While politicians at all levels and of all stripes squabble over the fate of health care reform, those most in need of some solution continue to be left behind.
A report released earlier this month by the non-partisan Center on Wisconsin Strategy further confirmed what we already know: fewer people are insured through their employers. Since 2000 the rate of employer coverage for adults 18 to 65 dropped 9 percent. For children, it dropped 10 percent.
The result is more Wisconsinites – average hard working middle class families – do not have adequate health insurance. In 2009 more than 349,000 people were uninsured through the entire year and another 300,000 had some lapse in insurance; at any one point in that year approximately 489,000 Wisconsinites were without insurance. And these numbers do not reflect the true burden of underinsurance since many people carry only high-deductible “catastrophic” policies.
Within those numbers are real people – mothers, fathers, children – who are put in an incredibly risky position. Without insurance injuries and illnesses can quickly lead to financial ruin. A simple trip to the emergency room can easily cost several thousand dollars. A more serious injury requiring hospitalization or surgery could quickly run up a bill in the tens of thousands of dollars. Illness leads to missed work and lost income. The combination of mounting bills and decreasing income are a sure road unmanageable debt for even the most responsible and frugal of families.
The burden of medical bills and debt is often overlooked in the vicious back and forth of the health care debate. But it is a real burden: 62 percent of personal bankruptcies are attributable to medical debt according to a 2007 study. This has increased from 46 percent of bankruptcies in 2001 and only 8 percent in 1981. Being uninsured or having lapses in insurance puts one at a higher risk of bankruptcy. But it is not just the uninsured; fully three quarters of those who went bankrupt because of medical debt had insurance. This argues again that there is a large burden of inadequate coverage if those with insurance can still face crushing medical debt.
No matter your view on healthcare reform, most people would say there is something perversely unfair in forcing people to choose between life-saving treatments and their families’ financial security. What good is our cutting edge medical technologies if their use condemns patients to a lifetime of debt? Of what value are years of financial responsibility if they can be undone with a slip on an icy step or a cancerous mutation in a random gene?
This is why health care reform is important. It will guarantee that those Wisconsinites who have health insurance can rely on it to cover them when they need it. This is accomplished with popular new regulations on the insurance industry that guarantee children cannot be denied coverage for preexisting conditions, eliminate annual and lifetime caps on benefits, and protect enrollees from being dropped if they become too expensive.
The law also provides a means for those without employer health insurance to find affordable coverage. This is accomplished through the creation of insurance exchanges: marketplaces where consumers could go to purchase coverage which met certain minimum requirements. The law leaves the creation of these exchanges in the hands of states, with the understanding that the federal government will step in if states are unable or unwilling to work toward creating exchanges by Jan. 2013.
But this is slow going. The committee responsible for creating the exchanges met earlier this month resulting in more bickering than progress. One member declared her opposition to the committee’s work saying “I don’t want to put my stamp on what comes out of here.” Another member, apparently failing to grasp the extent of the problem, suggested “there is no rush to do this at this time.” It is true that the state has until 2013 to put together a plan for implementation of the exchanges, but delay only means further hardship as more and more Wisconsinites find themselves without employer-sponsored insurance and vulnerable to huge medical bills.
There is a problem. We need to fix it. The healthcare reform act gives Wisconsin the tools and support to guarantee that all its citizens have access to affordable and reliable insurance. But it will take real leadership to overcome schismatic politics to make Wisconsinites more secure.
Geoff Jara-Almonte ([email protected]) is a fourth year medical student going into emergency medicine.
