagues at The Urban Institute, describes the
patchwork of federal money dedicated to care for the uninsured. The
report documents that federal support for community health centers
increased by more than 50 percent over the past four years, but still
only accounts for less than 3 percent of total federal spending on the
health care safety net.
The authors noted that because more than 70 percent
of federal support for the uninsured flows through Medicare and
Medicaid, which are both under budgetary pressures, “it is unlikely that
future funding will be able to close the gap or make up the difference”
in the increase in the uninsured and funding for their care.
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Another Commission study highlighted today,
authored by John Holahan and Allison Cook of The Urban Institute, was
published by Health Affairs this week. The study finds that all of the
six million increase in the number of uninsured from 2000-2004 was among
adults and two-thirds of the increase was among people with incomes
below 200 percent of poverty (about $39,000 for a family of four in
2004). Both adults and children were affected by the 4.6 percentage
point drop in the share of the nonelderly with employer coverage (67.8%
to 63.3%), but children were able to obtain alternative coverage through
Medicaid and the State Children’s Health Insurance Program.
When examined in even greater detail, about half of
the growth in the uninsured was among young adults (ages 19-34) who
experienced sharp declines in employer coverage rates. Fifty four
percent of the growth occurred in the Southern region of the country
which experienced the greatest growth in both the general population and
low-income population combined with the largest decrease in employer
coverage. This contributed to the 3.2 million increase in uninsured
people in the South alone.
A third Commission study, also authored by John
Holahan and Allison Cook, investigated the extent to which immigrants
contribute to the growth in the uninsured population. Immigrants are
disproportionately likely to be uninsured due to their employment in
low-wage jobs that are less likely to offer health coverage and
restrictions on their eligibility for public coverage. However,
examining the period between 1994 and 2003, the study found that apart
from the brief 1998 to 2000 period--years of unusually strong economic
growth and tight labor markets-- the growth in the number of uninsured
has largely been among native citizens.
Between 1998 and 2000 native citizens experienced a
decrease in the number of uninsured, while the number of uninsured
non-citizens increased by 800,000. However, in the periods preceding and
following this, the picture is much different. From 1994 to 1998 native
citizens accounted for 3.1 million of the 4.2 million growth in the
number of uninsured. During the 2000 to 2003 period, when the economy
slowed, native citizens comprised 3.6 million of the 5.1 million more
uninsured.
Today’s highlighted reports include:
-
Federal Spending on the Health Care Safety Net
from 2001-2004: Has Spending Kept Pace with the Growth in the
Uninsured?,
-
Changes in Economic Conditions and Health
Insurance Coverage, 2000-2004,
-
Are Immigrants Responsible for Most of the
Growth of the Uninsured?,
-
Threadbare: Holes in America’s Health Care
Safety Net,
-
Health Coverage in America, 2004 Data Update.
You may find the above reports and a summary of
findings
online.
In addition, the latest state-level health coverage
information, as well as changes occurring between 2000-2004, are also
available
online.
A
webcast of the policy
briefing on these issues that was held in Washington, D.C., can be
viewed after 5 p.m. E.T. today.
About Kaiser
The Kaiser Commission on Medicaid and the Uninsured
provides information and analysis on health care coverage and access for
the low-income population, with a special focus on Medicaid's role and
coverage of the uninsured. Begun in 1991 and based in the Kaiser Family
Foundation's Washington, DC office, the Commission is the largest
operating program of the Foundation. The Commission's work is conducted
by Foundation staff under the guidance of a bipartisan group of national
leaders and experts in health care and public policy. The Kaiser Family
Foundation is a non-profit, private operating foundation dedicated to
providing information and analysis on health care issues to
policymakers, the media, the health care community, and the general
public. The Foundation is not associated with Kaiser Permanente or
Kaiser Industries.
Safety Net Monitoring at Agency for Healthcare
Research & Quality -
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