Health insurance coverage in the United States is provided by several public and private sources. During 2016, the US population as a whole was around 325 million, with 53 million people aged 65 and more covered by the federal Medicare program. 272 million non-institutional persons under the age of 65 receive coverage from employer-based sources (155 million) or non-employers (90 million), or uninsured (27 million). Approximately 15 million military personnel receive coverage through the Veterans Administration. During 2016, 91.2% of Americans have health insurance coverage. Despite being among the world's top economic powers, the US remains the only industrial country in the world without universal health care coverage.
Costly fees are the main reason Americans have trouble accessing health care. At more than 27 million, higher than the entire population of Australia, the number of people who do not have health insurance in the United States is one of the main concerns raised by health care reform advocates. Lack of health insurance is associated with an increase in mortality, in the range of 30-90 thousand deaths per year, depending on the research.
Some surveys show the amount of uninsured quota between 2013-2016 due to the expanded Medicaid eligibility and health insurance exchange set for Patient Protection and Affordable Care Act, also known as "Obamacare". According to the US Census Bureau, in 2012 there are 48.0 million people in the US (15.4% of the population under 65 years) who do not have health insurance. This figure is down about 20 million, to 27 million by 2016 or 10% of the population under 65 years.
However, under President Trump, this increase in health care coverage has begun to reverse. The Commonwealth Fund estimates in May 2018 that the uninsured amount increased by 4 million from early 2016 to early 2018. Uninsured rates increased from 12.7% in 2016 to 15.5%. The impact is greater among low-income adults, who have an uninsured rate higher than high-income adults. Regionally, South and West have higher insurance rates than North and East. Furthermore, 18 countries that have not expanded Medicaid have an uninsured rate higher than those who do.
The cause of this degree of mistrust remains a matter of political debate. Nearly half of those who do not have insurance refer to cost as the main factor. Increased insurance costs have contributed to a trend where fewer employers offer health insurance, and many employers manage costs by requesting higher employee contributions. Many of the uninsured are working poor or unemployed.
Video Health insurance coverage in the United States
Overview
Health insurance coverage is provided by several public and private sources in the United States. Analyzing these statistics is more challenging because people with different sources of insurance, such as those with coverage under both employer plans and Medicaid. During 2016, the US population as a whole was around 325 million, with 53 million people aged 65 and more covered by the federal Medicare program. For 272 million other non-institutional people under the age of 65 years:
- There are 155 million with employer-based coverage, 90 million with other coverage, and 27 million uninsured persons.
- Of 90 million with other coverage, 57 million is covered by Medicaid and the Children's Health Insurance Program (CHIP), 12 million are protected by ACA/Obamacare exchange, 11 million are covered by ACA Medicaid expansion, and 10 million have other coverage, such as personal insurance purchased outside the ACA stock exchange.
- Of the 12 million in the ACA market, 10 million receive subsidies and 2 million are not.
- Of the 27 million uninsured, 21 million (79%) are US citizens while 6 million (21%) are non-citizens, including documented and undocumented immigrants. By 2015, 45% of the uninsured are white, 32% Hispanic, and 15% are black.
- About 15 million institutional (military) personnel are covered by the Veterans Administration by 2015.
- Uninsured rates are down from a 18.2% peak in 2010 to 10.5% by 2015, mainly because ACA/Obamacare is along with improvements in the economy.
- Countries that expand Medicaid under Obamacare have less insurance rates lower than states that do not.
- The inability to buy insurance is the main reason cited by people without coverage (46%).
- Lack of health insurance is associated with increased mortality, within the range of 30-90 thousand deaths per year, depending on the study. This figure is calculated on the basis of 1 additional deaths per 300-800 persons without health insurance, on the basis of 27 million uninsured persons.
Maps Health insurance coverage in the United States
Estimated uninsured amount
The Congressional Budget Office (CBO) estimates an uninsured amount of 27 million by 2016, about 10% of the population under 65 years of 272 million. Gallup estimates in July 2014 that the uninsured rate for adults (persons 18 years and over) is 13.4% in Q2 2014, down from 18.0% in Q3 2013 when health insurance exchanges created under the Patient Protection and Affordable Care Act (PPACA or "Obamacare") was first opened. Uninsured rates fall in almost all demographic groups. The Commonwealth Fund reported that the uninsured rate among adults 19-64 declined from 20% in Q3 2013 to 15% in Q2 2014, which means about 9.5 million more adults have health insurance.
The US Census Bureau annually reports statistics about the uninsured. The 2016 Census Bureau of Health Insurance highlights a summary report stating that:
- "Uninsured rate decreases between 2015 and 2016 by 0.3 percentage points as measured by ASEC CPS.In 2016, the percentage of persons without health insurance coverage for the entire calendar year is 8.8 percent, or 28.1 million, lower than the number and amount uninsured in 2015 (9.1 percent or 29.0 million).
- The percentage of people with health insurance coverage for all or part of 2016 is 91.2 percent, higher than the level by 2015 (90.9 percent).
- By 2016, private health insurance coverage continues to be more common than government coverage, at 67.5 percent and 37.3 percent, respectively. Of the subtypes of health insurance coverage, employer-based insurance covers 55.7 percent of the population for some or all calendar years, followed by Medicaid (19.4 percent), Medicare (16.7 percent), direct purchases (16.2 percent) and military coverage (4.6 percent).
- Between 2015 and 2016, Medicare coverage rates increased by 0.4 percentage points to cover 16.7 percent of people for some or all of 2016 (up from 16.3 percent in 2015). There were no statistically significant differences between 2015 and 2016 for other health insurance subtypes.
- Between 2015 and 2016, the percentage of people without health insurance coverage drops for the majority of under 65s, with generally larger declines for working age adults (ages 19 to 64).
- The percentage of uninsured children under 19 years, 5.4 percent, has not changed significantly between 2015 and 2016.
- By 2016, the uninsured rate for children under the age of 19 in poverty, 7.0 percent, is higher than the uninsured rate for children not in poverty, 5.0 percent.
- By 2016, non-Hispanic whites have the lowest uninsured rates among the races and groups of Hispanic origin, by 6.3 percent. Uninsured rates for Blacks and Asians were higher than for non-Hispanic whites, respectively 10.5 percent and 7.6 percent. Hispanic has the highest uninsured rate, which is 16.0 percent.
- Between 2015 and 2016, the percentage of people without health insurance at any time during the year fell 0.4 percentage points for non-Hispanic whites, dropping to 6.3 per cent. There is no statistical change in the uninsured rate for Blacks, Asians, or Hispanics during this period.
- Between 2015 and 2016, the percentage of people without health insurance coverage at the time of the interview declined in 39 states. The eleven states and the District of Columbia have no statistically significant change in the uninsured rate. "
Trend coverage under President Trump
Benefits in healthcare coverage under President Obama began to tumble under President Trump. The Commonwealth Fund estimates in May 2018 that the uninsured amount increased by 4 million from early 2016 to early 2018. Uninsured rates increased from 12.7% in 2016 to 15.5%. This is due to two factors: 1) Not addressing specific weaknesses in the ACA; and 2) Actions by the Trump administration that exacerbate the weakness. The impact is greater among low-income adults, who have an uninsured rate higher than high-income adults. Regionally, South and West have higher insurance rates than North and East. Furthermore, 18 countries that have not expanded Medicaid have an uninsured rate higher than those who do.
Uninsured demographics
The Kaiser Family Foundation reported in October 2016 that there were 27.2 million uninsured persons under the age of 65, about 10% of the 272 million people in the group. Kaiser reports that:
- 2.6 million are in "reach gaps" because 19 countries are choosing not to expand Medicaid programs under ACA/Obamacare, which means their income is above the Medicaid requirements limit but below the threshold for subsidies on the ACA exchange (~ 44% to 100% of the federal poverty rate or FPL);
- 5.4 million are undocumented immigrants;
- 4.5 million have an employer's insurance offer (makes them not eligible for ACA/Obamacare coverage) but rejects it;
- 3.0 million are not eligible for financial assistance under ACA/Obamacare due to high earnings;
- 6.4 million qualify for Medicaid or other public health care programs but do not pursue it; and
- 5.3 million are eligible for ACA/Obamacare tax credit but do not enroll in the program.
- An estimated 46% mention costs as a barrier to insurance coverage.
- Nearly 12 million (43%) people are eligible for financial assistance (Medicaid or ACA) but do not register to get it.
The Census Bureau reports that in 2007 nearly 37 million uninsured people were working age adults (ages 18 to 64) and more than 27 million worked at least part-time. About 61% of the approximately 45 million uninsured people live in households with incomes below $ 50,000 (13.5 million under $ 25,000 and 14.5 million at $ 25,000 to $ 49,000). And 38% live in households earning $ 50,000 or more (8.5 million at $ 50,000 to $ 74,999 and 9.1 million at $ 75,000 or more). As stated by the Census Bureau, Hispanic origin is the most affected by the uninsured; nearly a third of Hispanics have no health insurance. In 2004, about 33% of Latinos were not insured compared to 10% whites, non-Latinos. However, this rate decreased slightly from 2006 to 2007, from 15.3 to 14.8 million, a decrease of 2 percentage points (34.1% to 32.1%). The country with the highest percentage of uninsured is Texas (average 24.1% for three years, 2004-2006). New Mexico has the second highest percentage of population without health insurance of 22%. It is estimated that nearly one-fifth of the uninsured population can afford insurance, nearly one-quarter eligible for public coverage, and the remaining 56% need financial assistance (8.9% of all Americans). It is estimated that 5 million of those who do not have health insurance are considered "insurable" due to pre-existing conditions. A recent study concluded that 15% of people who shop online for health insurance are considered "uninsured" due to pre-existing conditions, or being overweight. These labels do not mean they can never get health insurance, but that they will not qualify for standard individual coverage. Persons with similar health status may be covered through health insurance provided by employers, Medicare, or Medicaid.
Uninsured child and young adult
Current estimates for uninsured children are not very different from previous estimates. In 2009 the Census Bureau stated that 10.0 percent or 7.5 million children under the age of 18 are not covered by medical insurance. Children living in poverty are 15.1 percent more likely than other children to be uninsured. The lower the household income the more likely they are not insured. In 2009, households with an annual income of 25,000 or less with only 26.6 percent were unlikely to have health insurance and those with an annual income of 75,000 or more only 9.1 percent would not be insured. According to the Census Bureau, in 2007, there were 8.1 million uninsured children in the US. Nearly 8 million young adults (those aged 18-24), are uninsured, representing 28.1% of their population. Young adults are the largest age segment of the uninsured, the most likely to be uninsured, and is one of the fastest growing segments of the uninsured population. They often lose coverage under their parents' health insurance policy or public program when they reach age 19. Others lose coverage when they graduate from college. Many young adults do not have stable jobs that will provide continuous access to health insurance. According to the Congressional Budget Office, the plan should now include unmarried dependents under their parent insurance up to age 26. These changes also affect large employers, including insured companies themselves, so the company bears the financial responsibility of providing coverage. The only exception to this is the policy that is maintained continuously before the enactment of this law. The policies will be realized.
Non-citizen
Non-residents are more likely to be uninsured than citizens, with 43.8% uninsured rate. This is due to the higher probability of working in low-wage jobs that offer no health benefits, and restrictions on eligibility for public programs. The longer a non-citizen immigrant resides in the country, the less likely they are to be uninsured. In 2006, about 27% of immigrants entered the country before 1970 were uninsured, compared to 45% of immigrants entering the country in the 1980s and 49% of those who entered between 2000 and 2006.
Most non-uninsured citizens are new immigrants; nearly half entered the country between 2000 and 2006, and 36% entered during the 1990s. Non-citizen foreigners accounted for more than 40% of the uninsured increase between 1990 and 1998, and more than 90% increase between 1998 and 2003. One of the reasons for the acceleration after 1998 may be the limitation imposed by Responsibility Personal and Work Opportunity Reconciliation Act (PRWORA) of 1996. Almost seven out of ten (68%) of non-uninsured citizens live in California, Texas, Florida, or New York.
Slump effect
A report by the Kaiser Family Foundation in April 2008 found that the deterioration in the US economy placed significant strain on the country's Medicaid and SCHIP programs. The authors estimate that a 1% increase in the unemployment rate increases Medicaid and SCHIP registration by 1 million, and increases the uninsured amount by 1.1 million. State spending on Medicaid and SCHIP will increase by $ 1.4 billion (total spending on these programs will increase by $ 3.4 billion). This increase in spending will occur while government revenues decline. During the last recession, Jobs and the Growth Tax Relief Reconciliation Act of 2003 (JGTRRA) included federal assistance to the state, which helped countries avoid the tightening of Medicaid and SCHIP eligibility rules. The authors conclude that Congress should consider similar assistance for the current economic downturn.
Cause
Uninsured Americans may be so because their job does not offer insurance; they are unemployed and can not afford insurance; or they can financially buy insurance but consider expensive fees. During 2009, a low level of permanent employment has negatively impacted those previously enrolled in employment-based insurance policies. The Census Bureau declared a 55 percent drop. Other non-insured Americans have opted to join health care sharing services as an alternative to insurance.
Low-income workers are less likely than high-income individuals to offer coverage by their employers (or by their spouse's employers) and are less able to afford them on their own. Beginning with wage and price controls during World War II, and cemented by an income tax exemption decision in 1954, most American workers have received health insurance from their employers. However, recent trends indicate a continuing decline in the benefits of corporate sponsored health insurance. In 2000, 68% of small companies with 3 to 199 workers offered health benefits. Since then, that number has continued to decline until 2007, when 59% offered health benefits. For large companies with 200 or more workers, by 2000, 99% of employers offered health benefits; in 2007, that number remains the same. On average, considering the company of all the number of employees, in 2000, 69% offered health insurance, and that number has declined almost every year since, until 2007, when 60% of employers offered health insurance.
One study published in 2008 found that people with average health were at least likely to become uninsured if they had a large group health coverage, were more likely to become uninsured if they had small group coverage, and were likely to become uninsured are insured if they have individual health insurance. But, "for the poor or fair health, the likelihood of losing coverage is much greater for people who have small group insurance than those who have individual insurance." The authors attribute this result to the combination in the individual market with high cost and guaranteed coverage. Individual coverage is more expensive when purchased after a person becomes unhealthy but "provides better protection (compared to group insurance) against high premiums for insured individuals who are at high risk." Healthier individuals are more likely to reduce individual coverage compared to cheaper and subsidized employment-based scopes, but group coverage makes them "more vulnerable to losing or losing any and all coverage than individual insurance" if they become seriously ill.
Approximately a quarter of the uninsured are eligible for public coverage but not listed. Possible reasons include lack of awareness of the program or how to register, reluctance due to perceived stigma associated with public coverage, poor registries, and aggravating administrative procedures. In addition, some state programs have registration caps.
A study by the Kaiser Family Foundation published in June 2009 found that 45% of low-income adults under age 65 did not have health insurance. Almost one-third of non-elderly adults are low-income, with family income below 200% of federal poverty. Low-income adults are generally younger, less educated, and less likely to live in households with full-time workers than high-income adults; these factors contribute to the possibility of being uninsured. In addition, the possibility of a healthy decline with lower incomes; 19% of adults with incomes below the federal poverty level describe their health as fair or poor.
Consequences
Insurance coverage helps save lives, by encouraging early detection and prevention of dangerous medical conditions. According to a 2014 study, the ACA is likely to prevent about 50,000 preventable patient deaths from 2010 to 2013. City Healthcare professors David Himmelstein and Steffie Woolhandler wrote in January 2017 that the decline of the ACA Medicaid expansion alone would cause around 43,956 deaths annually.
The Federal Reserve publishes data on early death rates by region, defined as those who died under the age of 74. According to the Kaiser Foundation, expanding Medicaid in the remaining 19 states will cover up to 4.5 million people, thus reducing mortality. Texas, Oklahoma, Mississippi, Alabama, Georgia, Tennessee, Missouri, and South Carolina, are indicated on the Federal Reserve map (see chart on the right) because it has many districts with high rates of premature death, not expanding Medicaid.
A study published in the American Journal of Public Health in 2009 found that a lack of health insurance was associated with about 45,000 preventable deaths per year. One writer characterizes the result as "now one dead every 12 minutes." Since then, since the uninsured amount has increased from about 46 million in 2009 to 48.6 million in 2012, the number of preventable deaths due to lack of insurance has grown to around 48,000 per year.
A survey released in 2008 found that the uninsured health effects of American consumers in the following ways:
- More than uninsured people choose not to see a doctor when sick or sick (53%) vs 46% of the insured.
- Fewer than uninsured reports (28%) are currently undergoing treatment or participating in the program to help them manage chronic conditions; 37% of the insured received such treatment.
- 21% of the uninsured, vs. 16% of the insured, believing that overall health is below average for people in their age group.
The cost of uninsured care should often be absorbed by the service provider as a charity treatment, passed on to the insured through health insurance premiums that are switched higher and higher, or paid by taxpayers through higher taxes. On the other hand, those who are not insured often subsidize the insured because those who are not insured use fewer services and are often billed at a higher rate. A study found that in 2009, uninsured patients who came to the US emergency department were less likely to be hospitalized than those who had Medicare, Medicaid, or private insurance. 60 Minutes reported, "The hospital imposes an uninsured patient two, three, four times or more what the insurance company will pay for the same treatment." On average, health care spending per capita on behalf of the uninsured is slightly more than half for the insured.
A study published in August 2008 in Health Affairs found that covering all uninsured in the US would increase the national health care spending of $ 122.6 billion, which would represent a 5% increase in health care spending and 0.8% of GDP. "From a community standpoint, protecting the uninsured is still a good investment.Failure to act in the near future will only make it more expensive to cover the uninsured in the future, while increasing the amount of lost productivity from not insuring all Americans," said Professor Jack Hadley, lead author of the study. The impact on government spending may be higher, depending on the details of the plan used to increase coverage and the extent to which new public coverage overcame personal coverage.
Over 60% of personal bankruptcy is caused by medical bills. Most of these people have health insurance.
From 2000 to 2004, the Institute of Medicine's Committee on the Consequences of Uninsurance issued a series of six reports that reviewed and reported evidence on the effects of the lack of health insurance coverage.
The report concludes that the committee recommends that the nation should adopt a strategy to achieve universal health insurance coverage. In 2011, a comprehensive national plan to address what the term "universal insured crisis" advocates the term "uninsured American crisis", has not been enacted. Several countries have made progress toward universal health insurance protection goals, such as Maine, Massachusetts, and Vermont, but other countries including California have failed to reform.
Six reports made by the Institute of Medicine (IOM) found that the major consequences of discomfort were as follows: Children and Adults without health insurance did not receive the required medical care; they usually live in worse health and die earlier than children or adults who have insurance. The financial stability of whole families can be risky if only one person is uninsured and requires care for unexpected health care costs. The overall health status of a community can be affected by a higher percentage of uninsured people in society. Coverage coverage between the insured and the uninsured has not declined even after recent federal initiatives to expand health insurance coverage.
The final report was published in 2004 and is named Insuring America's Health: Principles and Recommendations. The report recommends the following: The President and Congress need to develop strategies to achieve universal insurance coverage and set a strong schedule for achieving this goal by 2010. The committee also recommends that federal and state governments provide sufficient resources for Medicaid and Programs State Child Health Insurance (SCHIP) to cover all those currently eligible until universal coverage applies. They also warned that federal and state governments should prevent the erosion of outreach, feasibility, enrollment, and coverage of these specific programs.
Some people think that not having health insurance will have adverse consequences for uninsured health. On the other hand, some people believe that children and adults without health insurance have access to necessary health care services in hospital emergency rooms, community health centers, or other safety net facilities offering charitable care. Some observers note that there is ample evidence to suggest that most US health care expenditures are devoted to ineffective and sometimes even harmful treatments. At least for an insured population, spending more and using more health care services does not always result in better health outcomes or increased life expectancy.
Children in America are usually considered to have good health compared to adults, due to the fact that the most serious health problems occur later in life. Certain conditions including asthma, diabetes, and obesity have become much more common among children in recent decades. There is also a growing population of vulnerable children with special health care needs that require ongoing medical care, which will not be accessible without health insurance. More than 10 million children in the United States meet the federal definition of children with special health care needs "who have or are at increased risk for chronic physical, developmental, behavioral or emotional conditions and who also require health and related services of the type or amount beyond the needs of children generally ". These children need health-related services in excess of what the average American child needs. Usually when children get health insurance, they are much more likely to experience unmet health care needs before, this includes average children in America and children with special health care needs. The Committee on the Status of Health Insurance and its Consequences concluded that the health insurance effect on child health outcomes: Children with health insurance received a more timely diagnosis of serious health conditions, fewer hospitalizations, and fewer school days.
The same committee analyzes the health insurance effect on adult health outcomes: adults who do not have health insurance coverage that receives Medicare coverage at age 65, have improved health and functional status, especially those with cardiovascular disease or diabetes. Adults who have cardiovascular disease or other uninsured cardiac risk factors tend to be unaware of their condition, leading to worse health outcomes for these people. Without health insurance, adults are more likely to be diagnosed with certain cancers that may have been detected earlier by examination by a doctor if they regularly visit a doctor. As a result, adults are more likely to die of cancer being diagnosed or suffer from worse health outcomes.
Many cities and towns in the United States have high concentrations of people under the age of 65 who do not have health insurance. There are implications of high levels of discomfort for the community and for the insured person in the community. The Institute of Medicine committee warns of the potential problems of high levels of discomfort for local health care, including reducing access to clinical-based primary care, specialty care, and hospital-based emergency services.
Emergency Medical Treatment and Active Employment Act (EMTALA)
EMTALA, authorized by the federal government in 1986, requires emergency departments of hospitals to handle the emergency of all patients regardless of their ability to pay and is considered an important element in the "safety net" for the uninsured. However, federal law does not establish a direct payment mechanism for such treatment. Indirect payments and reimbursement of costs through federal and state government programs never provide full compensation for public and private hospitals for the full maintenance cost mandated by EMTALA. In fact, more than half of all emergency care in the US is now not compensated. According to some analyzes, EMTALA is an unfunded mandate that has contributed to financial pressures on hospitals in the last 20 years, causing them to consolidate and close facilities, and contribute to emergency room density. According to the Institute of Medicine, between 1993 and 2003, emergency room visits in the US grew by 26%, while in the same period, the number of emergency departments decreased by 425. Hospitals collect uninsured patients directly under cost-for- modeling services, often weigh more than would be paid by the insurance company, and the patient may become bankrupt when the hospital filed a lawsuit.
The mentally ill patients present unique challenges to emergency departments and hospitals. In accordance with EMTALA, psychiatric patients entering the emergency room are evaluated for emergency medical conditions. Once the patient is mentally ill mentally stable, the regional mental health agency is contacted to evaluate it. Patients are evaluated whether they endanger themselves or others. Those who meet these criteria are treated in mental health facilities for further evaluation by psychiatrists. Usually, the mentally ill patient can be detained for up to 72 hours, after which a court order is required.
Uninsured rate by state
The US Census Bureau regularly conducts the Current Population Survey (CPS), which includes estimates on health insurance coverage in the United States. These data are published annually in the Annual Social and Economic Supplement (ASEC). Data from 1999 to 2014 are reproduced below. By 2012, the five states with the highest percentage estimate of the uninsured are, in order, Texas, Nevada, New Mexico, Florida, and Georgia. The five states/territories with the lowest percentage estimates of the uninsured for the same year are, in order, Massachusetts, Vermont, Hawaii, Washington, D.C., and Connecticut. This ranking for each year is highlighted below.
Assist programs for uninsured
People without health insurance in the United States can benefit from a patient assistance program like the Partnership for Recipes Help. Uninsured patients can also use medical billing negotiation services, which can audit medical bills for overcharges and errors.
See also
- Health care reform in the United States
- Health insurance
- Health insurance in the United States
- List of health care reform advocacy groups in the United States
- Single payer health care
- Universal health care
- Patient Protection and Affordable Care Act
Note
References
External links
- Uninsured Crisis of America: Consequences for Health and Health Care Institute of Medicine, National Academy of Sciences, 2009.
- The UAE family contains links to various studies and literature on health care-related issues such as uninsured.
- The SHADAC Data Center is a web-based tool that lets users create custom tables and graphs that show approximate health insurance coverage using a US Census survey between 1987-2009.
- Paul Fronstin, "Source of Health Insurance and Uninsured Characteristics: Analysis of Current Population Survey March 2012." EBRI Problem Summary # 376, September 2012, Employee Benefit Research Institute.
Source of the article : Wikipedia
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