600,000 Oregonians without health care
By Katie Gauthier of Clackamas, Oregon. Katie is the Policy and Communications Director for Oregonians for Health Security.
President Bush’s lack of a health care plan presents an opportunity.
The impact of the health care crisis on families, businesses and the state budget is very clear. We have 46 million Americans uninsured, over 600,000 in Oregon- that is more than the entire population of Portland, our state’s largest city. We have seen health insurance premiums skyrocketing to the point where it costs a family $10,880 for health insurance and of this $1,128 is a hidden health tax paying for the cost of the uninsured.
Businesses are clamoring for relief- Starbucks spends more on health insurance for their employees than they do coffee and GM adds $1300 to the cost of every car to pay for health care. And contrary to Bush’s statement “Our government has a responsibility to help provide health care for the poor and elderly, and we are meeting that responsibility,” 85,000 people cut from the Oregon Health plan, a $172 million dollar budget hole, a federal Medicaid cuts that will shift more health care costs to the states- speak for themselves.
The Bush team seems oblivious to the polling. Americans are concerned about health care costs over any other issue. At a time when 60% of Americans disapprove of his handling of health care, Bush was pressed to address the growing crisis during the State of the Union. He dedicated less than one minute during the speech to rehash old ideas about health savings accounts and medical records. Shockingly, he didn’t even bring up the largest change to Medicare in the last 40 years. He must have gotten the message that seniors are seeing through his prescription drug sham and recognizing it for what it is- a huge give away to drug and insurance companies. Bush’s proposed budget makes additional cuts to Medicare and Medicaid as well as extending tax breaks for healthy, wealthy individuals- none of this helps the 46 million Americans without insurance or the millions more struggling to afford to keep their coverage.
As progressives we have an opportunity to shine a light on Bush’s inaction on health care and at the same time champion common-sense reforms that do reduce health care costs and increase access to quality, affordable and secure health care.
One of the few ideas Bush proposed in his budget is to extend tax breaks for Health Savings Accounts-here are some of the reasons they won’t solve our health care crisis:
1) Health Savings Accounts do not reduce costs! HSAs don’t reduce costs-they just shift it to working families. A survey by the Employer Benefits Research Institute compared cost and access issues for people with comprehensive coverage versus Health Savings Accounts. The study found that despite similar rates of health care use, individuals with HSAs are significantly more likely to spend a larger share of their income on out-of-pocket health care expenses. Individuals with HSAs were also significantly more likely to avoid, skip, or delay health care and face health problems because of costs than were those with more comprehensive health insurance.
2) Health Savings Accounts do not increase access to health care for low and middle income Americans. With annual payments often in the thousands of dollars, it is unlikely that low or middle income people will be able to afford high deductible insurance plans, much less have money to save away in Health Savings Accounts. HSAs provide no benefits to those with too low of income to pay taxes or who are unable to afford contributions to an HSA. Analysis done by the Commonwealth Fund finds, 55% of the uninsured would receive no tax benefits from a program of this type and an additional 39% would receive less than $60 in tax savings. Overall, Health Savings Accounts do not increase access to care for low-income or medically vulnerable-they simply give tax breaks to those with a couple thousand dollars to spare.
3) Health Savings Accounts do not lead to transparency, quality or cost-effective use of our health care resources. Finally, HSAs threaten the structure of an already unstable employer-sponsored health care system. Their widespread adoption would represent a potentially radical shift away from the basic insurance principle of healthier individuals subsidizing the sick through a common pool of premiums. Where employers offer multiple plans, a shift of healthy employees toward one type of plan can set off a spiral of premium escalation in other plans. In addition, HSAs create perverse health care incentives. They deter spending on cost-effective preventative care by people who have not met their deductible, while encouraging increased elective spending by those who have met their deductible.
Bush and leaders in Congress lack vision around health care. We need to make this election about health care and offer voters a stark comparison. We will enact common-sense solutions to reduce health care costs by reducing prescription drug costs, increasing accountability in the insurance industry and ensuring fair hospital pricing- they simply want to shift more costs to individuals, working families and state budgets.
|
Feb. 17, 2006
Posted in guest column. |
More Recent Posts | |
Albert Kaufman |
|
Guest Column |
|
Kari Chisholm |
|
Kari Chisholm |
Final pre-census estimate: Oregon's getting a sixth congressional seat |
Albert Kaufman |
Polluted by Money - How corporate cash corrupted one of the greenest states in America |
Guest Column |
|
Albert Kaufman |
Our Democrat Representatives in Action - What's on your wish list? |
Kari Chisholm |
|
Guest Column |
|
Kari Chisholm |
|
connect with blueoregon
Feb 17, '06
Yet another issue where personal experience has changed my perspective and opinion on an issue. I lost my health care insurance a year ago, and due to pre-existing conditions I can't get insurance anymore. It's been an eye-opener. You don't realize just how vulnerable you are medically until you lose your safety net. It's not about paying the doctor bills for routine check-ups or the occasional illness or minor injury. It's about what happens in the case of a catastrophic accident or illness or sudden loss of income. It's about what happens if I can't afford my ongoing health needs. My quality of life, and that of my family, is at stake. Now I finally get it. But can we come up with a system that doesn't compromise the quality of care? I don't know enough about it to answer that, but I'm sure a lot more interested in finding out than I used to be.
Feb 17, '06
Becky - if you got a job as a state worker, would you be covered? Would your pre-existing condition be covered?
Feb 17, '06
A health care discussion on Blue Oregon? Be still my beating heart!
One of the problems with our health care system today is that not enough people are in the pool. We're all paying the price for the 46 million uninsured Americans who still need health care - and like Katie said - the 600,000 here in Oregon (I mean try and wrap your head around that number!!!)
Bush's Health Savings Accounts will only make it worse by further segmenting our already fractured health care system. Healthy, wealthy individuals get another tax break, while the rest of us pay more for fewer health services. It looks like the Medicare prescription plan all over again - wealthy corporations make more while those of us who need the services go without. The few corporations making a lot of money in our current system like this plan because it preserves their profit margins. For the rest of us, it is another shift in costs and decrease in access to quality care.
Health Savings Accounts are simply another cost shift to working families. It won't reduce health care costs or help the majority of people who need to access health care. People will be less likely to seek cost-effective preventative care because they haven't reached their deductible. What else should we expect from the people who brought us the Medicare prescription drug fiasco?
A majority of voters identify health care costs as their top economic concern, yet I noticed that there have been only a handful of pieces or discussions on this site in the past on health care issues and I wonder why?
Is it because the health care crisis is too complicated for a blog discussion?
Any chance I can get a show of hands of the folks who read and contribute to this site who have no health insurance? I mean I'm guessing we're all for the most part employed, insured and healthy? Am I wrong here? Saying that - I don't want to perpetuate the myth of the uninsured since the face has changed in the past decade. The new face of the uninsured in this country is the working middle class. I mean a majority of those without access to health care have full-time jobs or at least someone in their house-hold with a full time job.
Is anyone else pissed off here?
Feb 17, '06
Any idea how many of that 600,000 uninsured choose not to insure but could afford to? And how about the number that undermines general support for the uninsured (regardless of the need)...how many are illegal aliens?
Feb 17, '06
To pseudo-quote Ex-Mayor of NYC Ed Kotch: "I won't even dignify that statement with a comment"
Two things worth reading:
1) Bush plan will cause 600,000 more to lose coverage
2) GAO finds younger, wealthier, individual men sign up for HSAs
Feb 17, '06
Actually Gordie - I checked with OHS and found that their numbers regarding uninsured Oregonians come from the US Census Bureau and 2004 Oregon Population Survey.
And 80% of those uninsured are either employed, or live in a household with at least one employed person.
The problem is that the people who are doing everything that they are supposed to be doing, as responsible members of society, frequently still can't afford health insurance on their own. Those numbers include a segment of our population with temporary and/or low wage and/or small employer jobs where health care benefits simply do not exist.
2:33 p.m.
Feb 17, '06
Becky asked, "But can we come up with a system that doesn't compromise the quality of care?"
Becky, given that you've lost your health care and now can't get it back - doesn't that mean your quality-of-care is down to zero?
It's interesting that we're so obsessed with maintaining the gold-super-deluxe standard-of-care for those who have it while denying it to so many millions of Americans. I'd settle for just silver-extra-regular care if everyone else had it too...
Of course, if everyone were insured, the total cost in the system would eventually go down -- less crisis care, less emergency room, more blood pressure meds and less heart attacks, etc. The problem isn't the amount of money we're spending -- it's where it's coming from and where it's going. More at John Kitzhaber's ArchimedesMovement.org.
Feb 17, '06
The Census Bureau counts illegal aliens amongst the uninsured. A number of folks are resistant to addressing the problems of the uninsured if potential solutions include providing befefits for illegal aliens. For better and for worse, the issues are inextricably linked.
I know numbers of folks who see/hear estimates of the uninsured that use the 44 million national figure and immediately discount the rest that speaker has to say. That's because the number includes folks who aren't Americans (over 20 percent), thus the speaker is thought to be dishonest.
I certainly realize that uninsured illegal aliens are part of the very complex issue of providing and paying for medical care for those who need it in this country. But I also know that a significant majority of Americans want some sort of immigration reform, and linking that to the uninsured issue makes it more difficult to achieve incremental solutions.
Food for thought.
7:12 p.m.
Feb 17, '06
This is a huge issue to me, as I have several ongoing medical problems. Even though we really can't afford to, we pay for health insurance through my husband's work each month. We just found out the price is going up again, as are co-pays, they'll now only pay between 80-90% after co-pays and our deductible is met, etc.
We'll now be paying $300/month for a family plan-- for 2 adults and a child. That's $3600 month, and our income for the year is about $24,000. That's 15% of our money going just to pay for the insurance-- that doesn't include any costs of actually using the system.
When we found out the prices were going up, we really had to consider whether we could continue to afford to keep the plan. However, since we have a toddler and I have these medical problems, we can't afford not to. Dropping off would also mean that my conditions will be "pre-exisiting" when we got onto a health care plan again.
Growing up, we never had health insurance. My parents paid for everything themselves-- and with no credit cards. Now that my dad is no longer self-employed, he has health insurance. But it costs so much to add people onto it that my mom is still without insurance. Most of my siblings are also without health insurance-- one has a "discount plan."
It's hard being without insurance, especially when you do have ongoing medical needs. It's also hard when you aren't making much, but are paying out a large chunk of your income just to have insurance.
We've got to do something about the system, or there will be even more people uninsured-- families like ours that eventually have to drop their coverage because they just can't afford it anymore.
Feb 17, '06
Add to the 600,000 those employed who are offered "high-deductible" health plans. My employer offers this as the only option. Here's how it works: for a family you pay $300 per month. Then, the "health plan" doesn't cover anything until you pay almost $10,000. After that, it pays 70 percent of covered charges.
Call me pessimistic, but at that point you basically don't have health insurance, even though you are supposedly "insured." Let's face it -- a lot of us are about one step away from the abyss.
Feb 18, '06
We are a self employed craftsperson/farmer family of 4. We pay almost $400/ mo. for health insurance with a $5,000 deductable per person. After that we have a 20% co-pay to a certain point (I forget just where) and then full coverage to another certain point and then nothing. Thats about a fifth of our income going out to save the farm if one of us should get a catastrophic illness. I'm 62 years old with a greatly diminished capacity to do physical work because of a worn out hip. I'm trying to nurse it through till I can get medicare because we can't afford the approximately $12,000 to $15,000 it would cost out of pocket. Now you know where my bias may lie.
That said, I know many hard working people in similar or worse circumstances. I believe that health care should be a right, not a privilege and should be one of the main responsibilities of government. I believe "health care for profit", besides giving me that queezy immoral feeling, is terribly inefficient. If you took the money we spend on insurance and all the money we spend on health care out of pocket every year(costs inflated to help pay for those who can't pay and cost more because care was delayed or in emergency rooms and inflated to include profits for HMO and insurance company investors), I'm sure the total would far exceed the increase in taxes I would need to pay for a single payer system. By the way,if our quality of care is so great, why are we so far down the list when it comes to longevity, infant mortality etc.?
Feb 18, '06
"The study found that despite similar rates of health care use, individuals with HSAs are significantly more likely to spend a larger share of their income on out-of-pocket health care expenses."
I'd like to know if these "out-of-pocket" expenses are paid for with funds that were first deposited in their Health Savings Accounts? If so (which is most likely), that's really no different than people who pay more in health insurance premiums every month so they can have a small co-pay for office visits. The comparison needs to be between the total spent on insurance premiums and out of pocket expenses for it to be meaningful.
And if people with HSA's go to the doctor less often or order fewer tests, isn't that just what you would expect to happen as people become more cost conscious and actually try to act like intelligent consumers?
Feb 19, '06
5% of employees incur 85% of the claims. That means 95% of employees are responsible for 15% of the claims. Out of pocket expenses for most HDHP with HSA are similar to existing employer plans. The difference is they are post-tax on low deductible plans unless funneled through a cafeteria plan. The 95% of employees are rolling a balance according to HSA Bank the largest HSA vendor. Fidelity's March 2005 study says the average couple age 65 retiring today will need $190,000 in post retirement income for health care expenses. Where will that come from? For many Americans that will come from their HSA. Most HSAs are funded by a combination of Employer premium savings and Employee reduced contributions on the HDHP. People with high deductibles and HSAs are finally getting involved in their health care. They are asking questions, they are looking for alternatives. They are demanding answers to questions that should be easy to obtain. How much does that cost? Are there alternatives? Who else provides that service? It's time America wakes up to how health care is delivered, billed and paid for in this country or we will be on a Canadian or German system and then your choices will be made for you....or you many not have any.
Feb 21, '06
I'll toss the bad words out, "Socialized Medicine". Now they've been said. Somebody will howl because they aren't using their head, we already have it, in a bastardized inefficient form. It's called, "the current mess." All the uninsured and underinsured people add cost to the system, that cost is passed right on back to the paying consumer in higher hospital costs, higher insurance rates, but it gets passed back after those outfits take their cut. Wouldn't a single payer system like Medicare make more sense? Give an opt out and weight treatments and emphasize prevention (seeing a doc costs less than a hospital). Medicare or Medicaid could be tooled up to be efficient if it actually mattered to somebody. Somebody who didn't see government as a nuisance as the RNC does.
I bet that makes me a few enemies, hopefully a man is measured by the quality of his enemies.
10:02 p.m.
Feb 21, '06
Howard Dean had a really good plan that would have ended up costing less than what many of us are paying for for insurance. If I remember correctly, it would be about 7% of your check (there's more to it than that, obviously, since for those making a lot of money would need some kind of cap, those who are under a certain income wouldn't pay, etc.).
My family is low income and we're paying more than 12% of our income on our health insurance-- and that doesn't include the dental and vision insurance. And it also doesn't include the large chunk that my husband's employer pays.
This would be huge for businesses-- big and small. They could take on the entire cost of the insurance and still pay less than they do now. You would keep your insurance as you moved from one job to another-- stopping problems with "pre-existing conditions" and people staying in dead-end jobs just so they won't lose their insurance.
Self employed people will be able to afford insurance. And all the money the local, county, state, and federal government currently spend on health-related items can be poured into the system. That includes Medicaid, Medicare, money counties give to the hospitals to cover the indigent, etc.
I'd really like to see the government look more seriously into something like this. We're the only industrialized nation that doesn't.
Feb 22, '06
Sorry, I have to disagree. Health Savings Accounts are reducing costs. Maybe not the provider costs, but they are reducing the premiums, which allows individuals to put that money into an HSA for future use. Those that can't afford to put the money into an HSA most likely couldn't afford the cost of the premium for a basic PPO plan. At lease the reduced premiums cost of the HDHP will allow them to purchase insurance that they otherwise couldn't have afforded.
And a lot of the problem with rising health cost is OVER-usage of the healthcare system. Instead of ripping these plans apart, why not go after the people that are using the systems for issues that they should be controlling with proper diet.
I write a lot of individual policies every year, in addition to the group coverage that I handle; and I have to say, where I live at least 9 out of 10 individuals that are rated for health issues have issues that could be controlled on an individal basis. But why should they do that when there are pills that they can take that control it for them?
I do agree that the low-income will not have the money to invest into the HSA, and even if they do, most likely at their tax bracket won't realize the savings that the middle-income or high-income individuals will. But fact is, the premiums are more affordable. It will also force people to seek treatment from a PCP or urgent care center before running to the ER for a more expensive visit, when that money is coming out of their pockets and not insurance carriers.
One Option: How about a happy medium. We will get rid of the HDHP's that you so disagree with. In turn, I believe the insurance company should not cover care for health issues that could be controlled with diet and common sense. An example, no more nexium for thoses that get heartburn from eating fatty and spicy foods. No more cholesterol and high blood pressure medication for thoses that are more that are outside of the insurance carriers approved height/weight class. No more life-time paxil to make people happy. The world is a hard place, learn to cope. Or do as Anthem of VA has done, Nexium will only be covered for the first 90 days, after that you better have a severe gastro. problem or you will receive no further coverage for the Nexium until after the end of a 180 day period. Don't get me wrong, I agree that there are people that have issues that are uncontrollable and need help, and I agree that this is where the insurance should kick in and provide help. But I bet you know people that are abusing the system and this is where a lot of the annual increases come from each year.
Second Option: How about we severely penalize those that have health issues that are controllable and don't penalize those that have health issues that are not controllable. At least we would be distributing the cost of healthcare properly.
Do I feel that everyone has a right to the same healthcare - NO! It's very discouraging to see the care that I get and the premiums that I pay, and my husband and I both work full-time. Then you have those that don't work, or choose to have only one working parent, and say they can't afford health isurance but get free care through the state hospital. If we are going to go to socialized medicine, let's do it based on your ability to work. If you are able to work full-time and choose not to so that you can stay home, tough, no coverage.
Last, if we know that Social Security is going broke, why does the system allow for someone to receive half of their spouse's avaialable payout or all of theirs? Why not do it based on what they paid in? Why allow someone who didn't contribute to collect anything at all? Again, I referring to the able-bodied individual.
Gripe session over - quit picking on people that are trying to come up with a solution and go after ones that deserve the real attack.