AAMC Reporter: May 2007

Momentum Grows for Covering the Uninsured

As the federal budget debate launches in earnest on Capitol Hill, recent data suggest an all-time high in public support for covering the uninsured. Congress and other powerful groups are making health insurance an important part of the budget discussions, and developing a slew of coverage proposals for the nearly 46 million Americans without health insurance.

To highlight and encourage this push, physicians, nurses, patients, business and religious leaders, and various organizations across the country marked the fifth annual Cover the Uninsured Week April 23-29. Again this year, the AAMC offered a grant program to fund Cover the Uninsured Week activities sponsored by medical students. Seven medical schools and their student representatives were awarded funding to organize activities on their campuses, including Albany Medical College, Emory University School of Medicine, Southern Illinois University School of Medicine, Johns Hopkins University School of Medicine, University of Iowa Carver College of Medicine, University of Wisconsin School of Medicine and Public Health, and Wright State University Boonshoft School of Medicine. Covered the Uninsured Week is a project of the Robert Wood Johnson Foundation.

"It was once a distant issue, but with higher costs and with employers dropping coverage as a benefit, this is reaching into people's lives and literally changing the face of the issue," said Bill McInturff, partner and cofounder of Public Opinion Strategies (POS), a national political and public affairs survey research firm that provided polling data on the issue.

As the federal budget debate launches in earnest on Capitol Hill, recent data suggest an all-time high in public support for covering the uninsured. Congress and other powerful groups are making health insurance an important part of the budget discussions, and developing a slew of coverage proposals for the nearly 46 million Americans without health insurance. To highlight and encourage this push, physicians, nurses, patients, business and religious leaders, and various organizations across the country marked the fifth annual Cover the Uninsured Week April 23-29.

Again this year, the AAMC offered a grant program to fund Cover the Uninsured Week activities sponsored by medical students. Seven medical schools and their student representatives were awarded funding to organize activities on their campuses, including Albany Medical College, Emory University School of Medicine, Southern Illinois University School of Medicine, Johns Hopkins University School of Medicine, University of Iowa Carver College of Medicine, University of Wisconsin School of Medicine and Public Health, and Wright State University Boonshoft School of Medicine. Covered the Uninsured Week is a project of the Robert Wood Johnson Foundation.

"It was once a distant issue, but with higher costs and with employers dropping coverage as a benefit, this is reaching into people's lives and literally changing the face of the issue," said Bill McInturff, partner and cofounder of Public Opinion Strategies (POS), a national political and public affairs survey research firm that provided polling data on the issue.

According to POS data, a record-high 63 percent of poll participants felt that the problem of health insurance would get worse and that the number of uninsured would rise. McInturff speculated that skyrocketing health insurance premiums—which lead some businesses to eliminate employee coverage—are bringing the problem to the forefront of public consciousness.

"People are increasingly aware that people who lack health coverage are working. There is a perception now that the uninsured are close to their lives,"McInturff said. "We've been tracking this issue over the last six to 10 years, and we have reached the highest percentage of people who are saying this will get worse, and that the ranks of the uninsured will increase."

Lawmakers and Cover the Uninsured Week organizers and participants share one primary goal above all others: to reauthorize the State Children's Health Insurance Program (SCHIP). Created 10 years ago to help low-income working parents afford health insurance, the program has helped cover 6.2 million children— although approximately 9 million children still lack coverage, according to federal figures.

"The data are very clear," McInturff said. "People want to see children covered first. People support the reauthorization of SCHIP and other efforts to insure children."

SCHIP and similar initiatives, such as Medicaid benefits that currently cover 27.8 million children, enjoy broad bipartisan support. However, differences exist on the best methodologies for improving the programs. An estimated seven in 10 uninsured children are eligible for SCHIP or Medicaid benefits, but are simply not enrolled in the programs. That is why some patient advocacy groups are urging automatic enrollment into a program upon a child's qualification for school-lunch or other assistance programs. The Bush administration has proposed one year of "deemed" Medicaid benefits for all eligible newborns whose mothers filed for Medicaid coverage of their delivery. Additionally, measures such as an "express" eligibility option or streamlining citizenship documentation procedures are also on the table. Differences also exist regarding SCHIP eligibility standards. Senate Finance Committee Chair Max Baucus (D-Mont.) and House Energy and Commerce Committee Chair John Dingell (D-Mich.), who have jurisdiction over SCHIP and Medicaid, support legislation to expand SCHIP eligibility. However, the president's FY 2008 budget proposal would limit eligibility to children with family income below 200 percent of the federal poverty level.

While Congress will likely approve a SCHIP reauthorization package before the current program expires Oct. 1, its final structure remains uncertain. Christiane Mitchell, a senior legislative analyst with the AAMC, said the cost of reauthorization will factor heavily in determining the future shape of SCHIP.

"Reauthorization levels remain up in the air right now, and that's almost entirely because of cost," Mitchell said.

In addition to the SCHIP and Medicaid deliberations, members of Congress have proposed other options for covering uninsured Americans. On Jan. 18, Sen. Ron Wyden (D-Ore.) introduced bill S. 334, which would mandate coverage for all Americans. The bill currently awaits consideration by the Senate Finance Committee. In a Feb. 13 letter to President Bush, a bipartisan group of senators laid out a blueprint of health-related initiatives including tax reforms aimed at making the nation's health care system into "a culture of wellness" and prevention, rather than emphasizing treatment for the sick. Meanwhile, several plans of varying scope are moving forward at the state level. Massachusetts and Vermont are in the process of implementing new state coverage programs, while Pennsylvania and California are considering initiatives of their own.

As various proposals wend their way through state and federal legislatures, the private and nongovernment sectors are putting their ideas on the table as well. America's Health Insurance Plans, a national association representing nearly 1,300 insurers, has proposed broad Medicaid and SCHIP expansions, as well as tax incentives for individuals purchasing coverage. The Federation of American Hospitals announced in February an approach combining federal subsidies and a reform of the individual insurance market.

Other new coalitions of insurers, providers, employers, and consumer advocacy groups make for unlikely partners in advocacy for coverage initiatives,Mitchell said. The Better Health Care Together campaign, which includes retail giant Wal-Mart and the Service Employees International Union, has called for universal coverage and a performance-based provider payment system. The Health Coverage Coalition for the Uninsured—comprising AARP, the American Medical Association, Kaiser Permanente, and the U.S. Chamber of Commerce, among others—support increased SCHIP and Medicaid outreach, along with program expansions and consumer tax credits.

To raise public support for and awareness of the issue, Cover the Uninsured Week organizers held thousands of community-based activities in all 50 states.

—Scott Harris

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