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- The U.S. Census Bureau estimates for 2000 indicate that African Americans, American Indians and Alaska Natives, and Hispanics currently represent a quarter of the U.S. population.
- Future projections indicate that some racial and ethnic minority populations will steadily outpace whites in growth.
- By 2010, Hispanics, African Americans, and American Indians and Alaska Natives are expected to represent 28% of the U.S. population, and Asian Americans and Pacific Islanders will bring that proportion up to almost a third of the U.S. population (COGME).
- African-Americans (19.6% uninsured) and Hispanics (32.7%) were much more likely to be uninsured than white, non-Hispanic people (11.3%).
As racial and ethnic minorities increase in population, there is a need for more minority physicians who will serve these populations. Because of cultural differences and the lack of many physicians cultural competency, health care quality differences have and may continue to occur as a result of patient-physician cultural differences. To help reduce health disparities among racial and ethnic groups, more under-represented physicians are needed.
- An increase in racially and ethnically concordant patient-physician relationships can lead to increased health care and better health outcomes for underserved and vulnerable populations (COGME).
Underserved populations face great challenges when it comes to accessing to quality healthcare. With healthcare cost on the rise, these patients often times lack adequate care and ultimately, seek care once an illness/disease has entered into its worst stages. Experts say that underserved patients will face additional access problems as fewer minority physicians move through the education pipeline. In 2007, cuts to Title VII grants no longer exist and leaders within Medicine are concerned that the number of minority physicians, already few, will decrease further (American Medical News). Uninsured: Data Source: The Henry J. Kaiser Family Foundation and the Center on Budget and Policy Priorities
- 46.6 million non-elderly Americans lack health insurance in 2005, Census data shows an increase of 1.3 million additional persons from the number of uninsured in 2004 (45.3 million)
- 8.3 million uninsured children in 2005, an increase of 360,000 from the 2004 level (7.9 million). However, since 1998 the percentage of uninsured children has steadily decreased from a high of 15.4% to 10.8% in 2004. Notwithstanding, uninsured rates among children moved upward in 2005, rising to 11.2% (Center on Budget and Policy Priorities, 2006).
- Between 2004 and 2005, nearly 18% of non-elderly people lacked health insurance
- Low-income Americans with family incomes below 200% of the poverty level run the highest risk of being uninsured. Over a third of the poor and 30% of the near-poor (100-199% of poverty) lack health insurance.
- Uninsured rates vary nearly three-fold across states largely due to differences in state economics and employer coverage, the share of families with low incomes, and the scope of the state Medicaid programs.
- Researchers estimate that a reduction in mortality of 5% to 15% could be achieved if the uninsured were to gain continuous health coverage.
- Surprisingly, The Institute of Medicine estimates that at least 18,000 Americans die prematurely each year because of lack of health coverage.
What Other States are Doing to Improve Their Uninsured Rates
Major health reforms have started to take a shift upwards. Several states have introduced significant health reform proposals, while many have begun implementing them. The healthcare reforms range from large new insurance pools with large subsidies for low income populations and an individual mandate (Massachusetts) to near universal coverage (California, representing nearly 6.5 million uninsured). The efforts made by the states show that states can, on their own, provide the health insurance coverage needed by their citizens.
California: The State of California is developing a comprehensive reform in healthcare which will impact both public and private insurance.
Three central goals of the Health Care Reform Plan:
- Prevention and health promotion, which builds on the Governor's previous emphasis of healthy lifestyles
- Affordability and cost containment
- Coverage for all Californians
Low-income Californians will be provided expanded access to public programs, such as Medi-Cal and Healthy Families, and lower-income working residents will be provided financial assistance to help with the cost of coverage through a new state-administered purchasing pool.
Key elements to California’s proposed reform include:
- An expansion of public insurance programs (Medi-Cal or Healthy Families) for legal resident adults to 100% ($9,800 for an individual, $20,000 for a family of four) of the federal poverty line, and for all children 300% ($60,000 for a family of four) of the federally poverty line, regardless of resident status.
- The provision of comprehensive insurance through a central purchasing mechanism for legal resident adults between 100% ($9,800 for an individual, $20,000 for a family of four) and 250% ($24,500 for an individual, $50,000 for a family of four) of the poverty line, with costs shared between the government, enrollees, and their employers.
- A mandate on all California residents that they purchase or maintain at least a high deductible insurance product.
- A payroll assessment of 4% on firms with 10 or more employees who do not offer health insurance to their employees, which will go towards the cost of employees’ health coverage. Companies with less than 10 employees—are exempt. This 4% will prevent employers of 10 or more from dropping their health care coverage in light of the state’s program.
- Physicians and hospitals will receive $10-$15 billion—and in turn, will contribute a portion back to universal coverage. Physicians will contribute 2% of revenues and hospitals will contribute 4%, ensuring some of the savings stays in the system to support total coverage and increased Medi-Cal rates to providers.
Data Source: California Office of Governor Schwarzenegger
Currently, the State of California has 6.5 million uninsured, approximately 750,000 of whom are children. However, 20 million residents are insured.
"The proposal is built on the vision that we all have a responsibility, it's not just an individual responsibility, there are benefits to all in terms of insuring that all people have healthcare coverage. To me and because I was a Registered Nurse, healthcare and being healthy is a right, I think that everyone should have coverage just like everyone should have a free public education. To the extent that society can put an initiative to achieve that goal, I feel like we are going in the right direction." Says Rene Mollow, MSN, RN; Associate Director, Health Policy Medical Care Services, State of California."
Massachusetts: The Commonwealth is working on comprehensive health care reform that will provide healthcare coverage to all its residents.
The programs are:
- Commonwealth Care
- Commonwealth Choice
Commonwealth Care: A government subsidized health insurance program for individuals who meet certain eligibility requirements and whose income is below 300% of the FPL.
Commonwealth Choice: Commercial (private) health insurance for uninsured and small groups not eligible for Commonwealth Care.
Date Source: The Henry J. Kaiser Family Foundation/Kaiser Commission on Key Facts, 2006. The state of Massachusetts enjoys a strong foundation of employer-sponsored insurance supported by an expansive Medicaid program.
- 68% of non-elderly Massachusetts residents have insurance coverage through their employer, compared to just 61% nationally.
- About 10% of the state’s population is uninsured, compared to the national average of 16%.
Components of the Plan:
- The Massachusetts Health Care Reform requires the participation of both individuals and employers. It mandated everyone in the state to purchase health insurance by July 1, 2007, and imposes financial penalties of up to 50% of the cost of a health insurance plan on those who do not, via income tax filing.
- The plan creates the Commonwealth Health Insurance Connector to “connect” individuals to insurance by offering affordable, quality insurance products.
- Small businesses and individuals can purchase insurance through the Connector. The Connector will also offer specially designed, lower-cost products for 19-26 year olds.
- It is expected that up to 215,000 residents have purchased coverage through the Connector.
- Insurance market reform is also an important component of the plan. In particular, the plan will merge the individual and small-group insurance markets by July 2007, which is expected to reduce premium costs for individuals by 24%.
- The Commonwealth Care Health Insurance Program will provide sliding-scale subsidies to individuals with incomes up to 300% of the FPL (or $49,800 for a family of three) for the purchase of health insurance. Individuals with incomes less than 100% of the FPL ($9,800 for an individual) will not be required to pay any premiums.
- Plans offered through the Commonwealth Care will not have deductibles and will be offered by managed care organizations that participate in the Medicaid program.
- Commonwealth Care is expected to subsidize coverage for 207,500 residents.
- Members receive benefits which include: doctors office visits, inpatient hospital care, pharmacy benefits, mental health and substance abuse services and vision. Members in Plan Type 1 also receive dental care. There is no monthly premium for Plan Type 1 and members in Play Types 2, 3, 4 have sliding premiums based on income.
The United States is a very diverse country. Racial and ethnic minority populations are growing rapidly, more so than their white
counterparts.
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