Universal Coverage Talking Points from CPA

Nearly 44 million Americans are without health insurance and 30 million more are underinsured. As a nation, we are left with the obvious conclusion: the healthcare marketplace is unwilling and ill-equipped to cover the uninsured. Indeed, the increasing financial instability of the managed care industry, and the increasing cost of premiums and prescriptions cast doubt on whether any American's health care is secure. The attempts by Congress to address the staggering numbers of uninsured have been piecemeal, makeshift and seemingly incapable of repairing the system's structural flaws.

Employers cannot be relied upon to provide healthcare coverage. Of the 44 million of our fellow citizens who have no health coverage, 85 percent are from working families. Seventy percent of uninsured workers and their families are not even offered health coverage through their employers. Of the rest, 84 percent cite the high cost of health insurance premiums as the reason for declining coverage. Only 55 percent of low-wage workers (earning under $7 per hour) have access to job-based heath insurance.

Uninsured Americans rarely get checkups and often don't seek treatment when sick. The uninsured are four times more likely to have no usual source of care than those with private insurance. When sick, they most often receive care at hospital emergency rooms or clinics. Too often, they don't receive healthcare at all. For example, only 33 percent of all uninsured children with recurrent ear infections, and less than 50 percent of all uninsured children with asthma, see a doctor.

The healthcare situation is getting worse. While the economic boom of the 1990s allowed states to increase health coverage through Medicaid and state Children's Health Insurance Programs (SCHIP), health costs rose as much as 15-20 percent per year, far faster than inflation. Today, medical bills are the primary cause of 50 percent of personal bankruptcies. With the economic slowdown continuing, more Americans will likely join the ranks of the uninsured.

With the federal government unlikely to act, states are taking the lead in trying to cover the uninsured. Rather than abandon the uninsured, or conclude that the problem is too overwhelming to solve, states are experimenting with an assortment of plans, programs and remedies that may point the nation in the right direction. While no state has implemented the perfect solution, some are pursuing comprehensive coverage plans, including vigorous efforts in Massachusettsand Maine.

The Health Care for All campaign in  Marylandprovides a thoughtful universal healthcare policy model.The Maryland Citizen's Health Initiative has crafted a two-stage legislative plan. The first stage offers comprehensive coverage to the uninsured by expanding SCHIP, raising Medicaid and SCHIP provider reimbursement rates to ensure access to quality care, and creating a quasi-public insurer to provide comprehensive benefits to uninsured adults. Within three years, the second stage mandates health coverage for all residents through a combination of employer-based insurance, existing government programs (i.e. Medicare/Medicaid), and the new quasi-public insurer. This multi-payer plan makes healthcare spending on the uninsured more efficient by streamlining the administration of the state's many existing healthcare programs. The only new tax needed for the first phase is a 70¢ increase in the state's tobacco tax.

The Health Care for All campaign also provides a strong organizing model. The Marylandcampaign is based upon a well-tested, long-term organizing plan. For two years, the Maryland Citizen's Health Initiative has built support for the concept of universal coverage, gaining official endorsements from more than 2,175 organizations in the state. Simultaneously, the campaign convened a task force of health policy experts-including economists, lawyers and physicians-who relied on research from the JohnsHopkinsUniversityand Universityof Marylandschools of public health. Throughout the process, the campaign has held a series of town meetings across the state to solicit input from every community. When the plan is turned into specific legislation in the spring of 2002, it will enjoy both solid credibility and unprecedented grassroots support.

Americans continue to demand improved health insurance programs. For more than a decade, public opinion surveys have found that universal health insurance is one of Americans' top policy priorities. It remains one of the clearest unaddressed policy priorities of our time.

This policy summary relies in large part on information from the Center for Policy Alternatives and the Maryland Citizens' Health Initiative.

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