Impact Of Uninsured Population Project, Research Paper Example

Introduction

This paper examines the underinsured and uninsured people of New York State, with specific reference to provision of vaccination against the H1N1 virus.  It considers the stance adopted by New York State to provide this free to all state residents who are underinsured or uninsured.  New York State, in 2006, had an estimated population around 19.5 million people.  The additional vaccines required were around 125,000 or 1.6% of the State population.  ” The New York State Department of Health (DOH) is distributing approximately 125,000 treatment courses of the antiviral medications Tamiflu and Relenza from the State emergency stockpile this week to more than 1,200 participating pharmacies outside of New York City. Antiviral medications are prescription drugs that help prevent and treat the flu, reducing the risk of serious complications and death. ” (Healthcare Finance News, 2009).

Considering the relatively small number of people (1.6%)  that drop into this category, this is considered a very prudent move.  The spread of a widespread epidemic or in worst case scenario a pandemic would seriously paralyze the state from both a financial and business perspective.  Anything that can be accomplished to mitigate that risk is a wise move.  This essentially is a very good example of proactive Health Administration and State Government. Governor Patterson commended the Pharmacies for working with the state in providing this solution ” A normal course of treatment with antiviral medications costs approximately $100, a financial hurdle that could prevent thousands of New Yorkers with limited or no health insurance from obtaining these potentially life-saving medications. ” (Healthcare Finance News, 2009).  The plan has gone into immediate effect and participating pharmacies have started to make the treatment available for underinsured New Yorkers for a maximum of $5 per course of treatment. “Steve Weingarten, Executive Director of the Chain Pharmacy Association of New York State, said: “Pharmacists across the state are eager to help people who are fighting the flu by providing beneficial medication to our customers, particularly those who are uninsured or underinsured.” (Healthcare Finance News, 2009).

Most people’s needs are financial and need the drugs to be made available to them with the minimum fuss or embarrassment about their personal circumstances.  The easiest way being through prescription from the local medical practitioner.  Statistics were released in 2005 indicating the serious problem of the underinsured and uninsured population within the United States.  These based upon information gathered in 2003.  With the recent recession these figures will certainly be deteriorated in 2009 given unemployment rising and people losing employee benefits. ” In addition to the 45 million uninsured adults in the United States, another 16 million adults were underinsured in 2003, meaning their insurance did not adequately protect them against catastrophic health care expenses, finds a study in Health Affairs. An estimated total of 61 million adults, or 35 percent of individuals, ages 19 to 64, had either no insurance, sporadic coverage, or insurance coverage that exposed them to high health care costs during 2003. ” (Cathy Schoen, 2005).

Who Are the Underinsured?

Statistics in this area take some time to filter through. Latest information is mainly based upon the period 2002-5.  A full study of this issue has not taken place since 1995.  An uninsured person has been defined as ” an underinsured person as one who has insurance all year but has inadequate financial protection, as indicated by one of three conditions: 1) annual out-of-pocket medical expenses amount to 10 percent or more of income; 2) among low-income adults (incomes under 200 percent of the federal poverty level), out-of-pocket medical expenses amount to 5 percent or more of income; or 3) health plan deductibles equal or exceed 5 percent of income.” (Cathy Schoen, 2005).

In 2003 it was estimated that 16 million people in the USA were underinsured.  The majority of those people were classified as being from low income brackets.  Of this it was computed that 73% of the annual incomes of the uninsured fell 200% below the Federal Poverty level.  The underinsured were under a huge amount of financial stress. Statistics indicated that 46% of the uninsured sample were visited by a collection agency for non payment of medical bills. A further 35% stated they had to go through major life changes in order to pay their medical bills.

Those that fell into the low income bracket faced the double jeopardy of being unable to pay their medical bills and the stress resulting from this gave them severe health problems. The uninsured groups were always more likely to report health access concerns, as opposed to those with coverage.

The Health Care providers need to conduct their own due diligence on the uninsured and underinsured groups.  They need to capture those who need financial assistance  much earlier in the process.  This saves potential discomfort from both parties points of view.  Financial assistance or counselling should be made available to those groups considered to be at risk.  They need to both understand the policies and what options are available to them.  In California the California Health Authority (CHA) requests its member hospitals to provide both guidance and financial assistance policies for the low income, at risk uninsured groups.  ” The guidelines call for every hospital to maintain understandable, written financial assistance policies that state the eligibility criteria and the process the hospital uses to determine a patient’s eligibility.” (Bolster, 2005).

Another example of proactive response comes from The Hospital & Health system Association of Pennsylvania who  published its Charity Care and Financial Aid Guidelines for Pennsylvania Hospitals in July 2004.  This paper went into clarification  on the  overall principles, federal tax exemption requirements, eligibility for financial aid, financial aid policies, accountability and advocacy, and collections policies. Further providing a suggested model of Financial Aid.

Advocate Health Care. based in Oak Brook, Ill., equally sent out details on  its charity care program and issued a  summary of charity care guidelines on its web site. The eight hospital, not-for-profit health system uses a variety of methods to notify patients about whom to contact regarding financial assistance.  “Billing statements include information about the availability of financial assistance and provide a phone number to call. Advocate offers bilingual phone options that enable patients to reach the right party to discuss financial assistance.”  (Bolster, 2005).

The US Senate continues to debate on health reform legislation and in particular the possibility of  Medicare buy-in-options for those adults in the 55-64 age group that are uninsured. In current terms this is expected to be upwards of 4 Million people.  The Health reform proposals consider the expansion of Medicaid to 150% of the Federal poverty level whereas the Senate Leadership bill would expand Medicaid to 133% of the Federal poverty level.  With both of these different scenarios the Federal Government would pick up a significant portion of the costs.  The current position on the Health Reform package, as of November 2009 is that it is stalled.  The difficulty being that the Senate will not support it as the House Bill is being blocked as unacceptable to a small number of democrats who hold the balance of power in the Senate.  The concept of  gradually extending  coverage to nearly all Americans by providing government subsidies to help pay premiums.  This is viewed by some as an unacceptable expense that would further deepen the recession and create conflict between the Federal Government and the Private sector Insurance firms.

“The measures would bar insurers’ practices such as charging more to those in poor health or denying them coverage altogether. All Americans would be required to carry health insurance, either through an employer, a government plan or by purchasing it on their own. ” (Associated Press, 2009)

In order to  keep the costs down it is planned for  the government subsidies and consumer protections not to come into  effect until 2013. During this three-year transition, both bills would provide $5 billion in federal dollars to help obtain medical coverage for all those with existing the medical problems who are rejected by private insurers. Perhaps the best summary and explanation of the current situation was delivered by President Obama in his 2010 Political Fiscal Budget speech  ” Health insurance costs reduce workers’ take-home pay to a degree that is both underappreciated and unnecessarily large. At the same time, health care costs are consuming a growing share of federal and state government budgets. The United States spends over $2.2 trillion on health care each year—almost $8,000 per person. That number represents approximately 16 percent of the total economy and is growing rapidly. If we do not act soon, by 2017, almost 20 percent of the economy—more than $4 trillion—will be spent on health care.”  (President Obama, 2009).

Statistics show that since 1999, health insurance premiums for families rose 131%.  the report carried out by the Kaiser Family Foundation discovered that, despite the general rate of inflation, which increased 28% over the same period, premiums had increased to this level.  The most alarming part of the survey was feedback from employees, who are no doubt considering the current impact of the recession, stating:  ” Nine percent said they plan to tighten eligibility for health benefits; 8 percent said they plan to drop coverage entirely. Forty-one percent of employers said they are “somewhat” or “very” likely to increase the amount employees pay in premiums — though that would not necessarily mean employees would pay a higher percentage of the premiums. Employers could simply be passing along the same share of the overall increase that they are doing this year” (Tuttle, 2009)

Works Cited

Associated Press. (2009, 11 8). Big question mark: Fate of health care in Senate . Retrieved 12 15, 2009, from Associated Press: http://www.msnbc.msn.com/id/33748707/ns/politics-health_care_reform/

Bolster, C. J. (2005, 3). Health Care Industry. Retrieved 12 15, 2009, from BNET: http://findarticles.com/p/articles/mi_m3257/is_3_59/ai_n13487273/

Cathy Schoen, M. M. (2005, 6 13). Insured But Not Protected: How Many Adults Are Underinsured? Retrieved 12 15, 2009, from http://www.commonwealthfund.org/Content/Publications/In-the-Literature/2005/Jun/Insured-But-Not-Protected–How-Many-Adults-Are-Underinsured.aspx

Healthcare Finance News. (2009, 12 3). New York State providing antivirals to uninsured and underinsured H1N1 patients. Retrieved 12 15, 2009, from Healthcare Finance News: http://www.healthcarefinancenews.com/press-release/new-york-state-providing-antivirals-uninsured-and-underinsured-h1n1-patients

President Obama. (2009, 11). President Obama’s Fiscal 2010 Budget. Retrieved 12 15, 2009, from Office of Management & Busget, The White House: http://www.whitehouse.gov/omb/fy2010_key_healthcare/

Tuttle, B. (2009, 9 16). Health Insurance Premiums Up 131% in Last Ten Years. Retrieved 12 15, 2009, from Time Magazine: http://money.blogs.time.com/2009/09/16/health-insurance-premiums-up-131-in-last-ten-years/