Alaska Dispatch

After months of work, Senator Baucus (D-Montana) and the Senate Finance committee have released a bill. Today, they are considering hundreds of amendments.

On the spectrum of health reform options, the Baucus bill most closely mimics the 2006 Massachusetts reform. Unlike the House Tri-Committee legislation (the other leading proposal in front of Congress), it doesn't include a government administered public option. The subsidy levels, in initial release, are set lower than those featured in the house bill - so low that Sen. Olympia Snowe (R-Maine) has voiced concern that they'll place an unfair burden on middle class Americans.

When the bill leaves committee, we'll take a look at how it compares to the House Tri-Committee legislation. Until that happens, though, I wanted to share with you some details about the uninsured population in this country.

The Uninsured

Sizing up the population of uninsured Americans is difficult but important when tailoring legislation to increase health access.

Recent estimates place the number of people without health coverage in America around 46 million, based on data collected by the US Census Bureau. For the census statistic, recipients of Medicaid, Medicare and employer provided or individually purchased health coverage are considered insured. Individual who lack all health coverage, or only receive Indian Health Service (IHS) benefits, are counted as uninsured.

The US Census bureau estimates the number of people who lack health insurance at any given time, and this most recent data is from March 2008. By its measure, Alaska has 133,000 people who lack coverage. There is, however, more than one way to size up our uninsured population. Using a completely different technique, if you measure the uninsured by including anyone who had a lapse of coverage over a two year period, the number is 209,000 for our state.

What the numbers show is that there just isn't one correct way to measure our uninsured population. And while the numbers may differ, one thing they agree on is a trend. The trend is that Americans are losing health coverage faster than they are gaining it.

The Working Uninsured

Health coverage is often tied to employment in America, but this doesn't mean that most of the uninsured lack jobs. In fact, over 8 in 10 uninsured Americans today are members of working families. While programs like Medicaid may help those with extremely low incomes, those hardest hit by our medical financing system often live in working households.

Here is an example of what an employed uninsured family may look like. In Alaska, minimum wage is $7.25 an hour. A household of four, with two employed adults each working full time for minimum wage, will earn $30,160 per year. The federal poverty level (FPL) for Alaska has been set at $27,570 for 2009. This places our hypothetical family of four at 109 percent - or just above - the FPL.

While the children in this household would probably qualify for Denali Kid Care, the adults probably wouldn't qualify for Medicaid. A variety of factors are taken into account for determining eligibility for each program, but generally, for Denali Kid Care, the rough cutoff is 175 percent FPL. For Medicaid, the rough cutoff is 85 percent FPL for adults, with additional hurdles such as asset tests.

Our hypothetical family isn't an outlier - in fact, if you compare all uninsured households by income, the example above falls roughly in the middle. Kaiser estimates that 37percent of the uninsured make less than 100 percent FPL annually, while 29 percent make between 100-199 percent FPL. 25 percent of the uninsured have household incomes between 200-399 percent FPL, while only 10 percent of the uninsured live in households with incomes above 400 percent FPL.

The Uninsured, By Age

Adults are more likely than children to lack health coverage in America. This can partly be explained by S-CHIP (Denali Kid Care in Alaska) programs which often insure children up to 250 percent of the FPL. Medicaid programs for adults have lower cutoff standards, rarely covering people above the federal poverty level. In our example above, the children would likely qualify for Denali Kid Care, even though our state has one of the lowest cutoffs for that benefit (175 percent FPL). The parents, however, probably wouldn't qualify for Medicaid.

Young adults, ages 19-29, make up 29 percent of the uninsured population in America. Kaiser credits this partly to the lower wages paid to recent graduates of high school or college, while others claim that younger adults often consider themselves invincible, and not needing health coverage. The reality is probably a combination of the two factors.

Students are another chunk of the US population that often lack health coverage. Recently AETNA provided my office with a chart which estimates that roughly 25 percent of college students lack health coverage, comprising 10 percent of the total uninsured population.

Insured vs. Uninsured: Health and Financial Outcomes

The financial hurdle of seeking medical treatment without health insurance is insurmountable for many Americans. Kaiser reports that 25 percent of uninsured Americans couldn't afford a prescription drug in 2007, while only 4 percent of those with private insurance had the same difficulties. 41 percent of the uninsured went without preventative care in 2007, while only 6 percent of public or private plan recipients skipped preventative attention. On top of skipping needed care, more than half of personal bankruptcies in this country are partly due to medical bills.

While programs exist that cover the youngest and poorest residents in America, young adults and the working poor often fall through the cracks. Health reform aims to increase health access by reducing the number of uninsured in this country. With the passage of legislation, our country can reduce the number of uninsured families like the one described in the example above.

In our next update, barring any drastic development by Congress, we'll take a look at the insured and underinsured populations in America, and how reform could affect them.

Sen. Hollis French was first elected to the State Senate in 2002, and he represents District M, which includes the Turnagain and Spenard areas of Anchorage. He has promoted health reform legislation since 2007, and presently serves as chairman of the Senate Judiciary Committee. Sen. French has filed to run for governor in 2010.