Ornery Facts

As we work to cover the uninsured, a goal all Americans share, it is key to understand who they are.  Otherwise we will change the law but not achieve the goal. Let’s accurately identify who really needs a new program to provide coverage.

20% are eligible for government programs but are not enrolled. That is almost 10 million people who don’t need a new program; what they need is better outreach by existing programs. Add to that the 19%, or 9 million, that earn more than $75,000. (close to 400% of the FPL for a family of 4) and the 13%, or 6 million, that are eligible for employer coverage (only 5% of whom go uninsured). They don’t really need a new program either. Then there are the 22% who are ineligible because they are here illegally or are in their first five years of legal residence.  That’s 12 million who DO need some type of coverage. So you get some idea of the impossibility of measuring success by “47 million”. (more…)

There are many aspects of our health care system whose continued success we need to assure as we address the great weaknesses of the American health care system. The community health center program provides excellent care for the uninsured and those who rely on publicly-funded programs like Medicaid and Medicare. In many parts of the country the community health centers are leaders in preventative care and the use of health information technology to improve quality of care. It’s a great approach to establishing a broad safety net and we must focus on enhancing and expanding it.

The private market will continue to have a role as well. Our pharmaceutical and biotech industries are responsible for major advances in finding pharmaceuticals to address both cutting-edge needs and rare diseases. Our medical technology industry has developed less intrusive procedures and technological solutions to enormous medical problems. As we seek to eliminate waste and inappropriate care, and as we address the challenges our health system faces, primarily to cover all Americans, improve the quality of care and control costs, we must do so in ways that don’t slow advances in medicine.

Finally, recent government and private sector initiatives to foster public-private collaboration on such issues as information technology, chronic care management, payment reform, access, accountability and patient safety – while they might benefit from careful review – were begun to explore the value of innovative approaches to solving problems and should be retained as we move forward. A fascinating example of such innovations is comparative effectiveness research, on which there is still debate over the most effective and appropriate governance. Consensus must be reached on how to build on the work of AHRQ and others in this critical area of advancing our knowledge about what works and what doesn’t work, so we can target our spending appropriately.