Census Bureau Report Could Spur System Overhaul

Pressure to provide health care coverage for everyone in the United States and to overhaul America’s health care system may build as a result of a recent U.S. Census Bureau Report, according to health policy analysts.

The report, "Income, Poverty, and Health Insurance Coverage in the United States: 2005," says the ranks of the uninsured in the United States grew to 46.6 million in 2005 -- 15.9 percent of all Americans -- and those most affected by the increase were families earning $50,000 to $75,000 a year.

In addition, the report notes that the number of people covered by employment-based health insurance has decreased. Although the percentage of Americans with Medicaid coverage has remained stable, according to the Census Bureau report, in 2005, 59.5 percent of Americans -- down from 63.6 percent in 2000 -- had employer-based health insurance.

The growth in uninsured families may reflect the decline in employment-based benefits. Although the poor were most likely to be uninsured -- 24 percent of people in households earning $25,000 or less had no insurance in 2005, an increase of only 0.2 percent since 2004 -- in 2005, the number of middle-income Americans -- those earning between $50,000 and $75,000 -- without health insurance grew to 13 percent, an increase of 1 percent from 2004. In addition, nearly 20 percent of people in households earning $25,000 to $49,000 had no health insurance in 2005, an increase of 0.8 percent from the previous year. Among families earning $75,000 or more, only 8.2 percent had no health insurance, an increase of 0.3 percent.

The data add to previous research pointing to a looming health care crisis that may spur demand for complete reform of the health care system, according to AAFP Board Chair Mary Frank, M.D., of Mill Valley, Calif., who also chairs the Academy’s Task Force on Health Care Coverage for All.

“The pattern in our country is that it has to be the middle class that’s impacted for something to happen,” she said. “This is similar to what happened in the 1970s and 1980s with the emergence of health maintenance organizations.”

Americans’ dissatisfaction with health care costs and access may spur interest in changes that go beyond Band-Aids and focus on a comprehensive overhaul of the system, said Frank.

“What we need to do is look at the health care system as a whole, as opposed to how we can get insurance cards for people,” she said. “The crisis we’re coming to now gives incredible opportunity to re-evaluate and redirect how we provide care and finance care in this country.”

The Academy’s Task Force on Health Care Coverage for All agreed at its February meeting to expand its scope beyond its title and address overall health system reform. In March, the AAFP Board of Directors agreed.

"The conclusion of the group was that the task force should consider system reform as a whole rather than just focus on issues of the uninsured, which are a symptom of a broken system,” said a summary of the task force’s February meeting. “An American solution to an American problem needs to be developed. This should include workforce issues, where and how care is delivered, the cost, and the legal system, as well as redirection of funds in the health care system."

In June, the AMA House of Delegates echoed the Academy’s position by approving a resolution that called for comprehensive health system reform “to be of the highest priority” for the organization.

"There was no debate about whether the health care system needs reform," said Dale Moquist, M.D., of Houston, chair of the AAFP delegation to the AMA, after the meeting. "It's interesting to see how the focus has changed in the past two or three years. Physicians of all specialties are frustrated with how the system is going, with how the number of uninsured people is going up, not down.”

Frank agreed. The challenge for the Academy and the Task Force on Health Care Coverage for All is to identify the elements of different reform models, develop proposals that can be put before the membership and create a model that meets patients’ and family physicians’ needs, she said.

“Our previous plan modified the system we already have in place,” she said. Task force members agreed to first study methods for providing insurance to all in the United States under the current system. That report has been accepted by the Board of Directors and is being submitted to the 2006 Congress of Delegates.

The second step will address reforming the entire health care system.

“What if we have a totally have different plan?” Frank said. “Other models are out there that might be workable. We need to look at all the potential approaches and see what’s workable and what isn’t and determine what’s good for the country.”