Number of Uninsured Americans Continues to Rise
Yet Focus of Congress is Elsewhere

Laura Clay Trueman

While Congress works furiously to add extra benefits like prescription drug coverage to Medicare’s program for seniors, there is an awful irony: another group of Americans, just as large as the elderly – some 44 million – lack even the most basic health insurance. Before they can worry about paying for prescriptions, uninsured folks must first be able to afford a visit to the doctor.

In this country, we have provided access to health care for the elderly with Medicare and for the very poor with Medicaid. Many people falsely assume that helping these two vulnerable populations with their health care needs provides the necessary safety net and that everyone else works and, thus, can obtain health insurance through their jobs. In fact, 15% of Americans lack any health insurance. Figures released this week say the number has increased two million since last year’s report. Waitresses, taxi drivers, hairdressers, agricultural workers and many others work long hours and still can’t afford health insurance. Unfortunately, these hard-working Americans pay with their health. Lacking insurance, they delay necessary medical treatments and are more likely to be admitted to the hospital, where health care is most costly.

Why doesn’t Congress act? Money and politics have gotten in the way. The uninsured do not have the political clout that power house associations like the AARP have on the Hill. Most uninsured people are too busy working one or two jobs to be activists. Money and politics also affect Congress’ thoughts on this issue. Republicans are reluctant to move forward with a government solution for fear of creating another federal subsidized program for 40 million uninsured that may hemorrhage the budget like Medicare and Medicaid, programs that have increased exponentially since they began. Most Democrats, including many presidential candidates, have decided that bigger government is the answer through mandates on businesses and the expansion of welfare (with the unspoken result of higher taxes to support this). Never mind that businesses are crippled with double-digit inflation in affording health care for their workers or that mandates can mean fewer employers and fewer jobs, deepening the plight of the uninsured.

The good news is that lawmakers have an opportunity to get this solution right and avoid the mistakes of the past. The uninsured want a hand-up, not a handout. Many “working poor” are resistant to the idea of needing or receiving welfare. If solving this problem were as simple as expanding Medicaid, then the 30 percent of the uninsured who are already eligible for Medicaid would be using it.

Helping the uninsured means looking at what works. What works for 75 percent of all Americans is owning private health insurance. Government doesn’t need to become an insurance company; it just needs an effective way to help people afford the insurance that is already out there so they can enjoy the same medical choices and coverage that most of us do.

One solution that makes sense is to offer people a refundable and advanceable tax credit for the purchase of private health insurance. If their employer offers health insurance, this would help them afford to participate in a health plan. If they don’t have access to group health insurance, then the credit can be used to purchase individual health insurance. It stays with them, leaving coverage uninterrupted if they change jobs. If they don’t make enough money to owe much in the way of taxes, the credit is refundable, meaning the government will still provide the credit amount to help individuals pay for health insurance. It can be made advanceable, so that the credit is there when people need it, each month when the premium is due, rather than waiting for a refund at the end of the tax year. The amount of the credit should make health insurance affordable to people while still requiring some personal contribution. By making the credit a fixed amount, rather than a percentage of the premium, lawmakers can avoid creating incentives for large policies which bust the bank.

Go ahead, Congress, finish the important business of Medicare modernization. But, don’t leave the uninsured empty-handed. The time for bold action is now! Otherwise, our nation’s leaders will be guilty of giving more to the “haves” while ignoring the “have-nots.”

Laura Clay Trueman is Executive Director of the Coalition for Affordable Health Coverage, a diverse alliance of groups committed to helping the uninsured through market-based initiatives.