Are You One of the 30 Million
Dear Leading Ladies,
Visiting a friend in a rehabilitation hospital last week, shortly after reading Matthew Desmond’s Poverty by America, it was impossible to ignore the varying levels of health care available to people in our country.
The rehab hospital is surrounded by well-groomed gardens, with outdoor spaces for patients and visitors. A Starbucks in the lobby offers the usual array of overpriced snacks and barista offerings. Upstairs, most patients have private rooms, all with large televisions, recliners, and a surprisingly impressive choice of menu options. The important stuff – occupational, physical, and speech therapy – is provided up to three hours a day by skilled and cheerful professionals who don’t appear harried or stressed.
What does this facility cost its patients? Nothing…for the insured. Those who have Medicare with a secondary payer, such as Blue Cross/Blue Shield, are entitled to all the services this great hospital has to offer.
And when these patients are ready to leave? Some will go home with support from the local Visiting Nurse Association, along with physical and occupational therapists coming to the home, also covered by insurance. Some may need to go to a nursing home, where their long term health care policies may foot the bill. Without long-term health care insurance, they may have to use their assets to pay for the nursing home, depleting the money they’d hoped to leave for their children’s inheritance. For people of means, however, there are ways to protect their savings with savvy financial guidance.
Nurse Mariam Kamyab goes over surgery instructions with Craig Smith after he was referred to the surgery department at Alta Bates Summit Medical Center in Berkeley, Calif. Forty-six percent of respondents in the Commonwealth Fund Biennial Health Insurance Survey said they had skipped or delayed care because of the cost, and 42 percent said they had problems paying medical bills or were paying off medical debt. Photo: Carlos Avila Gonzalez/San Francisco Chronicle via Getty Images
Lack of health insurance is still a problem
But what of those with no health insurance? Even after the Affordable Care Act and the strides that came with the response to COVID, significant numbers of people in this country remain uninsured.
In fact, 30 million Americans – or 9.2% of the population – had no health insurance in 2021, according to Money Geek in May of this year. “Nonelderly AIAN [American Indian and Alaska Native] and Hispanic people had the highest uninsured rates at 21.2% and 19.0%, respectively as of 2021,” reported the Kaiser Foundation last December. “Uninsured rates for nonelderly NHOPI [Native Hawaiian and other Pacific Islander people] and Black people (10.8 and 10.9%, respectively) also were higher than the rate for their White counterparts (7.2%).”
Most of the uninsured are adults living in low-income families where at least one person is working. The cost of coverage is the most common reason for not being insured, since many do not receive insurance through their jobs and, in many cases, are ineligible for Medicaid.
The results can be catastrophic.
As Kaiser reports, “Because people without health coverage are less likely than those with insurance to have regular outpatient care, they are more likely to be hospitalized for avoidable health problems and to experience declines in their overall health. When they are hospitalized, uninsured people receive fewer diagnostic and therapeutic services and also have higher mortality rates than those with insurance.” We’ve written before about the Black men whose heart symptoms receive less attention in the emergency room that those of their white counterparts; and the pregnant Black women whose concerns are disregarded until they are clearly life-threatening.
Moreover, when uninsured people do seek health care, they can become burdened with insurmountable health bills that lead them into debt. And let’s not forget about prescription drugs that become unaffordable without health insurance, so that people with chronic illnesses like diabetes or acute infections go untreated until their problems become serious and even life-threatening.
Even those with health insurance can face financial obstacles to receiving care. According to the West Health-Gallup Healthcare Affordability Index, 36% of Americans are “cost desperate,” meaning they are unable to pay for needed medical treatment over the prior three months; skipped prescribed medication due to cost over the prior three months; and are unable to afford quality care if it was needed today. Another 8% are “cost insecure,” having one or two of these affordability challenges. “Over one-third (35%) of cost desperate adults report that they have cut back on utilities, and half have cut back on food in the past 12 months to pay for necessary healthcare, rates that are 10 times greater than their cost secure counterparts,” West Health-Gallup reports.
In Desmond’s book, he talks about the physical pain that often accompanies poverty. “Poverty is pain,” he writes. “It is in the backaches of home health aides and certified nursing assistants, who bend their bodies to hoist the old and sick out of beds, and off toilets; it is in the feet and knees of cashiers made to stand while taking our orders and ringing up our items; it is in the skin rashes and migraines of maids who clean our office buildings, homes, and hotel rooms with products containing ammonia and triclosan.” Too many of these people lack adequate, or any, health insurance ten years after the Affordable Care Act. Desmond notes that public insurance covers only a small portion of dental costs so that a quarter of children living in poverty have untreated cavities that can become infections that can even travel to their brains.
Many full time workers are denied insurance because they are considered independent contractors or their hours are kept just under the minimum number required for coverage. The new proliferation of gig jobs exacerbates the problem, with employers not only withholding health insurance but also sick days. Yet few of the uninsured make enough money to pay the costs of private insurance.
What are the answers?
The solution is clear: universal health care – health care that is free, accessible, and designed to meet the needs of the people it serves. A medical clinic or center in the middle of a poor Black community will not look the same as one in a Latino or white neighborhood. Translators may be needed in different languages; different health issues may be more prevalent in one or another; patients may need to see health providers who look like them in order to trust their caregivers. But the quality and accessibility of care must be equal.
We’ve come a long way in expanding health care in this country, it’s true. But 30 million people without insurance is still too many, particularly when there is such an obvious fix. As Desmond points out, “the United States has the unique distinction of lacking universal healthcare while still having the most expensive healthcare system in the world.”
Universal health care is only part of the solution
Of course, universal health care alone won’t solve poverty, but it’s an important part of the puzzle. We need universal health care that includes access to hospitals, clinics, and doctors’ offices near to people’s neighborhoods and open when people need them; dental care that prevents cavities from turning into infections that can become life-threatening; available family planning information and contraception; paid sick days so that workers can attend to illnesses before they become crises; and affordable medications that can control acute and chronic health problems such as diabetes and high blood pressure. For 30 million people, this would be a game changer.
To get there will take legislation and more. Desmond recommends that workers unite to demand benefits such as health care, as well as a living wage and safe working conditions. On an individual level, Desmond advises his readers to vote with their wallets and sell any investments in corporations that exploit their workers. Just as we consider the environmental impact of products we purchase, he encourages us to consider the poverty impact also, which includes health care access. He further suggests looking at the policies of our schools and alma maters, the stores and companies we frequent, to determine if they offer liveable wages, including health benefits, to their employees. Desmond believes that when we make decisions based on our values, we should share our decisions with others because our decisions can influence others.
We’re counting on it. Please share this letter with friends.
Judy (she, her, hers)
Therese (she, her, hers)
Didi (she, her, hers)
Leading Ladies Executive Team