Uninsurable and Underinsured

A growing population of uninsured individuals are the "uninsurable". These are individuals who can't qualify for insurance because of pre-existing conditions, such as chronic illnesses, previous cancer, auto-immune disorder, etc. Because of the high cost of health care these individuals require, private insurers are unwilling to take the risk, so much of the costs in caring for these individuals is passed onto the rest of us just as the costs for the uninsured. There are programs in each state that subsidize care for those who qualify, but it is not a low cost plan, the covered person has to pay a premium that is often unaffordable.

The definition of underinsured "means that public or private health insurance coverage does not cover the costs of medically necessary services relative to family income, resulting in out-of-pocket expenses that exceed an insured individuals ability to pay." www.coloradotrust.org Small business owners, entrepreneurs, employers who opt for high deductible plans, young adults and Medicare recipients can all fall into this category. The underinsured are almost as vulnerable as the uninsured in terms of the eventual high cost of care, because they too delay being seen because they can't afford the initial cost to seek care.

The next post will have the mandates that are part of the reform bill's Patient Protection and Affordable Care Act to address the uninsured, underinsured and uninsurable.

Politics aside...

The health care crisis cannot be neatly packaged as a partisan-created problem with a partisan solution. We all need to educate ourselves on the core issues that led to reform and avoid being influenced by partisan rhetoric so we all speak to it responsibly.

How did we get here?

The first several posts will provide a foundation for the individual mandates that I will address in future posts. I encourage you to submit questions, so I speak to your primary questions and concerns early on.

Who are the uninsured?
The Federal Poverty Level (FPL) determines who can receive a government funded benefit, such as Medicaid. 100% FPL has been traditionally referred to as "welfare". The children and pregnant mothers at this poverty level are covered by Medicaid.

To be at 100% FPL, a family of four's income cannot exceed $28,000 per year (gross hourly wage of $13.40). For a family of four to afford private health insurance, the household income needs to be at least $65,000 (gross hourly wage of $31.25). This category of uninsured is defined as "the working poor". In Colorado alone, the total population that falls into the "working poor" category is approximately 800,000 and is growing by 1-2% each year.

How does this impact the health care system?
Two primary scenarios that burden the system are: the uninsured not having the financial means to afford an office visit or the cost of possible blood tests, x-rays, prescriptions etc, so they delay their care until it becomes a crisis. Had the patient been seen at the onset of their condition, costly tests and treatment may have been avoided. The second well-known scenario is the emergency room being used as a clinic by patients who know they cannot be turned away regardless of the fact that they are not in need of emergency treatment. The debt from both scenarios costly care goes largely unpaid by the patients, so it is passed onto the health care system of providers who are left with no choice but to pass it onto patients in terms of increased charges.

I don't want this blog to become a reliable sleep aid, so I am going to stop for now. I could use some initial feedback (I can take it!) on the length of the posts and their content.

Thanks for reading my first, of hopefully many, posts. I hope to post at least 2-3 times per week, so please be sure to check in. Anne