Information on Getting Health Insurance & Health Care
- Cover the Uninsured has guides to finding health insurance in your state.
- Georgetown University is funded by the American Cancer Society and the Robert Wood Johnson Foundation to provide state-by-state Consumer Guides for Getting and Keeping Health Insurance.
- The Health Resources and Services Adminstration (HRSA) provides the other half of the federal health care safetey net (along with Medicare, Medicaid, SCHIP) funding Community Health Centers, National Health Service Corps doctors, Maternal & Child Health Title V funded prenatal and early childhood care, Ryan White Care Act progams, Hill Burton funded hospitals that are obliged to provide some free care, and other programs to provide services to otherwise underserved, vulnerable and special needs populatins. You can look-up clincs and hospitals near you that provide low cost or no cost services.
- Another federal agency, Substance Abuse and Mental Health Services Administration (SAMHSA) also has a look-up tool for finding mental health services near you as does the non-governmental umbrella group Mental Health America's get help page.
----------------------------------------------------------------------------------------------------
-------------------------
Health Insurance and Access to Health Care Data
It is important to note that none of these surveys gets at the QUALITY or CONTENT of the coverage... how high is the deductible, how easy is it to get an appointment, what is out-of-coverage and what do they make you pay out of pocket for, do they pay upfront, how easy to get reimbursed...? That said here are some examples of the insurance coverage numbers:
Uninsured:
- 41 to 48 million with no insurance now; at single point during year.
- 51 to 68 million with no insurance at some point during year.
- 22 to 45 million uninsured over entire year.
Access:
- 41% of adults without health insurance coverage, compared to 9% of adults with health insurance coverage, were unable to see a doctor when needed due to cost in the past 12 months.
- 16% of adults with health insurance coverage, 57% of adults without health insurance coverage do not have a personal doctor or health care provider.
- 22% of uninsured adults self-report a health status of ‘fair’ or ‘poor’ (versus ‘good,’ ‘very good,’ or ‘excellent’), compared to 12% of insured adults.
- It's not just young adult: 15% of even adults age 50-64 had no health insurance over a two year period.
There is a nice state-by-state level break out of not only insurance per se, but actual measures of real world access to care at the State Health Access Profile.
----------------------------------------------------------------------------------------------------
-------------------------
Where does that Uninsured and Health Access data come from?
The two main ongoing annual sources for data on the uninsured, insured and also for more detailed information regarding actual access to care are the Behavioral Risk Factor Surveillance System (BRFSS), and the National Health Interview Survey NHIS (NHIS) whose most recent report is available here.
It is the BRFSS which is the source for the state-specific data in the section above and lots of other presentations. Many states use variations of it and sample down to the county level allowing for more local information.
Here are the basic health insurance and access questions from this most utilized source:
- Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare?
Yes
No
Don’t know / Not sure
Refused
This is the insurance question, and it does not get into type, source or quality.
- Do you have one person you think of as your personal doctor or health care provider? If "No," ask: "Is there more than one, or is there no person who you think of as your personal doctor or health care provider?"
Yes, only one
More than one
No
Don’t know / Not sure
Refused
We sometimes refer to this as whether you have a "medical home"; that you know that you have a regular source of care. It is a measure to get a sense of whether you have regular source for access to care itself, separate from whether you have health insurance per se.
- Was there a time in the past 12 months when you needed to see a doctor but could not because of cost?
Yes
No
Don’t know / Not sure
Refused
While question 2 ask about access in a general way, question 3 gets at the worst case scenario!
- About how long has it been since you last visited a doctor for a routine checkup? A routine checkup is a general physical exam, not an exam for a specific injury, illness, or condition.
Within past year (anytime less than 12 months ago)
Within past 2 years (1 year but less than 2 years ago)
Within past 5 years (2 years but less than 5 years ago)
5 or more years ago
Don’t know / Not sure
Never
Refused
Question 4 gets at access and utilization for general primary preventive care.
----------------------------------------------------------------------------------------------------
-------------------------
Of course the U.S. Census Bureau also has lots of information regarding Health Insurance particularly with their regular Current Population Surveys.
The CPS asks not only whether insured but what kind by the following categories. This amounts to a more detailed equivalent to the BRFSS question 1 above, but they do not ask any equivalent of the BRFSS access and utilizations questions 2, 3, or 4.
Same as last year's poll on this subject, today's poll uses the the Census CPS categories:
Employment-based health insurance is coverage offered through one’s own employment or a relative’s. It may be offered by an employer or by a union.
Direct-purchase health insurance is coverage though a plan purchased by an individual from a private company.
Medicare is the Federal program which helps pay health care costs for people 65 and older and for certain people under 65 with long-term disabilities.
Medicaid is a program administered at the state level, which provides medical assistance to the needy. Families with dependent children, the aged, blind, and disabled who are in financial need are eligible for Medicaid. It may be known by different names in different states.
SCHIP is the State Children’s Health Insurance Program, is a program administered at the state level, providing health care to low-income children whose parents do not qualify for Medicaid. SCHIP may be known by different names in different states
TRICARE or CHAMPUS is a military health care program for active duty and retired members of the uniformed services, their families, and survivors.
CHAMPVA is a medical program through which the Department of Veterans Affairs helps pay the cost of medical services for eligible veterans, veteran‘s dependents, and survivors of veterans.
VAMC provides medical assistance to eligible veterans of the Armed Forces and other Uniformed Services.
Other State-specific or city-specific plan: Some states have their own health insurance programs for low-income uninsured individuals. These health plans may be known by different names in different states.
Indian Health Service (IHS) is a health care program through which the Department of Health and Human Services provides medical assistance to eligible American Indians at IHS facilities. In addition, the IHS helps pay the cost of selected health care services provided at non-IHS facilities.
For the true data geek there is even a discussion about the differences in methods here.
So... How about you? Do you have health insurance? If so what kind?
----------------------------------------------------------------------------------------------------
-------------------------
About that "Cover the Uninsured Week":
As I suggested last year, the Cover the Uninsured Week is partially a do goodnik stop-gap campaign by the Robert Wood Johnson Foundation to provide some awareness of the problem and some limited information for people in need of coverage... and partially a way of corporate lobbying pretense of caring. After all, in this case the sponsors include America's Health Insurance Plans (AHIP), U.S. Chamber of Commerce, The Federation of American Hospitals (FAH is the national representative of investor-owned or managed hospitals and health systems), etc. Coalitions with everybody in them tend to be do nothing or just astro-turf.
----------------------------------------------------------------------------------------------------
-------------------------
What to Do?
Regardless of the Presidential campaign and proposals, it is important to have strong better options coming out of Congress.
Here are the four simple questions to ask of any health care proposal.
- Is it Universal (covers all people)... but just that is not enough, you must also find out how the proposal deals with items 2, 3 & 4:
- Is it Comprehensive (does it cover all needed conditions, prevention, treatment)?
- How much is it going to Cost Individuals; is it affordable year-in and year-out and can you afford to get sick (their total cost in taxes, premiums, deductibles, copays, uncovered conditions/expenses, total out of pocket...)?
- How much is it going to Cost Overall, total cost of the system to the country (and yes, we do need overall cost-control); and how is it paid for, and who is paying, all the pieces, direct and indirect?
Too many folks don't seem to get that it is not real Universal Coverage, IF that Coverage is really "coverage" because it leaves you with too much legitimate care not actually covered, leaves you with high out of pocket expenses, and total system costs keeps rising as percent of GNP.
John Conyers is the lead sponser for HR-676, "Improved and Expanded Medicare for All", would institute a single payer health care system in the U.S. by expanding a greatly improved Medicare system to every resident: It would cover every person in the U. S. for all necessary medical care including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, dental, mental health, home health, physical therapy, rehabilitation (including for substance abuse), vision care, hearing aids, chiropractic and long term care. HR 676 ends deductibles and co-payments. HR 676 would save billions annually by eliminating the high overhead and profits of the private health insurance industry and HMOs.
The bill garnered 88 co-sponsors so far, more than any other reform proposal, including the chairman of Ways and Means (Rangel, D-NY).
So, here is what YOU can DO now:
- Ask your congressperson to sign-up as a co-sponsor of HR-676! You can look-up your elected officials here
- Get any organization you belong to -- civic, religious, labor, community, etc. to pass an HR-676 endorsement resolution: Here is how to do that via Physicians for a National Health Program. Or here if you prefer via a non-physician group.
----------------------------------------------------------------------------------------------------
-------------------------
