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Covering the Uninsured

An estimated 18,000 uninsured adult Americans die each year because they don't have access to the medical care they need.

Last week marked 'Cover the Uninsured Week,' a bipartisan campaign co-chaired by former Presidents Gerald Ford and Jimmy Carter and endorsed by 250 national organizations, 2,500 regional groups, and a long list of government officials including nine former U.S. surgeons general and secretaries of Health and Human Services. The campaign carries special significance in Louisiana, where nearly one in four working adults lacks health insurance -- the third-highest rate in the nation, according to a new report from the Centers for Disease Control and Prevention (CDC).

Uninsured Americans get too little care, too late -- even for common medical conditions such as high blood pressure, diabetes, asthma, arthritis and high cholesterol. In materials for the campaign, former surgeon general C. Everett Koop gets right to the point. 'To be blunt,' Koop writes, 'uninsured patients are more likely to die than their insured counterparts with the same diagnosis.'

Consider the differences in care for heart disease. Data from the CDC's 2003 National Health Interview Survey show that 25 percent of uninsured adults with heart disease reported no doctor visits within the past year while only 6 percent of insured adults with heart disease reported no visits. As a result, the National Academies' Institute of Medicine estimates that 18,000 uninsured adult Americans die each year because they don't have access to the medical care they need. Researchers estimate that this mortality could be reduced by 5 to 15 percent if the uninsured had continuous health coverage.

Each year, Cover the Uninsured Week kicks off with new reports from respected organizations such as the Robert Wood Johnson Foundation, the campaign's national sponsor, and the Henry J. Kaiser Family Foundation, which conducts research on the topic through its bipartisan Commission on Medicaid and the Uninsured. Most reports begin by outlining the ways in which Americans currently receive health insurance. Nearly two-thirds of Americans under age 65 receive health insurance through their employers; most over 65 are covered by Medicare. Children used to be the focus of most public-policy debate on the uninsured, but the proportion of children without insurance has thankfully been declining for several years -- beginning in 1997, when Congress created the State Children's Health Insurance Program, an expansion of Medicaid designed to cover low-income kids. Louisiana launched its version -- LaCHIP -- in 1998, and several years later started LaMOMS, which covers pregnant women. Both are jointly funded by the federal government and the state. Since LaCHIP's inception, it has doubled the number of enrolled children -- covering 350,000 additional kids in just seven years. Children still make up one-fifth of this nation's uninsured, but programs like LaCHIP have gone a long way toward closing the coverage gap.

Medicaid, however, has its own gaps. In Louisiana, the program almost exclusively covers children, pregnant women and the disabled. It covers almost no able-bodied adults under age 65. Layoffs and cutbacks during the recent economic downturn left many young and middle-aged workers without private, employer-sponsored health care. Several states responded by expanding their Medicaid programs to cover parents, because insured parents are more likely to be able to work and care for their children -- and more apt to take their kids to the doctor. Louisiana hasn't taken that step.

Uninsured adults desperately need assistance in New Orleans, which has had a crisis on its hands since late 2003, when the state cut $40 million from the budgets of Charity and University Hospitals. At those facilities -- often the first and only stops for this city's uninsured -- non-emergency patients can now expect to wait eight to 12 hours. Last June, in an effort to expand the city's health-care safety net, the City of New Orleans submitted a 200-page grant proposal for a 'federally qualified health center.' It was turned down.

The state Department of Health and Hospitals (DHH) has pursued other solutions via requests filed with the federal Centers for Medicare and Medicaid Services. If approved, Louisiana would soon begin helping low-income parents pay insurance premiums for their families through their employer-sponsored insurance plans. (DHH estimates that this will help 2,000 families.) If approved, the state would also launch LaChoice, a program that would, through subsidies paid to employers, expand the number of small businesses offering health insurance. (This could assist an additional 3,000 low-income workers, according to DHH.)

In some other states, premium-assistance programs have required aggressive outreach and expensive administration. But, in its recent report, The Uninsured -- A Primer About Americans Without Health Insurance, the Kaiser Commission includes premium-assistance as a solution that has succeeded in some states, including Iowa and Rhode Island.

Experts on the topic seem to agree that there is no clear, single solution and that Louisiana's approach, using a range of solutions, makes sense. Through its wide-ranging group of supporters and a growing body of research, Cover the Uninsured Week has successfully emphasized one message: health care for all Americans must be a priority. For the health of Louisiana, we must continue this discussion year-round.

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