Ten months ago, we wrote this piece because we were concerned about what might be coming down the road. Like hurricanes and pandemics, recessions are inevitable, and preparing for them makes more sense than ignoring them. But how to prepare?
Well, knowledge is always relevant. In an attempt to get a better feel for what might happen, we asked What's The Effect Of Recession On The Health Care Safety Net?:
That's a question worth mulling over. We know the safety net, though poorly understood, appears stable. Yet we know that even before the recession hits (or hit, as we might be there already) the net is threatened, and we know everyone, including the voters, are talking about the economy. But is there anything out there that helps us get a better feel for what's likely to happen?
We can guess that recessions trigger unemployment, which makes it hard to keep health insurance, but do we go back to the way it was afterwards? How long does it take? And what happens to the safety net in the meantime? In other words, is there any data or are we just guessing?
Here's what else we wrote:
The most vulnerable remain the most vulnerable. And, here's where SCHIP can help (.pdf) by mitigating the effects on children of lost health insurance.
SCHIP also served as a safety net for low-income children during the 2000 recession and beyond, when many families lost employer-sponsored coverage. Although children and nonelderly adults experienced similar losses of private coverage between 2000 and 2003, earlier gains in children’s coverage were sustained through continued growth in public coverage, largely attributable to SCHIP.
We could have passed
SCHIP improvements, but they were vetoed by Bush and overridden in the Senate but not the House.
More of what we wrote:
So, loss of employment begats loss of insurance which begats loss of health care, in an environment which makes the states less able to pay for the safety net. Those state funds that help fund local safety nets become ever more threatened by recession. Local clinics, local hospitals and local public health services are all at risk when state funds dry up.There's nothing about the data review that suggests good news; if anything, the recession effects appear likely to be felt for years after the Bush recession is over. In addition, for-profit safety net additions like walk-in clinics are untested and uncertain to survive recession.
Not just walk-in clinics, but hospitals and ERs are threatened as well.
Well, that was then and this is now. So where are we in all of this? Unsurprisingly, just where we thought we'd be. As families slide into poverty, Medicaid and SCHIP pick up the slack... for now
Using U.S. Census Bureau data reflecting the three-year period 2005-2007, [FamiliesUSA] the non-partisan organization representing healthcare consumers has revealed that about half a million children gained health insurance between 2006 and 2007. At the same time, the number of children living in poverty increased by 500,000 to 13.3 million.
This safety net is being stretched and might well break, however, because states do not have unlimited funds and cannot (most of them) run a deficit.
The non-partisan FamiliesUSA sums it up with this November 2008 study:
8.6 Million Children Are Uninsured
- One in nine American children (11.1 percent) is uninsured.
- The five states with the largest number of uninsured children are Texas, California, Florida, New York, and Georgia. Together, the uninsured children in these five states account for nearly half of all uninsured children in the country (48.3 percent).
- The five states with the highest rates of uninsured children are Texas, Florida, New Mexico, Arizona, and Nevada. More than 15 percent of children in each of these states are uninsured, compared to a national median of 9.2 percent.
Medicaid and the State Children’s Health Insurance Program (CHIP) Are Picking up the Slack
- Between 2006 and 2007, the number of uninsured children declined by 521,000.
- The number of children covered by private health coverage declined by 65,000.
- The number of children covered in Medicaid and CHIP increased by 954,000.
FamiliesUSA also found the majority of uninsured children come from working families with two-parent households, so another myth goes out the window. This isn't class warfare, this is everyone.
Remember, this is just the beginning. Covering kids through Medicaid and SCHIP will temporarily help kids (but not adults), and mask what's really happening as people lose insurance and can't get it back (that takes at least two years after a recession). When states start to hurt, eligibility will be cut back and/or new enrollment will be limited at the state level.
Even were it not for a recession, reforms in health care are badly needed. From TIME:
By too many measures, America is a lot less healthy than a developed nation has any business being.
This Trust For America's Health report from October, 2008 focuses on better ways to spend health dollars:
Even though the United States spends more than $2 trillion annually on health care, tens of millions of Americans suffer from preventable diseases and major vulnerabilities exist in the nation's preparedness to respond to health emergencies.
If there's any doubt as to why health reform is at the top of the new Obama Administration's agenda, these numbers should put that to rest. A health disaster is staring us in the face, and "status quo" is far more tenuous than it appears. Covering the kids, important as it is, is only a piece of the puzzle.
The safety net is doing its job, but it can't do everything for everyone and can't do more with less. A weakened traditional health system (that's where we start, and recession will weaken it further), and an ignored public health system is a recipe for disaster. Let's hope a year from now, we're not writing the same thing again.