The Uninsured and the Health Care Safety Net. Grace-Marie Turner, Ph.D. President Galen Institute, Inc. Alexandria, VA . The U.S. health care system is in trouble. Rising insurance costs threaten coverage for many Millions are uninsured
Grace-Marie Turner, Ph.D.
Galen Institute, Inc.
Total $1.8 trillion15% of GDP
“2004 Mercer U.S. National Employer-Sponsored Health Plans Survey,” Mercer Human Resources, November 22, 2004. http://www.mercerhr.com/knowledgecenter/reportsummary.jhtml?idContent=1051300
U.S. Department of Labor, Bureau of Labor Statistics. Consumer Price Index. January 19, 2005. ftp://ftp.bls.gov/pub/special.requests/cpi/cpiai.txt
Robert Blendon and John Benson. “Americans’ Views on Health Policy” Health Affairs. March/April 2001.
Office of the Actuary, Centers for Medicare and Medicaid Services
Kaiser 2003 Employer Health Benefit Survey
18% General health care inflation
22% New medical advances, drugs
18% Rising provider expenses
15% Government mandates and regulation
15% Increased consumer demand
7% Litigation and defensive medicine
5% Fraud and abuse, etc.
Can State health insurance regulations
reduce costs and increase access
to health insurance?
The GAO identified 16 States that passed these insurance regulations in the early- and mid-1990s.
% growth rate in number of uninsured
# of States
“Uninsured Rates Rise Dramatically in States with Strictest Health Insurance Regulations,” Arnett GM, Schriver ML. The Heritage Foundation 1998. http://www.galen.org/statehealth.asp?docID=179
Why is it so hard for the States to solve this problem?
Low income families hard to reach with job-based coverage regulations in the early- and mid-1990s.
Persons with job-based health insurance, by income
U.S. Census Bureau, Current Population Survey, 2004 Annual Social and Economic Supplement. Table HI01. Health Insurance Coverage Status and Type of Coverage by Selected Characteristics: 2003 (All Races)
Population under age 65 with
Conceptual depiction based upon the logo of the Galen Institute.
“Empowering Health Care Consumers through Tax Reform,” Grace-Marie Arnett, Ed. University of Michigan Press, Ann Arbor. September 1999. http://www.galen.org/book.asp
Mark Pauly and Bradley Herring. “Expanding Coverage Via Tax Credits: Trade-Offs and Outcomes,” Health Affairs, January/February 2001.
My assessment of general agreement based upon joint publications and position papers by political leaders, including President Bush, Senator Kerry, Senator Frist, Senator Clinton, etc.
“Health Savings Accounts: The First Year in Review,” eHealthInsurance, February 15, 2005.
Teresa Chovan and Hannah Yoo. “Health Savings Accounts Off to a Fast Start in the Individual Market,” America’s Health Insurance Plans, January 12, 2005.
Catastrophic coverage + preventive care
High deductible insurance
Employer, employee, or individual makes deposit to HSA. Unspent funds roll over to next year.
Funds routine health spending. Preventive care exempt.
Consumer choice in health care and coverage
Engaging consumers as partners rather than adversaries in managing health costs and getting the best value for health care dollars