The number of uninsured Americans is one important measure of how serious a problem the lack of health coverage is. But counting the uninsured is harder than it sounds. While Census Bureau estimates of the uninsured are the most widely quoted (41.3 million in 2001), Americans who lack health insurance are a constantly changing group. They may lose coverage when they are laid off, shift employers, no longer qualify for public insurance programs or go through divorce or the death of a covered spouse. Then many regain it.
Numerous comparisons have been made between the rates of spending growth in Medicare and private health insurance. Many believe that private sector innovations present opportunities for constraining Medicare costs. Nonetheless, recent research looking at the past 30 years concludes that Medicare spending growth has been similar to the private sector, and at times even slower. Figures from the Centers for Medicare and Medicaid Services show Medicare cost growth was lower than that of private insurance in 2000 and 2001. Some of the difference may be attributed to the fact that private insurance, unlike Medicare, usually covers outpatient prescription drugs, one of the fastest-growing segments of health care. Moreover, some analysts say that Medicare’s relative success in controlling costs has been at the expense of quality and access.
Although less well known than Medicare, Medicaid covers even more people. In fact, about 47 million people were expected to have been covered by the program for at least part of last year, including more than one in four children across the country. Medicaid, which is financed by both states and the federal government, also pays for nearly half of all long-term care services.
Much of the early health reform discussion in the administration and new Congress will focus on Medicare. On the agenda: Both the possible addition of a prescription drug benefit and the need for structural changes to the program itself.
The 107th Congress adjourned with many health issues unresolved. The House passed a Medicare drug bill, but the Senate didn’t follow suit. Medicare provider givebacks likewise got through the House, but not the Senate. The Senate, but not the House, passed a bill to restrain health costs by making generic versions of prescriptions drugs available sooner. Tax incentives for health insurance that would have been part of an economic stimulus package never saw the light of day.
Employers enjoyed relatively low health care cost increases in the mid-1990s, but the situation since then has drastically changed. Employer-paid health care premiums in 2002 rose an average of 12.7 percent, the highest leap since 1990, according to a recent major survey. Benefits consultants project even higher increases for 2003. Meanwhile, small businesses have faced even steeper increases than larger firms. Many have responded by discontinuing health coverage for their workers. Sixty-one percent of small firms offered benefits in 2002, down from 67 percent in 2000.
In November 2002, the Centers for Medicare and Medicaid Services (CMS) launched a nationwide initiative to improve nursing home quality by making information about the quality of care in individual nursing homes much more widely available. This was a welcome step toward giving consumers more information about the quality of nursing home care. Since a study by the Institute of Medicine more than 15 years ago found serious and widespread deficiencies in nursing home care, several major studies have confirmed continuing difficulties.
Yet another nursing shortage is upon us but this time it’s projected to be here for decades. Almost as many people are leaving the nursing profession as are entering it. Many nurses are nearing retirement; only 12 percent of registered nurses are under age 30. At the same time, the aging baby boomer population is creating a growing need for nursing care.