WASHINGTON, May 5 (UPI) -- Americans should be required to have health insurance but employers need incentives to provide those benefits, panelists said at a Cover the Uninsured Week forum.
The conservative-leaning America Enterprise Institute asked analysts to discuss their plans to implement universal health coverage in the United States.
The group was in agreement that some type of mandate requiring everyone to have health insurance was needed because it isn't just the sick and the poor who lack coverage.
Policy experts and politicians have proposed plans to reform the healthcare system and to provide more families with health insurance. President Bush's 2006 budget proposes tax credits for low-income families, above-the-line tax deductions for middle-income families and association health plans for small businesses. The Medicare Modernization Act Health of 2003 created health savings accounts, which allow Americans to save money in a tax-free account to pay for healthcare services, in conjunction with a high-deductible catastrophic insurance plan.
University of Pennsylvania Professor Mark Pauly said there isn't a typical image of an uninsured person.
"On average, the uninsured are as healthy as the insured because they are younger," Pauly said. "Most of the uninsured are not poor, and the population varies by income, age, health state and almost anything else you could think of."
The U.S. Census Bureau reported in 2003 that 15.6 percent of the U.S. population or about 45 million people were uninsured at some time during the year.
Devon Herrick, health economist at the National Center for Policy Analysis in Texas, told United Press International 60 percent of the uninsured had access to healthcare. They might qualify for Medicaid but are not enrolled, or they make enough money but choose not to spend it on health insurance. He said the true number of the uninsured -- those too rich for Medicaid but too poor to afford insurance is close to 18 million people.
The Census Bureau also reported young adults, ages 18-24, were the least likely age group to have health insurance -- with more than 30 percent uninsured. Nicknamed the young immortals, the reason this group doesn't buy insurance, Herrick said, is they do not believe they are going to have serious medical problems.
"The punch line is that we can get people who are uninsured to get health insurance," Pauly said.
The first step is to stop making insurance so expensive, he said. Better empirical evidence also is needed to show all the good things insurance can do for the non-poor uninsured -- taxpayers cannot be shamed into paying for coverage but rather must be persuaded it is what they need.
Pauly said he favored an employer-enforced mandate to workers and tax subsidies as incentives for the uninsured to get coverage. He stressed even some coverage is better than no coverage.
"The uninsured who can afford coverage need to be blitzed by marketers: 'This is your brain without health insurance,'" Pauly said. "You need to get health insurance when you're healthy; not on the way to the hospital in an ambulance."
Jon Gabel of the Health Research and Educational Trust said there are two myths that make it difficult to grab the public's interest and get people to care about this issue. No. 1 is the myth the uninsured do not work and the second is that uninsured patients get the same healthcare as everybody else.
The Census Bureau reported in 2003 full-time workers were more likely to have health insurance than were part-time workers or the unemployed. The uninsured rate for full-time workers was 17.3 percent -- a small increase from 2002. The number of people covered by employer-based health insurance decreased by 1.3 million in one year. That was mainly because the rising cost of healthcare put financial pressure on employers, who passed some of those extra costs to workers via higher co-pays and premiums. That forced some workers to drop health insurance and, in some cases, companies that decided they could not afford the increases dropped the benefit entirely.
The likelihood of having health insurance rises with income. More than 91 percent of people making over $75,000 a year had health insurance.
Gabel said the quality of care uninsured patients receive also is less than that given to insured patients. He said the uninsured enter the hospital sicker, are discharged sooner, and are more likely to die in the hospital.
He added another problem is that lawmakers do not have a single piece of legislation to point to when guiding the process.
The problem for some uninsured people run is not that they don't want health insurance, it is that they can't afford it.
Gable suggested an individual mandate would work to cover the uninsured and all those who did not sign up would be randomly assigned to a plan when filing income tax.
Eugene Steuerle of the Urban Institute suggested an indirect mandate -- those who did not buy health insurance would lose some tax benefits. He also suggested employers could have an automatic enrollment plan and employees could opt out if they did not want the company's coverage.
"Most people claim we don't know how to solve the problem," Steuerle said "But we do know certain things that can help."
Len Nichols, director of the health policy program at New America Foundation, said an increasing fraction of the American workforce is unable to afford health insurance, but because the problem is moving at a slow pace, it has not been labeled a crisis and there is no sense of urgency to solve it.
There is a moral imperative to provide universal health coverage, he said, just as food is essential to life.
"Medical care is an essential gift that is necessary to sustain life," Nichols said. "To deny health insurance is equivalent to denying food."
He said mandatory health insurance would help solve the problem but cautioned against taking away choice in coverage. He said the biggest problem is to devise and articulate a fiscally credible solution.
"The American people can't write a blank check for universal health coverage," Nichols said.
