Case Overview, Providing Health Insurance for the Uninsured

This document provides background information and summarizes the debate over providing health insurance for the uninsured. The links to the left will lead you to public documents that we have found.

          This nation's health care system has remarkable strengths. In terms of advanced treatments and surgical procedures, the United States is unparalleled. But not all is well with the healthcare system. In the richest country on earth, 41 million went without medical insurance in 2001. Since many people move from employed to unemployed status during the course of a year, the number of people who were uninsured at any one time during this 12 month period was 75 million. This means that nearly one out of every three Americans under the age of 65 were uninsured for part of 2001.
          Employment status is key because most Americans receive their health insurance as part of their compensation from their job. Typically, an employer pays a portion of the monthly premium and the employee pays a portion. An individual or a family can purchase insurance directly but it is much more expensive than doing so through one's employer. The insurance companies offer lower premium rates if they're servicing a large group of people rather than a single subscriber. Among the western industrialized democracies the United States is unusual in tying health insurance to employment. In Canada, for example, there is a single payer system where all citizens are insured by the government.
           Uninsured Americans are not completely without access to healthcare, but many receive very spotty care or fail to take advantage of what's available because they don't understand the complex publicly supported systems for treating the uninsured. Some states have relatively progressive Medicaid programs that enroll those without insurance in community health centers. The federally funded CHIP program provides care for many low-income children, but doesn't reach all children who lack insurance. Sadly, many uninsured defer needed care and end up at hospital emergency rooms very ill, instead of being treated when it would have been much simpler and less costly.
           Everyone agrees that the lack of health insurance for all Americans is a terrible problem and something needs to be done about it. In the 106th Congress (1999-2000) there was considerable discussion and, philosophically, the differences were great. Conservative Republicans favor plans that would give the poor a tax credit that they could use to purchase a bare bones health plan from private insurers. Liberal Democrats tend to favor either a single payer system or a broadened Medicaid program. But as far apart as these plans are, there should be room for compromise if there is a commitment on the part of both parties to make the issue a priority.
           Complicating the philosophical divide is a more basic and practical one: cost. It's a very expensive proposition to cover the uninsured, even taking into account the savings from giving those without insurance regular care instead of treating them when they've deteriorated to the point of an emergency. An additional problem for the 106th Congress was that President Clinton was still skittish because of the resounding defeat of his ambitious health care restructuring bill in the first years of his administration. A lobbyist for physicians complained, "The White House had very little, if anything, in their budget for the uninsured." Various health groups floated proposals in abstract terms, trying to find a starting point for negotiation. Everyone knew, however, that ultimately the 106th Congress would pass the problem onto to the next president and the next session of Congress. And that's what happened.