Monday, January 01, 2007

The uninsured as Medicaid failure

In October 2006, the Kaiser Family Foundation Commission on Medicaid and the Uninsured released this Issue Paper:

The Issue Paper cites Federal Census data reporting that the estimated number of uninsured grew by 1.3 million people between 2004 and 2005, and now stands at 46.2 million, or about 17.9% of the under-65 population. This Paper thus provides additional support for the expressions of concern that “one out of every 6 Americans is uninsured”.

But wait a minute. Statements like that only reflect the average. Even an accurate average says nothing about the distribution of the population. It is accurate to say that "one out of 5" persons on the face of the earth is Chinese but that does not tell you how many Chinese live on your block. Fact is, the overwhelming majority of Chinese live in China. Similarly the uninsured don't simply comprise "one out of every 6 Americans". Fact is, the odds of being uninsured are hugely driven by poverty.

The Issue Paper confirms this fact, which prior surveys have also consistently found. And it stands to reason - - the very poor tend not to have regular, full-time jobs that offer employer-based group insurance; they often don't sign up for employer-based insurance even if eligible, because of the cost; and they can't afford to purchase individual insurance.

Table 1 in the Issue Paper shows that people below 2X's the federal poverty level comprised about 65% of all uninsured, non-elderly Americans in both 2004 and 2005. For people below 2X’s the FPL, the rate of uninsurance was 32.3% in 2004 and 33.3% in 2005. This raises some questions for Medicaid. Why is Medicaid failing to meet the needs of so many of our most impoverished citizens??? Aren't these exactly the people that Medicaid was created to serve?? How can Medicaid be falling so far short of meeting the goals for which it was established??? The KFF Commission on Medicaid and the Uninsured does not comment on these questions in the Issue Paper.

If all the nonelderly below 2X’s the federal poverty level could be enrolled in Medicaid, the proportion of uninsured Americans would fall from 17.9% to about 6% of the total population under age 65. (Enrolling everyone below 4X’s the federal poverty level into Medicaid would reduce the uninsured all the way down to 2%).

Seems to me that Medicaid is failing in its purpose as a governmental safety net for the poor, and that public pressure must be brought to bear on the new Congress to fx it within e.g. 100 days of their taking office in January.

OT Bleg: We're in the running for a MedBlog Award, and would appreciate your vote (just click here, select "InsureBlog" and press "Vote"). Thank you!

blog comments powered by Disqus