By LEE BOWMAN
Scripps Howard News Service
March 26, 2010
In the meantime, stop-gap measures tucked in the bills are expected to give some regular access to health care for about half of the uninsured. But the burden of health expenses will continue to erode family budgets of the insured and uninsured alike, experts warned in a new study released Thursday.
"The uninsured are not all uninsured for the same reasons -- a lot are unemployed, others are in jobs that don't offer coverage or coverage they can afford, or they opt out for various reasons. But we can expect their numbers to keep growing at least until the economy gets stronger,'' said Peter Cunningham, a senior fellow at the Center for Studying Health System Change.
As author of a new report that looked at a growing financial burden from health care both among the insured and uninsured, Cunningham says he doesn't expect the reforms will do much to reduce premiums or out-of-pocket costs for most Americans in the near term.
Nationally the study found that as of 2006 almost 20 percent of families with insurance and more than 15 percent of those without coverage were spending 10 percent or more of their incomes on health care.
"For the lower-income families who qualify for Medicaid or hefty subsidies or for families that are paying 50 percent of their income for an individual policy, they're probably going to see their burden decrease (with reform), but everyone else will still be facing fairly stiff costs,'' Cunningham said. "Many of the uninsured don't spend much on health care because they don't get routine care and put off dealing with chronic problems."
One group that is expected to gain early help is adults with medical conditions that have caused them to be denied health coverage for at least six months. Thirty-four states operate high-risk insurance pools for people with pre-existing conditions now, but they serve only about 200,000 individuals, in part because premiums are steep.
Jennifer Tolbert, a policy analyst for the non-profit Kaiser Foundation on Medicaid and the Uninsured, said it's likely the federal government will try to contract with those existing state plans -- and perhaps encourage the remaining states to set up pools -- as part of the $5 billion program to subsidize coverage for the medically-disqualified that's supposed to be in place later this year.
"Basically the subsidy will go to the plan, and the person with the medical condition would pay the same rate they'd otherwise pay if they did not have that condition,'' Tolbert said. "Otherwise, though, most of the uninsured aren't going to see a lot of immediate help."
Probably the biggest boost for the uninsured could come from provisions in the reform package that would double the capacity of federally subsidized community health clinics over the next five years.
The reform plan, counting the update package slated for final approval by the Senate and House Thursday, allocates some $9.5 billion in new operating subsidies for the clinics, which could double the number of health center sites to around 15,000, according to the National Association of Community Health Centers.
"With $2 billion from the economic recovery package, we've been able to serve about 2 million more clients; this funding would allow us to almost double our patient-load to about 39 million,'' said Dan Hawkins, senior vice president for public policy with the association.
More than 40 percent of the clinics' clients are uninsured; another 30 percent are on Medicaid. "We are concerned that some of the state and local support the clinics get may be cut, but we're confident we're going to be able to significantly expand the care we provide,'' Hawkins said. And with the reform plan still not expected to reach about 23 million uninsured people by 2019, there will still be plenty of demand.
The clinics are concentrated in areas the government considers medically underserved, but Hawkins said he would encourage anyone without insurance to seek out a center near them and register for services.
"Even if they can't get them in right away, it could help them get into a regular source of primary care earlier than later. There's a lot in the reform plan to increase the number of providers, but there's also going to be 32 million new people looking for a medical home. It pays to get in line."
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