Universal Health Insurance Urgently Needed, IOM President Says at Academy Symposium

NEW YORK CITY, Oct. 7 - The lack of universal health insurance is the "great unfinished policy agenda" in the United States, stuck in neutral because it is a politically risky pursuit that elected officials are reluctant to champion, Institute of Medicine President Dr. Harvey Fineberg said today at The New York Academy of Medicine. Fineberg made his comments during a two-hour breakfast meeting organized by the Academy, marking his first New York speaking engagement since his six-year term began in July.

Some of New York's most knowledgeable health policy experts gathered with Fineberg to discuss a new Institute of Medicine (IOM) report that finds the lack of health insurance by even one family member can have grim emotional, medical and financial consequences for the entire family. Just last week, the U.S. Census Bureau reported that 41.2 million Americans were without health insurance in 2001: that's an increase of 1.4 million uninsured people since 2000. Eight million children are uninsured, even though five million are eligible for public programs such as Child Health Plus and Medicaid. Part of the reason is that there are 9 million uninsured parents in the U.S., and uninsured parents are much less likely to get coverage for their children. One in five families in the United States includes someone who is uninsured, the report found.

"From my vantage point, there is hardly a topic that could have wider significance at improving the health of the nation than expanding health insurance coverage," Fineberg told the audience of about 75 academics, policy makers and health insurance experts. "Politicians view health insurance as a tar baby: afraid to touch it because they'll get enmeshed in an insoluble morass."

"Health Insurance Is a Family Matter" is the third in a series of six IOM reports being published to examine the effects of uninsurance on society and to start a serious dialogue that leads to expanded coverage. Gerry Fairbrother, Ph.D., a senior scientist in the Academy's Division of Health and Science Policy, explained that single-parent families, families headed by non-citizens or minorities (especially Latinos), and families earning below 150 percent of the poverty level are at highest risk for being uninsured. While uninsured families can get some medical treatment in hospital emergency rooms, they must pay for important elements of care including prescription drugs, dental care and eyeglasses. "The subtext is that many families don't buy prescription medications and glasses," said Fairbrother, who served as a consultant on the report. That leads to an erosion of health and results in worsened problems that will ultimately be costlier to treat.

Contrary to popular belief, lack of insurance is not always a result of unemployment. Approximately 80 percent of uninsured Americans live in a family where somebody works, according to the IOM's first report in this series, "Coverage Matters," published last October. New Yorkers of many different stripes work low-wage jobs that do not offer health insurance. Few can afford to purchase a private health insurance plan, which can cost $12,000 a year in New York, said Shoshanna Sofaer, Ph.D., the Schering-Plough Chair in Health Policy and Administration in the Baruch College School of Public Affairs. "This is basically off the boards in terms of affordability," Sofaer said.

James R. Tallon, Jr., President of the United Hospital Fund of New York, a not-for-profit health care research and advocacy organization, predicted that the situation will worsen before it improves. The state's economic crisis may last beyond this fiscal year and into the next, Tallon said. That could result in significant cuts in public programs created in the 1990s to stem health insurance and care provision problems. "There's a very big hole out there," said Tallon, who served in the New York State Assembly for 19 years and chaired the Assembly's Health Committee. "We're facing very big challenges in real-dollar terms, bigger than we faced in 1991."

The report provided evidence that insured parents who use medical services, are more likely to get their kids insured and bring them for care. So how can states get more uninsured adults to participate in available insurance programs like Family Health Plus? The most novel solution offered today came from Dr. Benjamin Chu, President of the New York City Health and Hospitals Corporation, the nation's largest public hospital system. Chu, who was among the audience members at the invitation-only event, suggested that the government set up a clearinghouse system that pre-approves people for the patchwork of public health insurance programs that are available.

"If I can get 12,000 credit card applications in the mail for everything from soup to nuts, we can certainly send out pre-approvals for Child Health Plus," Chu said.

As with pre-approved credit card applications, pre-approved health insurance applications could be generated based on income eligibility criteria, Chu said. The government would be able to punch in data about a family, generate a list of programs for which each family is eligible, and mail easy-to-complete "preapproval" forms to those families. Many more people would be enrolled in public insurance programs if the government performed active outreach rather than waiting for citizens to learn about programs on their own, Chu said. "I think it's eminently possible in the computer age," he said.

To access "Health Insurance Is a Family Matter" and other IOM reports, visit www.iom.edu. The New York Academy of Medicine is a non-profit institution founded in 1847 that is dedicated to enhancing the health of the public through research, education and advocacy, with a particular focus on the problems affecting disadvantaged urban populations.

Posted on October 8, 2002

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