The byproduct of tighter bottom lines for America’s industry is the big squeeze in health benefits. Those still lucky enough to have employer-based insurance coverage most likely have higher deductibles and co-pays or have been shifted to plans with a limited choice of providers. For those 1.3 million who have become uninsured in the past year, welcome to the growing legions of working class Americans who are “going bare” and hoping for good health.
As the chart below indicates, data just released from the government shows the steady and relentless rise in our country’s uninsured population.
This past year we have added 1.3 million new Americans to this very vulnerable group. And many of these people work full time.
Rethinking Your Stereotype of the Uninsured
Let me help you discard your stereotypes regarding the uninsured. Many are the working poor. They are caught in that dangerous economic wasteland between poverty and unemployment with the benefits of Medicaid and the ability to purchase affordable health insurance that will leave them with enough left over to feed, clothe, and house their families.
There are 37.8 million Americans of working age without insurance, and 27.3 million of them actually had paying jobs for some or all of last year. Even more astounding, the number of uninsured full-time workers grew by 1 million, from 20.5 million in 2004 to 21.5 million in 2005. Only 27.3% of uninsured Americans did not work at all.
This is not solely a problem for the poor and uneducated. More than 5 million of the uninsured had a college degree, more than 15 million had attended college at one time, and 22.6% had household incomes of more than $50,000 a year.
This is a particular problem for young Americans. Almost 70% of the uninsured are under 35 years of age. Even more disturbing, the number of children without insurance coverage rose from 7.9 million in 2004 to 8.3 million in 2005. This phenomenon occurred despite a number of legislative efforts to cover children and the allocation of extra resources in many states for sign-up drives organized to enroll more children.
The racial makeup of the uninsured population may surprise you as well. More than 22 million uninsured are non-Hispanic whites. In an emergent trend, however, an increasing percentage of the uninsured are Hispanic. There are now more than 14 million uninsured Hispanics in this country, representing a growing percentage of the Hispanic population in states such as California and Texas.
Implications for Hospitals and Hospitalists
Like emergency department physicians, hospitalists are hospital-based and ready to take all comers—regardless of insurance coverage or ability to pay the bills. On the clinical side, it is well known that those without insurance coverage generally avoid outpatient services that might have prevented an acute hospitalization. In addition, there is more often a chance for a falloff in post-discharge medical follow-up in those who lack insurance and a supportive outpatient physician. This can lead to unnecessary morbidity and readmissions.
For hospitals, finding a specialist to manage the patients in the emergency department or to co-manage with the hospitalist upon admission creates an additional strain. Depending on the hospital’s locale and patient mix, any increase in patients who are “self pay,” or uninsured, creates a financial strain that can affect the hospitalist service, as well as other hospital-supported clinical functions.