How Many Uninsured can Afford Insurance but Don’t Purchase Any? How Many Use the ER?


The following is in response to a comment that was posted on GroundUP today concerning the issue of mandates in the Senate health care bill.  Rather than write a reply comment, I want to open the conversation up as the issues raised here are shared by many.  Please read and share your thoughts: “Individual Mandates and the Public Option are not linked … Mandates are meant to stop people who can afford insurance (but don’t buy any) from using the emergency room as their health plan. It is a key component of cost control in this, and the Massachusetts plans.”

Are individual mandates and the public option linked or not? The public option ensured that everyone had access to affordable insurance options and the mandate made sure they purchased same. The public option has been removed and we do not have a clear idea of what the impact will be or the what final legislation will look like, especially in the area of affordability and the fact that the number of expanded coverage continues to decrease.  We need to er on the side of caution by taking time to allow the bill to kick in before we implement mandates and penalties from the start. While it has often been the practice of the previous administration to enact unfunded mandates, such as the No Child Left Behind Act, we have a new administration wherein we can take the opportunity to fund mandates.  Health care reform should be no different.

Emergency Room Usage. This is an issue that is multi-layered and perhaps is best addressed by reviewing existing data and studies that seek to analyze the rise in ER usage.  In 2008, the Center for Disease Control released a report, “National Hospital Ambulatory Medical Care Survey: 2006 Emergency Department Summary, that found that ER usage jumped 32 percent from “90.3 million in 1996 to more than 119 million in 2006.”

CDC’s study does not necessarily address the reasons for the increase; however, it concludes that access to and availability of primary care physicians is key, stating that:

“Patients with Medicaid use the emergency department more frequently than patients with private insurance — 82 per 100 persons for Medicaid compared with 21 per 100 for private insurance. Medicaid patients have a harder time finding physicians who will treat them than do patients with private insurance, which accounts for the disparities in ER visits.” Moreover, “In 2006, nearly 21 million of 119.2 million visits to hospital emergency rooms were from patients who had no insurance.”

Using the data above, since the majority of the ER visits were made by those with insurance, we cannot claim that those without insurance are the ones driving up health care costs. A worthwhile venture would be to update this study, using data from 2007 and 2008, when we experienced a high job loss.

While not directly related to the comment above, in June 2008, Fact Check.org published a report, “The ‘Real’ Uninsured,” that reviews and analyzes the uninsured issue from a variety of concerns, noting various studies and reports.  While focusing more on the actual numbers of uninsured, the report brings to light just how complex this issue is.  It is worthy a read with regard to the question of who is actually using ER and potentially note between the lines why.

In conclusion, a good rule of thumb in this scenario is, “Garbage in; garbage out.” Before we saddle everyone with yet another potentially unfunded, federal government mandate no matter how well intended, we need to thoughtfully and systematically review the facts first.

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