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POLICY: Uninsured number will rise, but maybe not enough

In an article in Health Affairs today called It’s The Premiums, Stupid Gilmer and Kronick project the numbers of the uninsured through 2013. Kronick, BTW was a co-author with Alain Enthoven of some of his market-based consumer choice articles, though he seems to have moved leftwards since the early 1990s.   Essentially they forecast that there will be a continued price effect with low and middle-income workers continuing to be squeezed out of insurance as the costs go up.  For the human side of this, take a look at the LA Times article which assessed this phenomenon yesterday. For the numbers, Kronick and Gilmer say:

Based on the
projected growth rates for health spending and personal income, we
estimate that the rate of uninsured non elderly workers will increase by
4.0 percentage points to 27.8 percent in 2013. We estimate that the
uninsurance rate among all nonelderly Americans will increase by 3.3
percentage points to 20.5 percent in 2013. With an expected population
of 271 million people under age sixty-five in 2013, we estimate that
there will be fifty-six million uninsured Americans in this age group,
an increase of thirteen million over the CPS estimate for 2002. Of this
estimated increase, 8.6 million occurs because of the expected increase
in the proportion of the population that is uninsured, and 4.4 million
because of an increase in population size.

The problem is that while there are countless stories of misery behind these numbers, and some real costs to being uninsured in terms of both access to care and worse health status —  not to mention the corresponding increase in people being severely underinsured — this may not be enough to change things.  Vic Fuchs at Stanford always used to say that we needed a national crisis to change the health system.  Adding a couple more million people — and they are poorer, more marginalized people than the typical voter — to the uninsured numbers each year isn’t going to change too much.  If however, things are getting worse, and we see these numbers increase at a faster rate — particularly amongst white middle income males in their 50s (i.e. Republican voters) — then there might be some real change coming up in 4-8 years.  I think that’s an equally plausible scenario, but if Gilmer and Kronick are right, then it’s probably more of the dreary same.

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newbiewonknewbiewonkSueAggravatedDocSurgtony Recent comment authors
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newbiewonk
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newbiewonk

Sue,
I think all of your points are valid. As you say, the fact that something doesn’t appear on your MIB report doesn’t mean that you’re insurance company won’t contact your previous insurers to dig for dirt.
Gadfly,
If you’re rejected for insurance, you have a right to a free copy of your MIB report.

gadfly
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gadfly

Two questions about the MIB Database. 1) Why isn’t is subject to HIPAA? If the Seattle case established that HIPAA could be extended beyond Health Plans and Providers, then it seems to me that MIB Database should be high on the list of Other Privacy Concerns. The information in the MIB could adversely affect the lives of thousands of people, skewing against people with genetic disorders and the elderly. 2) It bothers me that people have to pay to see a copy of the MIB report. When a person reports a credit card theft or gets rejected for a loan,… Read more »

Sue
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Sue

Great infomation newbiewonk and I’ve requested a report copy to see what is there. The challenge is that health questionnaires are worded very carefully. The one I’m looking at now wants a list of every medication I’ve taken in the past five years in addition to detail on potential health conditions. It even has a catch-all question that asks if you’ve “sought advice” at an emergency room in the last five years. The one before wanted detail on every doctor’s visit over the past five years. Plus both want lists of previous insurers and ask if an insurance company has… Read more »

newbiewonk
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newbiewonk

Sue, Why don’t you request a copy of your health record from the Medical Information Bureau (MIB). The MIB is a centralized database used by the health insurance companies to keep tabs on whether you’re being truthful on your health insurance applications, etc… Here’s a description of the MIB excerpted from the Privacy Rights Clearinghouse (http://www.privacyrights.org/fs/fs8-med.htm). “The Medical Information Bureau (MIB) is a central database of medical information shared by insurance companies. Approximately 15 million Americans and Canadians are on file in the MIB’s computers. About 600 insurance firms use the services of the MIB primarily to obtain information about… Read more »

gadfly
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gadfly

//I don’t think I have any health problems, but I’m sure not going to do anything to document them// This seems to me to be a very interesting corrolary to physician’s practicing “defensive medicine” and trying to avoid diagnosis. Another discouraging factor for the uninsured is just having to discuss your financial situation with some judgmental and/or skeptical bureaucrat. The thought of this indignity was enough to make me hesitate about going to the ER when I was at risk of legal blindness in one eye. Hemhorraging eyes vs. patronizing ER clerk: actually a tough decision. Maybe we’re moving toward… Read more »

Sue
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Sue

Gadfly, I am insured (with high premimum and high deductible) and I avoid doctors, not because of the cost, but because I’d like to switch insurers and am afraid of what I may have to answer on the next health questionnaire if I see a doctor. I made the mistake of doing a lot of diagnostic tests in my mid-40s thinking that recommended preventative screening was a good idea. It didn’t uncover any major problems, but listing those visits cost me a 25% upcharge in premiums because it showed a hereditary hiatal hernia. I have had the the condition all… Read more »

gadfly
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gadfly

//The number of uninsured hoping to stay healthy who aren’t seeking medical care is probably much larger// I’m wondering what segment of the uninsured realize they aren’t healthy (or, in economic terms, “optimally productive”) but regard their health problems as “not acute”. These are the people who end up weighing their tolerance for various physical problems against their willingness to go into debt. In my own case, I’m currently able to work, and I’d describe my only medical problems as uncomfortable. When I was insured, however, I took several medications: I don’t know if they are still necessary, and any… Read more »

Sue
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Sue

To me, simply implementing common sense billing and having larger deductibles should ensure better premiums. But the medical community and insurers don’t want to see that happen. A few years ago my dog had cancer. We were able to discuss every option with the vet and figure out the best course of action with a full understanding of costs and benefits. Why? Because vets recognize that people won’t use their services if the costs aren’t kept reasonable and understandable. The vets in that area (East SF Bay area) actually created a consortium that shared high dollar diagnostic equipment throughout the… Read more »

gadfly
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gadfly

I have yet another tale of hospital billing mystification… While I was dealing with my recent ER bills, it came to light that I had an ER bill in collections from 2001. At that time I was insured by Blue Cross. I remember something very similar to my recent problems occured: I had to go to the ER twice, I got a series of bills, and I assumed Blue Cross was taking care of it. As it turned out my insurance information was only processed for the physician bills and not the ER bills. I eventually got a Collections call… Read more »

AggravatedDocSurg
Guest

There is no longer any reason for a patient to get seriously involved in the billing and payment for his/her medical care until well after that care has been delivered. Because Medicare and 3rd party payors have effectively removed the patient from any immediate payment responsibility, by the time the bill gets down to the patient, it is very difficult to determine what has been paid, when it was paid, and what is left for the patient to pay. I feel that it is time for us to go back to the system of billing the patient first. That eliminates… Read more »

tony
Guest

It’s unfortunate that our political system rarely deals with the most serious problems until they become crises. not enough political will means more bandages on top of bandages…
I think many hospitals are aware of these difficult billing situations. HFMA has come out with http://www.patientfriendlybilling.org/ to help hospital administrators “de-mystify” billing as much as possible. still a long way to go, but a step in the right direction.

Suneel
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Suneel

This is silly in light of gadfly’s post above … but his name really couldn’t be Kronick, could it?

gadfly
Guest
gadfly

I’m wondering what will happen when unpaid medical bills (which I see as a form of predatory lending) collide with expanding use of credit checks and tougher personal bankruptcy laws. I’d like to raise the example of what I see as a deliberate attempt of Hospitals to exploit a loophole in the Patients Bill of Rights and use collections agencies to manage billing of the poor. When I went to Alta Bates (a Summit Hospital) ER for an eye problem, I explained up front that I didn’t have an income, and I asked what I should do about paying for… Read more »