Bob Semro: A big job ahead

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— If you live in Colorado, there’s a good chance you don’t have health insurance, or enough insurance to cover a serious accident or illness. The latest Colorado Health Access Survey, produced by the Colorado Trust and the Colorado Health Institute, provides a sobering look at the state of health insurance coverage in Colorado.

One-third of Coloradans — more than 1.5 million people — lack health insurance or are underinsured. This problem affects the poor and the middle class, the employed and the unemployed, the young and the old. And even for those who have coverage, the costs of treating the uninsured and the underinsured affect the price they pay for insurance and the care they receive.

 Let’s begin with the uninsured.

 Currently, 829,000 people in Colorado do not have health insurance. To put the number in perspective, that is roughly the combined population of Colorado Springs, Fort Collins, Pueblo, Boulder and Grand Junction. To make matters worse, that number has increased by 151,000 people (more than the population of Fort Collins) in just two years.  

According to the survey, the cost of health insurance is the most common reason for being uninsured (reason cited by approximately 85 percent of respondents). In 2011, the average annual premium for family health benefits was more than $15,000, an increase of 9 percent from the previous year. The latest increase comes as family incomes continue to decline — down almost 10 percent since 2008.

Thirty-nine percent of those surveyed said that changing jobs or losing employment was a reason for their being uninsured. In just two years, from 2009 to 2011, the number of Coloradans who had employer-sponsored coverage dropped from 63.7 percent to 57.8 percent.

To break the uninsured population down further, almost 50 percent of the uninsured are between 19 and 54. In terms of ethnicity, 58 percent are categorized as non-Hispanic whites, followed by Hispanics at 33 percent. More than 18 percent are employed. More than 52 percent are unemployed and looking for work while 18 percent are not in the workforce.

Twenty-eight percent of those surveyed visited an emergency room (the most costly form of health care) at least once in the 12 months prior to the survey. That number is up 4 percent in the past two years.

The Affordable Care Act has the potential to cover as many as 540,000 uninsured Coloradans, according to data from the Census Bureau and CHI’s 2008-09 Colorado Household Data Survey. According to preliminary results from Dr. Jonathan Gruber, of the Massachusetts Institute of Technology, 185,000 women and 85,000 children will join the ranks of the newly covered two years after the implementation of the Affordable Care Act through Medicaid, private or employer-sponsored insurance. Gruber’s study projects that as many as 350,000 will remain uninsured two years after full implementation.

Now let’s consider the underinsured.

Underinsured Coloradans are those who have either public or private insurance coverage that does not adequately cover the costs of “medically necessary services” when compared to family income. To put it simply, underinsured Coloradans face out-of-pocket costs that exceed their ability to pay. According to the survey, 674,686 Coloradans are underinsured.

Underinsurance can have a major effect on a family’s long-term financial stability. In 2007, illness and medical bills were linked to at least 62 percent of all personal bankruptcies (78 percent of those whose illness led to bankruptcy had insurance coverage when their illness began, and 60 percent of those people had private insurance). Most medically bankrupt families were middle-class before they suffered financial setbacks.

The Affordable Care Act does a number of things that might improve the condition of the uninsured and underinsured. For example, in 2014 the law will require that insurance companies provide coverage regardless of health status or age. It also provides subsidies through tax credits to help lower-income Americans afford coverage through the new Health Insurance Exchanges. The law currently prohibits insurance companies for imposing lifetime caps on benefits, and it places restrictions on annual benefit caps for individual and group health plans until 2014, when they are eliminated.

But the Affordable Care Act is not a panacea for the uninsured and the underinsured; it merely reduces the number in each category. By showing us how many Coloradans live under that cloud, the Health Access Survey shows us the size of the job ahead.

Bob Semro is a health policy analyst with the Bell Policy Center, a nonprofit, nonpartisan think tank based in Denver.

Comments

sledneck 2 years, 4 months ago

As long as americans continue to view health insurance as something that should cover ALL medical expenses from cradle to grave there will NEVER be enough money or laws to get everyone taken care of.

If people expected their car insurance to cover oil changes, new tires, new batteries, paint, wiper blades, etc their car insurance would be just as unobtainable as their medical "insurance" has become. Yet this is exactly what they have come to expect from health insurance... check-ups, flu shots, you name it, americans expect it to cost them nothing.

Quality medical care and forced insurance coverage are two entirely different things. I would rather have quality, readily available medicine even at a high price, than to have guaranteed access to lousy, second rate medicine. Today, and for decades, people from all over the world have come here for their medical care; for the medicine we are told is "broken"; the medicine our government now says it can "fix".

America has not only provided world leading medicine here at home but has carried it around the world to those in need. The innovative, ground breaking, miracle cures of this century came at great expense. For us to think that those advances will continue "with no money down", "no deductible", "zero co-pay" and "free of charge" is insanity. But, then again, I don't hear a lot of people accusing Americans of being sane these days.

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sedgemo 2 years, 4 months ago

Sled, I think I understand your comments, but they prompt me to this idea... why so many who paid for insurance year after year without ever using it, now find (through divorce or loss of employment) they have no insurance and can't afford the expense of a new policy. Pre-divorce ten years ago I was added onto my spouse's insurance for $10 additional per month. Prior to that I paid in for over 20 years through various work situations and private carriers. Post divorce, though I was the same risk (never used the insurance at all, same body etc.) my rates went immediately to over $350 per month. The one who suddenly had increased risk was my ex... at my hands!

I disagree that people want everything free, it's pretty standard to have co-pays and very high deductibles anymore. So high sometimes it's not much different than being uninsured for most situations, and proactive health care is not rewarded. What people want is something resembling a fair shake and some reasonable way to avoid complete financial ruin at the stroke of a pen.

I understand about risk etc. but at some level it just seems wrong to pay in year after year without taking anything out, then be screwed later on as though you never paid in, and just showed up with an "issue."

Forced insurance is probably not a good answer, and the funds collected will be monkeyed with no doubt, but it is clear the system now is very broken. We need a better answer... maybe something like a reverse mortgage where you pay in during your younger healthier years but are guaranteed some sort of coverage in later times. The frontier situation we live with now serves only to fuel class warfare and insurance corporations.

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sledneck 2 years, 4 months ago

Why you paid for insurance "year after year" and now have none is not a curiosity reserved for HEALTH insurance. I paid for liability insurance "year after year" and was subsequently sued. The insurance company refused to defend me because "that was then; this is now". I had to defend myself. When you stop paying, you stop having... that's how insurance works.

Deductibles and co-pays are WAY, WAY different than "being uninsured". I spent two (2) nights in the hospital a few years ago. The bill approached six figures. Thats way different than a simple deductible. Way different.

I totaly agree that it sucks that "pro-active health care is not rewarded" but look at other insurence... Homeowners insurance will not pay you to remove a tree that is leaning precipitiously toward your house. Same thing. And even if you pay your homeowners insurance faithfully for 100 years, if your home burns down the following year (after you cancell your insurance) that counts for NOTHING. The point here is that these terms are not foreign to the insurance world; so why are they so objectionable just because it is medical insurance instead of car insurance??

I also agree that "avoiding complete financial ruin..." is (or should be) the primary concern of medical insurance. But you then must agree that flu shots and check-ups are NOT within the concept of "health insurance" for the purpose of avoiding financial ruin, no? If we got rid of the concept of using health insurance for everyday maladies it would be more available for the catastrophic events that sink people financially.

In the end, we need cutting edge medicine. The only way to get that is to pay cutting edge prices. Replacing cutting edge medicine with lacklustre alternatives will allow more people into the system, but the system into which they are allowed will not be the one which the rest of the world admires. Nor will it be the system that is capable of saving your life from diseases the rest of the world can't even diagnose.

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rhys jones 2 years, 4 months ago

I'm part of the problem, can't offer any solutions. I can't afford insurance. But if I show up at the ER, they'll treat me, they have to, they took an oath. Then when I can't pay the bill, they'll ruin my credit, and write it off on their taxes as a business loss. Buried in this outrageous bill are not only the extravagant salaries of everyone remotely involved, but a proportionate percentage of the payments on any nearby equipment, lights, gas, mortgage, retirement fund, and any other expense they can justify. Multiply this by millions of folks even worse than me, and that's quite a writeoff.

"Legitimate" bills paid by insurance include all these costs, along with business losses from patrons such as myself. Double-billing in its classic form, a second time. Where's Yogi?

Hospitals are lucrative ventures. Insurance is a scam. And good thing I'm so healthy, eh?

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sledneck 2 years, 4 months ago

Getting your credit ruined is one thing. For many of us that would actually be a blessing. Having your possesions sold out from under you to pay a delinquent hospital bill is another. The difference is that, in many ways, those who actually HAVE property are hostage to those who go through life penniless. The "haves" can't go without insurance or they will lose all they have worked for. The "have nots" get the same medical care while pissing their insurance premiums away on beer and cigarettes.

Actually, this sounds quite similar to the moral hazard created by government in other areas... like banking... real estate... social security... Just piss your life away, make foolish choices, sit on your ass drinking beer, spend your retirement money on a bass boat or whatever fill-in-the-blank/ you-name-it... and the government will step in, put a gun to someone elses head and take their property away and give it to you.

What Sedgemo said on this topic kind of rings true right here. You work your whole life, doing the "right thing". working hard, paying your bills, making your insurance payments, making your house payments, car payments, electric bill, etc. And then the deadbeats come driving past you in the fast lane of life, in a car given to them by Uncle Scam, who got the money from YOUR hard work.

And we wonder why people don't want to invest in America? Go figure.

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rhys jones 2 years, 4 months ago

I'm not going to pay for something I can't afford and never use. I've needed one "procedure" in the last 10 years, and that was covered by the VA. I gave four years of my life to this country during Vietnam to earn this privilege. Otherwise I avoid doctors with a passion. The AMA killed my brother.

I have no sponsors or partners in my computer endeavor, business is slow, so I am going to work in a kitchen today in order to survive. My truck is 23 years old this year. This earns me the title "deadbeat."

So YOU want ME to play YOUR game? We can talk about that, after I get your dishes clean. Tell me you earned every dime you've got, inherited nothing, then you MIGHT get my respect. More likely you were born with the silver spoon already in your mouth.

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sedgemo 2 years, 4 months ago

You both eloquently describe my main point, which is THE SYSTEM IS SERIOUSLY BROKEN. I did a rough calculation of what I would have paid in by now if I'd kept my insurance post-divorce... if the rates didn't rise the tally is over $400k, which is significantly more than my ENTIRE lifetime earnings to date. My hope is to die as politely and quickly as possible, and to keep people from trying to extend it beyond my intentions (yes I have a living will).

Star, I thought the VA provided Vets care for life? It did for my dad, anyway. Glad you made it back from Nam, I lost friends there, too. High price to pay to be unappreciated now. Kudos.

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rhys jones 2 years, 4 months ago

The VA hospital in Phoenix is hallowed ground, in my book. I felt the ghosts in the cavernous halls, and lots of those old guys with walkers and oxygen will never leave that property. The quality of care is second to none, despite the aged facility. If it is possible to enjoy a visit to the hospital, they do the best they can.

Is there a VA facility in Craig? To the best of my knowledge, the nearest VA hospital is in Grand Junction. Which is why I won't go into the trees until we have adequate coverage, fearing submerged stumps and branches. No VA at YVMC's ER.

Thanks for the support, sedgemo, nobody sees what I really do, so they judge me by my rants. Nobody ever gave me a thing, the evil step-mother stole all the cookies, and I am left to try to parley government training (vastly supplemented) into some sort of a real life. Few of my detractors could even begin to do my job. Deadbeat my a$$.

I'm not asking for sympathy; I chose this path. The real heroes never left the VA hospital, or made it that far.

Yes the system is broken, and from the top down, not the bottom up.

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sledneck 2 years, 4 months ago

Rhys, I did not mean the "deadbeat" comment for you specifically. I was trying to make a point that the "moral hazard" issue facing banks and Wall St execs. also applies to those who take no responsibility for their risky behavior and then show up in front of taxpayers with their hand out. My point was that it isn't just Wall St that gets "bailed out".

Now I have some questions that will rub more people the wrong way than just you. Do you drink beer? Do you smoke pot? Do you ski, Mt Bike, hunt, fish ?? Do you take vacations (you mentioned recently about traveling to the southwest)?

Anyone who does ANY of these things while shirking their responsibiliy to carry medical insurance has made a choice to drink beer, ski, or "whatever" and stick taxpayers with their medical bill.

When I look at my hospital statement and see $12 aspirins I do not see money grubbing doctors and hospitals charging me 12 times for a $1 aspirin. I see 3 poor people who genuinely needed help paying for their $1 aspirin and 8 deadbeats who stuck it to me for their aspirin and the 1 aspirin I had myself. 12- $1 dollar aspirins... all on my bill because I'm the only one with insurance.

Do I sound mad about it? Damn right I'm mad.

Pray I don't ever get any say-so about it... I would propose some changes at the ER... First, show up with pot (or any other optional substance) in your blood and without insurance and you are outta luck. Die, or call someone who cares. Ditto for the unemployment office, welfare, etc, etc.

Now, about the "silver spoon". I DID earn every dime. I worked for many years in the unrelenting humidity and heat, rain, mud and snow; elbow deep in concrete. I worked like puttin' out fire. So did everyone around me. I grew up on a farm. I peeled fence posts, split firewood with ax and wedge, suckered tobacco and cut it and put it six tiers high in a smokey barn (without any hint of a safety line) mowed grass and baled hay and ran fence while my peers "hung out" and smoked weed. They were working for me when they turned 17. I inherited nothing. My parents are still alive. 85 years old; born into the great depression in the mountains of VA and grew up dirt-poor enough to eat groundhogs and possums. 6th grade education but their hard work made them wealthy now. And their example put a work ethic in me. THATS how I get by. NOT on a trust fund. Not by a long shot.

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rhys jones 2 years, 4 months ago

sled -- pardon any assumptions on my part. Consider yourself lucky to have both parents at that advanced age. Mesothelioma took my Dad, long before my computerized version of his estimating system was nearly complete (the third edition. I'm on the fifth now).

Can you honestly say they never helped you get started in whatever it is you do? Not a dime?

Other than the initial form and numbers, I can. I don't have Dad's clout, so I have to elbow my way into an established business. With absolutely no support.

I'm sorry if I offend; I just hate to hear how it is, from those who don't have any idea what it's like on the other side of the tracks.

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sledneck 2 years, 4 months ago

I wasn't trying to attack you personally either, Rhys. I was attacking a situation and a system which I find reprehensible. Yes, I must admit I am standing on the shoulders of my forebears. But there is no exaggeration in my story.

You did not offend me though I did get a bit preachy there. No need for an apology. Like I have said before, I am just here chumming for dingbats; and I enjoy exchanging ideas with anyone.

I also understand how people who served this country would expect some help. Our priorities are in contango.

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rhys jones 2 years, 4 months ago

sled -- Thanks bud; we're not that far apart. I'm not asking for any help, although I do appreciate what the VA still offers, especially in health care. I hope to never be a burden on anybody. Like sedgemo, I hope to die quietly, and quickly.

The exorbitant costs for prescription meds are at least partially explained by R&D costs, clinical trials, and the fact that the major pharmaceutical companies have moved their development operations to India, owing to the vastly greater subject pool. I will pontificate no further on their motives there.

We still owe those old fogies padding the halls at the VA hospital far more than we can ever repay. Our country survives, on their blood. They are the forgotten ones. God Bless 'em all.

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