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Universal Coverage, Health Inequalities, and the American Health Care System in Crisis (Again)
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APSA 2004
U
NIVERSAL
C
OVERAGE
3
incomes of $75,000 or more rose to 7.3 million in 2002, an increase of 633,000 from the prior year.
8
Not only are there millions of Americans without insurance, the costs for
those who do have insurance are rapidly increasingly. Unlike a decade ago, when health care costs and insurance premiums were decreasing, both have been steadily rising at a greater pace than the general rate of inflation since 1998.
9
Total national
spending on health care grew 8.6% in 2002, marking the biggest one-year increase since 1993.
10
Employers’ health insurance premiums rose by an average of almost
14% in 2003, more than anticipated and the largest increase since 1990.
11
Small
companies of less than ten employees have seen their insurance premiums rise—provided they can still afford them—by as much as 20% or more per year since 2001.
12
Unfortunately the future does not look better. “The number of uninsured
will continue to grow as long as health insurance premiums rise more rapidly than earnings, as they have for a decade,” notes Drew E. Altman, president of the Kaiser Family Foundation, which tracks health coverage trends.
13
“Losing health
benefits is becoming a middle-class issue. If it had not been for expansions in the child health program and Medicaid, we would have 10 million more uninsured.”
14
One particularly alarming consequence of these worsening trends is that
health care related problems are one of the leading causes of personal bankruptcy in the United States.
15
Upwards of 600,000 individual cases in 1999, or nearly 50%
of the total number of non-business bankruptcy filings, were traceable to one or more of these problems: lack of health insurance, insufficient health insurance, and/or substantial medical bills.
16
Given the recession and sluggish economic
8. H
EALTH
I
NSURANCE
C
OVERAGE
:
2002, supra note 4, at 2.
9. Bradley C. Strunk et al., Tracking Health Care Costs: Growth Accelerates Again in 2001,
H
EALTH
A
FFAIRS
W
EB
E
XCLUSIVE
, W299, W300-02 (Sept. 25, 2002), at
http://content.healthaffairs.org/cgi /reprint/hlthaff.w2.299v1 (last visited Apr. 4, 2004).
10. Stephen Heffler et al., Health Spending Projections for 2002-2012, H
EALTH
A
FFAIRS
W
EB
E
XCLUSIVE
, W3-54, W3-56
(Feb. 7, 2003), at
http://content.healthaffairs.org/cgi
/reprint/hlthaff.w3.54v1 (last visited May 30, 2004).
11. Id. at W3-55. See also Barbara Martinez, Rate of Increase for Health Costs May Be Slowing,
W
ALL
S
T
.
J., June 11, 2003 at A1.
12. Len Strazewski, Benefits Business: Health Plans Stay But Change, R
OUGH
N
OTES
M
AGAZINE
,
Jan. 2004, available at http://www.roughnotes.com/rnmagazine/2004/january04/01p12.htm (last visited Apr. 4, 2004).
13. David Broder, Problem of Lost Health Benefits is Reaching Into the Middle Class, N.Y.
T
IMES
,
Nov. 25, 2002, at A1.
14. Id.
15. E
LIZABETH
W
ARREN ET AL
.,
H
ARVARD
L
AW
S
CH
.,
W
ORKING
P
APER
N
O
.
008,
M
EDICAL
P
ROBLEMS AND
B
ANKRUPTCY
F
ILINGS
5-6,
(2000),
available at http://ssrn.com/abstractid=224581 (last
visited May 30, 2004).
16. Id. at 5-6.
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APSA 2004
U
NIVERSAL
C
OVERAGE
3
incomes of $75,000 or more rose to 7.3 million in 2002, an increase of 633,000
from the prior year.
Not only are there millions of Americans without insurance, the costs for
those who do have insurance are rapidly increasingly. Unlike a decade ago, when
health care costs and insurance premiums were decreasing, both have been steadily
rising at a greater pace than the general rate of inflation since 1998.
spending on health care grew 8.6% in 2002, marking the biggest one-year increase
since 1993.
Employers’ health insurance premiums rose by an average of almost
14% in 2003, more than anticipated and the largest increase since 1990.
companies of less than ten employees have seen their insurance premiums rise—
provided they can still afford them—by as much as 20% or more per year since
2001.
Unfortunately the future does not look better. “The number of uninsured
will continue to grow as long as health insurance premiums rise more rapidly than
earnings, as they have for a decade,” notes Drew E. Altman, president of the
Kaiser Family Foundation, which tracks health coverage trends.
benefits is becoming a middle-class issue. If it had not been for expansions in the
child health program and Medicaid, we would have 10 million more uninsured.”
One particularly alarming consequence of these worsening trends is that
health care related problems are one of the leading causes of personal bankruptcy
in the United States.
Upwards of 600,000 individual cases in 1999, or nearly 50%
of the total number of non-business bankruptcy filings, were traceable to one or
more of these problems: lack of health insurance, insufficient health insurance,
and/or substantial medical bills.
Given the recession and sluggish economic
8. H
EALTH
I
NSURANCE
C
OVERAGE
:
2002, supra note 4, at 2.
9. Bradley C. Strunk et al., Tracking Health Care Costs: Growth Accelerates Again in 2001,
H
EALTH
A
FFAIRS
W
EB
E
XCLUSIVE
, W299, W300-02 (Sept. 25, 2002), at
http://content.healthaffairs.org/cgi /reprint/hlthaff.w2.299v1 (last visited Apr. 4, 2004).
10. Stephen Heffler et al., Health Spending Projections for 2002-2012, H
EALTH
A
FFAIRS
W
EB
E
XCLUSIVE
, W3-54, W3-56
(Feb. 7, 2003), at
http://content.healthaffairs.org/cgi
/reprint/hlthaff.w3.54v1 (last visited May 30, 2004).
11. Id. at W3-55. See also Barbara Martinez, Rate of Increase for Health Costs May Be Slowing,
W
ALL
S
T
.
J., June 11, 2003 at A1.
12. Len Strazewski, Benefits Business: Health Plans Stay But Change, R
OUGH
N
OTES
M
AGAZINE
,
Jan. 2004, available at http://www.roughnotes.com/rnmagazine/2004/january04/01p12.htm (last visited
Apr. 4, 2004).
13. David Broder, Problem of Lost Health Benefits is Reaching Into the Middle Class, N.Y.
T
IMES
,
Nov. 25, 2002, at A1.
14. Id.
15. E
LIZABETH
W
ARREN ET AL
.,
H
ARVARD
L
AW
S
CH
.,
W
ORKING
P
APER
N
O
.
008,
M
EDICAL
P
ROBLEMS AND
B
ANKRUPTCY
F
ILINGS
5-6,
(2000),
available at http://ssrn.com/abstractid=224581 (last
visited May 30, 2004).
16. Id. at 5-6.
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