The High Cost Of Health Care Gridlock

Gridlock: "A complete lack of movement or progress resulting in stagnation." The most obvious signal that nothing was getting accomplished at the Blair House health care summit was when Sen. Mitch McConnell complained that the Democrats had been allowed to talk for 52 minutes, while his Republicans were held to only 29 minutes. Stalemate.

Back in the real world, there is a cost to this bottleneck, both now and especially in the near future if no reform is enacted. The 46 million Americans without health insurance represent a mixture of people with different and changing life circumstances who cannot be lumped together into a simple "poor" category.

Instead, groups emerge that might include many of us at some point in our lives; self-employed workers or those who work in firms with fewer than 100 employees, workers who lose access to employer-sponsored insurance, those people who have had or currently have significant health problems, older workers and those asked to retire early, and finally, workers with low incomes.

In a report just released by the Urban Institute, these groups are identified as having the most to lose from reform inaction. To start, maintaining the current health insurance status quo, marked by exorbitant costs, would increase the number of non-elderly uninsured from 18.4 percent of the population in 2009 to 23.2 percent in 2019, according to the analysis.

Self-employed workers and small businesses with fewer than 100 employees, thought to be the backbone of our economic recovery, account for over 50 million people. In 2008, just 57.3 percent of these workers had access to an employer-sponsored plan, but by 2019 that number could fall to 12 percent, assuming current health care cost and premium inflation continues.

Current reform proposals call for the establishment of insurance exchanges that small employers could access. By spreading risk across a wider exchange population, premium variation could be better controlled, making it possible for employers to continue benefit plans.

For a variety of reasons, part-time employment, early retirement or unemployment, 90 million Americans have no access to ESI with 43 percent of those having no insurance at all. Many are caught in the middle since they do not qualify for Medicaid, yet still have health expenses. Access to non-group plans are limited, resulting in direct pay plans that few can afford.

Reform would provide expanded options for these people, including Medicaid growth, bans on insurers' denials based on pre-existing conditions and a more transparent system.

Then, there are the poor and lower middle class populations. According to the report, 96.2 million non-elderly Americans lived in families earning less than 200 percent of the federal poverty level, with a third of those having no health insurance. Also, patients with chronic medical needs are often locked out of the market because of their effect on the risk pool. The top five percent of patients in terms of health care expenditures account for just under half of the nation's total bill.

Many Americans choose sides in the reform debate based on their current situation. Those who have good jobs and ESI don't see a need to subsidize those who don't. However, as the 14.8 million unemployed Americans know, life can change fast. Health care reform is about having a back-up plan for everyone. "The value of comprehensive health care reform is not simply for those who benefit at a particular time," said Linda Blumberg, health policy analyst and author of the study, "but to ensure that all individuals have affordable access to adequate health insurance coverage over the course of their lifetimes -- regardless of employment, age or health status."

Photo credit: IndyDina with Mr. Wonderful