Government Programs for the Uninsured Are Poorly Targeted, Ill-Designed, Not Working

Published July 1, 2008

A recent study found one in four uninsured Americans eligible for Medicaid or the State Children’s Health Insurance Program (SCHIP) fail to take advantage of those programs.

“The stigma of being enrolled in a public program along with the difficulty in getting, and staying, enrolled in these programs are the main reasons why people don’t take advantage of the opportunities,” said Julie Schoenman, director of research and development at the National Institute for Health Care Management, which released the report.

“Signing up for Medicaid and SCHIP can require too much paperwork and be quite difficult,” Schoenman continued. “States can make it more or less difficult for people to sign up depending on how much money they have to fund these programs.”

12 Million Not Enrolled

Approximately 12 million people who could receive public health coverage fail to do so, according to the report. The Census Bureau has estimated some 47 million Americans are without health insurance at some point during the year.

“People just don’t see a compelling need to be covered because someone wants them to be, especially if they are pretty healthy,” said Greg Scandlen, who directs Consumers for Health Care Choices. “Plus, if something serious happens to them, the hospitals will get them covered in almost all cases. So whether they are previously covered or not, it doesn’t matter because they still end up getting coverage in cases of catastrophic events.”

Changes in Coverage Needed

The study found the majority of the 12 million who qualify for Medicaid and SCHIP but do not take part are from low-income families, including 64 percent, or 6.1 million, of the nation’s uninsured children.

For adults without children, establishing eligibility for Medicaid can be difficult. Only 2.4 million, or 10 percent of childless adults, are eligible for coverage; the figure reaches 3.6 million or 29 percent for uninsured parents.

“The two things that were so striking [were] the number of childless adults and the fact that the states aren’t doing anything about it and can’t,” Schoenman said. “Secondly, it’s shocking to see the number of people who aren’t taking part in these programs but can.

“Outreach is important, and there should also be something like automatic enrollment in order to make it easier for people participate,” Schoenman continued.

“For instance, if you are low income enough to get free school lunches for your children, then you should automatically be enrolled in Medicare,” Schoenman suggested. “It’s about sharing of data across programs and trying to make it easier for parents.”

More Variety Required

To increase coverage among childless adults, some health care experts say changes are needed in the types of coverage available.

“The programs need to have more variety in the types of coverage available,” said Scandlen. “A lot of the uninsured are young Hispanic males. The archetypical uninsured person is a 24-year-old Latino working in a grocery store. That person does not see the need for in-vitro fertilization coverage or psychiatric or social work coverage. Yet, these are all the things they are required to have coverage for. These consumers just don’t see the need to pay for coverage they aren’t going to use.

“If there were a variety of coverage options out there at an appropriate premium for a 24-year-old Latino male to cover the things that could happen to him, he would be more apt to sign up,” Scandlen continued. “Another program that would be attractive to the uninsured is health savings accounts, because they minimize premium payments and put money aside for the individual’s future health care needs.”

Scandlen suggests there should be a change in the tax code so those who buy their own coverage get the same tax-free advantages as those under employer coverage. And, he says, people should be able to buy health insurance policies across state lines.

“If you want to buy something else over state lines you can,” Scandlen said. “And the same should be the case for insurance. This is the United States of America, so buying across state lines shouldn’t matter.

“This is especially apparent in the case of Massachusetts,” Scandlen pointed out, “where people are paying two-and-a-half times the price of insurance as people next door in Connecticut for the same sort of coverage.”

Aricka Flowers ([email protected]) writes from Illinois.