Health Care for America

A proposal for guaranteed, affordable health care for all

Americans building on Medicare and

employment-based insurance
b y J a c o b S . H a c k e r

America’s $2.2-trillion-a-year medical complex is enormously wasteful, ill-targeted, inefficient, and unfair. The best medical care is extremely good, but the Rube Goldberg system through which that care is financed is extremely bad—and falling apart. One out of three non-elderly Americans spend some time without health insurance every two years, and the majority of those remain uninsured for more than nine months. Meanwhile, runaway health costs have become an increasingly grave threat, not just to the security of family finances, but also to corporate America’s bottom line. The United States spends much more as a share of its economy on health care than any other nation, and yet all this spending has failed to buy Americans the one thing that health insurance is supposed to provide: health security.

Health insecurity is not confined to one part of the population. It is experienced by all Americans: those without insurance as well as those who risk losing coverage; those who are impoverished as well as those with higher incomes who experience catastrophic costs; those who are sick or injured as well as those who are just one sickness or injury away from financial calamity. As health care costs have skyrocketed and the proportion of Americans with stable benefits has eroded, health insecurity has become a shared American experience, felt by those who thought they had it made as well as those just struggling to get by.

This growing problem is pushing health care reform back onto the agenda of American politics after more than a decade of neglect. And yet, nothing guarantees that this debate will end differently than previous battles. Again and again in the 20th century—most recently, in the early 1990s—efforts to make health insurance an integral piece of the American social fabric were stymied. The stakes are too high to allow reform to be blocked again. America’s economy, the finances of its middle class, the quality of its medical care, and the health of its citizens all hang in the balance.

To avoid the dismal fate of previous reform campaigns, a successful agenda must take seriously the political constraints and organizational realities that have hamstrung reform efforts in the past. Limits on public budgets, resistance to measures that might be seen as taking away what Americans already have, and the embedded realities of the present system all stand squarely in the path of grand policy redesigns—from single-payer national health insurance, to individual mandates requiring that everyone purchase private coverage, to a universe of individualized Health Savings Accounts. Instead, the most promising route forward is to build on the most popular elements of the present structure—Medicare and employment-based health insurance for well-compensated workers—through a series of large-scale changes that are straightforward, politically doable, self-reinforcing, and guaranteed to produce expanded health security.

The full proposal by Jacob Hacker can be viewed at: http://www.sharedprosperity.org/bp180/bp180.pdf

Health Care Insecurity Increases as Employer-Based System Continues to Erode

Health insecurity across education levels

by Heidi Shierholz

It is widely recognized that the employer-based health care system is eroding. The share of workers with employer-provided health insurance has decreased substantially in recent years, even amidst relatively low levels of unemployment and growing productivity. From 2000 to 2006, the share of workers who received health insurance from their own jobs declined 4 percentage points. Perhaps surprisingly, the decline in coverage has taken place across the entire age, education, occupation, industry, race, and ethnicity spectrum. As an example, the chart below shows the decline in employer-provided health insurance between 2000 and 2006 for workers with different levels of education. While workers with more education are more likely to receive health insurance from their employers, workers from all education levels have seen similar declines in coverage. Specifically, workers with no more than a high school education saw a decline of 5.0 percentage points, workers with some college education but no bachelor's degree saw a decline of 4.2 percentage points, and workers with a college degree or more saw a decline of 3.6 percentage points. Overall, 6.4 million fewer workers had employer-provided health insurance in 2006 than in 2000.

These findings, along with others in the Economic Policy Institute paper A Decade of Decline, show that health insecurity is now a broadly shared American experience. The erosion at all levels of the employer-based system, along with the critical need to control skyrocketing health care costs, indicate that the time has come to reform our health care system to guarantee that all Americans have access to affordable, high-quality health insurance. The Health Care for America plan, for example, would ensure that all Americans receive coverage and would do so at a lower total national cost than the current system.

The full report can be viewed at: http://www.epi.org/content.cfm/bp209

INCOME INEQUALITY GREW IN MOST STATES

Low-Income Families Lost Ground Since Late 1990s

The gap between the richest and poorest families, and between the richest and middle-income families, grew significantly in most states over the past two decades, according to a new study by the Center on Budget and Policy Priorities and the Economic Policy Institute. In fact, the nation’s longstanding trend of growing inequality accelerated since the late 1990s as incomes fell
for poor families and stagnated for middle-income families in a number of states.

The study, based on inflation-adjusted Census data, is one of the few to examine income inequality at the state level. It measured and compared income trends among the highest-, middle-, and lowest-income families in three periods – the late 1980s, the late 1990s, and the mid-2000s. (If anything, the study understates inequality because it does not include income from capital gains, which goes overwhelmingly to those at the top.) Low- and middle-income families have reaped few gains since the late 1990s, despite the recent years of economic prosperity. Average incomes actually fell by 2.5% for those in the bottom fifth of the income scale and rose by just 1.3% for those in the middle fifth. Meanwhile, incomes climbed 9% for those in the top fifth.

“Before the recent downturn hit, our economy was generating solid income gains. The problem was that high levels of inequality meant these gains failed to reach middle- and low-income families, whose living standards stagnated or even declined,” said Jared Bernstein, senior economist at the Economic Policy Institute and co-author of the report. “As we head into an economic downturn, these families are illprepared to weather the storm.” Elizabeth McNichol, senior fellow at the Center and the other co-author, added, “Rising inequality raises basic issues of fairness, and harms the nation’s economy and political system. It dampens economic
prosperity as incomes stagnate for tens of millions of average Americans and it threatens to widen the nation’s political cleavages, generating more cynicism about political institutions.”
During the longer time period – from the late 1980s to the mid-2000s – in 37 states, incomes grew much more slowly for the bottom fifth of families than for the top fifth. In these states, the incomes of the richest fifth grew by an average of $36,300 (39 percent), while the incomes of the poorest grew by only $1,600 (9 percent). The purchasing power of the poorest families increased by just $93 per year.

The full report can be found at http://www.cbpp.org/4-9-08sfp.htm.

Geography as Destiny

“LIFE AND DEATH” DIFFERENCES IN U.S. CHILD WELL-BEING EXIST BETWEEN TOP AND BOTTOM STATES, YOUTHS UP TO THREE TIMES MORE LIKELY TO DIE BEFORE ADULTHOOD IN SOME PARTS OF U.S.

The Forgotten 2008 Campaign Issue? “Shocking” Disparities Show That “Geography Matters” for U.S. Children

WASHINGTON, D.C., April 2, 2008, The states of Louisiana and Vermont may be part of the same nation, but they are worlds apart when it comes to the well-being of children living within their borders. Across the United States, where a child is born and raised can make a shockingly large difference to their chances of getting and staying healthy and then surviving to adulthood, according to a major new report released today by the nonprofit and nonpartisan Every Child Matters Education Fund (ECMEF). Entitled “Geography Matters: Child Well-Being in the States,” the ECMEF report concludes: “There exists a huge gap among states on a wide variety of child well-being indicators. The state they live in should not adversely influence the life and death of children—but it does. Such inequalities affect all Americans, rich and poor alike, and weaken both our economy and our democracy.

Children in the lowest ranking state are:
• Twice as likely to die in their first year as children in the highest ranking state.
• Three times more likely to die between the ages of one-14.
• Roughly three times more likely to die between the ages of 15-19.
• Three times more likely to be born to a teenage mother.
• Five times more likely to have mothers who received late or no prenatal care.
• Three times more likely to live in poverty.
• Five times more likely to be uninsured.
• Eight times more likely to be incarcerated.
• 13 times more likely to die from abuse and neglect.”

Based on a wide cross-section of 10 major child well-being standards, the 10 bottom states identified in the Every Child Matters Education Fund report are: Arizona (41); South Dakota (42); Nevada (43); Arkansas (44); South Carolina (45); Texas (46); Oklahoma (47); New Mexico (48); Mississippi (49); and Louisiana (50). The 10 top states for children by the same measures are: Maine (10); Washington (9); Minnesota (8); Iowa (7); Hawaii (6); New Hampshire (5); Rhode Island (4); Connecticut (3); Massachusetts (2); Vermont (1).

Michael R. Petit, author of “Geography Matters; Child Well-Being in the States,” and founder of Every Child Matters, said: “Every Presidential candidate and state-office seeker should be asked to speak to these stark findings. Nearly 13 million American children," continued Petit, "live in poverty today. Over eight million U.S. children have no health insurance. Nearly three million children nationwide each year are reported abused and neglected. As Americans, we need to ask ourselves: Does every child in the U.S. deserve an equal opportunity to be healthy and survive to adulthood? Is there a floor below which no American child should fall, regardless of the accident of geography that accounts for where they are born and raised? It should no longer be politically acceptable to permit – or simply ignore -- the vast differences in life chances that exist for children today.”

Elizabeth J. Clark, Ph.D., ACSW, MPH, executive director, National Association of Social Workers, Washington, D.C., said: “As social workers working with the most troubled children and families across the country, we have always known about the disparate treatment of children from state to state. We look forward to a national commitment to protect all children, to create equal opportunities, and to strengthen families and communities. We know that more can be done to ensure that our children have the supports they need to thrive, no matter what state they call home.”

More information, and the full report can be accessed at: http://www.everychildmatters.org/homelandinsecurity/index_geomatters.html