EDITOR'S NOTE
Insuring the Uninsured

January 18, 1999

Somewhere between 28 million and 42 million men, women and children in this country have no access to anything but emergency health care.

Many experts think this problem is the most critical of all the healthcare issues we face. But it’s even more complex than it looks.

That’s because a significant percentage of people who qualify for Medicaid or for other federally sponsored health insurance programs aren’t signing up. And a large percentage of those who are employed are not willing or able to get health insurance coverage through their employers.

A study by the UCLA Center for Health Policy Research found that nearly one-fifth of the nonelderly in the nation’s largest metro areas have no health insurance. The study found that areas with higher-than-average numbers of uninsured all had large numbers of minority residents, particularly Hispanics. Several Texas cities had the worst rates of coverage among the 85 metro areas studied in the UCLA report. In Houston 31 percent of the residents are uninsured, and in San Antonio 27 percent are without insurance. But in Knoxville, Tenn., and Ann Arbor, Mich., the best-insured of the cities studied, only 8 percent lack health coverage.

"The major factor that determines the number of uninsured people in a region is the rate of job-based health insurance coverage," said Rebecka Levan, the study’s lead author. "That number tends to depend on a region’s economy. Areas with relatively large numbers of smaller employers and low-paying jobs tend to have more people without job-based health insurance."

Complicating any analysis is the fact that workers in their 20s and 30s often opt out of health insurance offered by their employers because they do not feel vulnerable to illness or cannot—or choose not to—pay their share of the premiums.

A study recently released by the Henry J. Kaiser Family Foundation in Menlo Park, Calif., showed that many of those who qualify for federal- or state-sponsored healthcare coverage don’t know they’re eligible or don’t know how to get it. They’re unsure of whether they qualify or how to sign up, or they decline the insurance because of language barriers, immigration or residency issues, or frequently changing life circumstances, such as recurring moves.

The majority of uninsured children could gain access to health care if these enrollment problems were solved. Seven out of 10 (7.3 million) of the nation’s 10.7 million uninsured children are potentially eligible for Medicaid or the recently enacted Children’s Health Insurance Program. Solving the enrollment problem would go a long way toward making sure every child in America has access to health care.

What can we do about it? We need to learn more about what keeps eligible people from accessing free or affordable health coverage and create culturally sensitive programs and services that acknowledge the fears and concerns of potential participants.

What good is it to keep expanding coverage if those who already qualify for services aren’t signing up? What do you think?

What do you think?

Barbara Bronson Gray, MN, RN
Editor in Chief

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