More Workers Going Without Health Benefits

[IJ Reilly]

A federal report says an additional 2.6 million adults joined the ranks of the uninsured in 2003.

By Vicki Kemper
Times Staff Writer

July 1, 2004

WASHINGTON — The economy started creating jobs again last year, but the number of working-age adults who went without health insurance for more than a year jumped sharply, the government reported Wednesday.

An additional 2.6 million people ages 18 to 64 were uninsured for more than a year, raising the total to 24.5 million, according to the federal Centers for Disease Control and Prevention.

The report, released by the agency's National Center for Health Statistics, is the government's first statistical look at health insurance coverage during 2003, when the economy began reversing the job losses that started with the 2001 recession.

The increase in the number of long-term uninsured, which Robin A. Cohen of the statistics center called "quite a significant jump," underscored the chronic nature of the problem and the decreasing likelihood that a job guaranteed access to health insurance, analysts said.

"As we lose jobs in the manufacturing sector to jobs in the service economy and small businesses, we're losing the stability of big employers and replacing it with a much more fragile system," said Diane Rowland, executive director of the Kaiser Commission on Medicaid and the Uninsured. "Our uninsured problem is becoming more of a permanent problem instead of a temporary, transitional problem."

Kate Sullivan Hare, executive director of health policy for the U.S. Chamber of Commerce, said rising healthcare costs were making it more difficult for employers of all sizes to offer coverage to workers. As businesses that still offer health insurance pass on more of the costs to employees, greater numbers of workers are deciding that the coverage is not worth the cost, she said.

Health insurance premiums that employed Americans pay for family coverage have increased by almost 50% over the last three years, according to the Kaiser Family Foundation, and voters questioned in public opinion polls consistently cited rising healthcare costs and worries about losing health coverage among their top concerns.

About 20 million U.S. families, or 1 in 7, had difficulty paying their medical bills last year, according to a report this week by the Center for Studying Health System Change.

A higher number of Americans without health insurance for a year or more also means that more people are dying prematurely, "living with greater health risks, more serious illness and a greater burden on society to care for them," Rowland said.

The CDC study determined that 53.1 million Americans of all ages, or 18.6% of the population, went without health coverage for some part of 2003, a slight increase from 2002. Of those, 28.5 million, or 10% of the population, had been uninsured for more than a year.

The one bright spot in the report was a decline in the number of uninsured children. Thanks to the success of the State Children's Health Insurance Program, created by Congress in 1997, the percentage of children who were uninsured for some part of the year declined from 14.6% in 2002 to 13.7% in 2003.

With private insurance increasingly unaffordable for employers and workers, the campaigns of President Bush and Sen. John F. Kerry of Massachusetts, the presumed Democratic presidential nominee, are seeking to address the issue.

"This report is a stunning indictment of George Bush's failure to deal with the healthcare crisis that is occurring on his watch," Kerry campaign spokesman Phil Singer said.

The Bush campaign did not respond to a request for comment.

http://www.latimes.com/news/nationworld/nation/la-na-insure1jul01,1,344117.story

[IJ Reilly]

Right diagnoses, wrong prescription, IMO.

I'm not opposed to tort reform, but to place blame on lawsuits for these massive increases in health care costs, without even mentioning the 25-35% of our health care dollars that go straight to the insurance industry (and provide no health care at all), is to miss the main event.

[takao]

hmm i just searched for austrian numbers the only thing i found was a number of 160.000 people...or 2,4 percent of the 15 years or older population...majority of the people don't know that they are not insured.. either because they just had a divorce,just came into the country,etc.
local charity organizations are already warning that this could lead to a humanitarian catastrophe ...

then i look at the US numbers :eek:

[Chip NoVaMac]

The cost of insurence is beyond outrageous. I know a company with around 200 employees down here who had the problem that if they paid their insurance new prices they would essentially be giving some of their employees 30% raises. So what they did was raise the deductible to $1000 from $500. Then the company paid the difference so that the employees didn't see a change. In the first year the company saved $36000.

At my company I offer $100 towards heath insurance per month. It is all I can afford. 1 of my employees took me up on it. I then offered AFLAC also. The other employees took AFLAC for the balance of their $100. I have health insurance from my wife's job. A group policy for my employees that covered their families would cost me almost $1000 a month per employee. That is a 12000 a year benefit!

I think if they don't put a cap on damages lawsuits against Doctors our insurance rates will completely be unpayable before long. I think the lawsuits raising insurance prices are the reason less companies are offering insurance.

Question, are there any tax benefits for you to offer insurance to your employees?

Tort reform is not the only answer. Getting the states to remove doctors much more quickly will also help.

[Chip NoVaMac]

But massive medical suits are in my opinion ridiculous. I am O.K. with the suits when the wrong limb is amputated, or something with gross negligence. But many doctors get sued ever time there is a minor mistake. Life isn't perfect, but in america we can sue to make it that way.

I agree. But who gets to decide what the damages should be? The insurance companies? The lawyers? The politicians? Or the judges? And how much is too much?

I also think that no civil lawsuit should have the condition of non-disclosure of the settlement removed. You settle, it becomes public knowledge.

Also to you answer to my original question. There should be some incentive for you to provide affordable insurance to your employees. There is another benefit to offering insurance to your employees over retention, and that is a healthy worker is a more productive worker.

[blackfox]

The only benefit is for my employees. If I offer the insurance then they don't have to pay income tax on the money they spend on insurance. For me it doesn't make a difference.

The benefit for me is that my employees have health insurance, and they are less likely to job shop. And if you take care of your employees then they take care of you... :)
Stelliform, while I have nothing too constructive to add, may I ask what business you are in, and of what size? I find it commendable that you make these efforts on the behalf of your employees, as the GM of a small business a few years ago, I wished to make the same steps, for the same reasons, but was overruled by ownership. I find it kind of funny that many small(er) businesses attempt coverage of their employees, at a greater proportional cost, than larger companies, who are more able to afford to...anyway, kudos to you.
I agree that they insurance companies are taking huge profits right now. (They have been empowered by 9/11. Since they had to raise rates so tremendously to pay off the pay offs, then they didn't drop them back down.)

But massive medical suits are in my opinion ridiculous. I am O.K. with the suits when the wrong limb is amputated, or something with gross negligence. But many doctors get sued ever time there is a minor mistake. Life isn't perfect, but in america we can sue to make it that way.
The thing here is the way so many laws are written, it seems like someone is always screwed. On one hand, the current system allows for those with legitimate cases to work towards fair compensation, while also allowing frivolous claims. On the other hand, an over-arching law, while prohibiting frivolous claims, may inadvertantly bar legitimate claims as pertaining to context, as laws are generally not flexible enough to deal w/ every situation.

I would add, that perhaps part of the problem, is the tendency for some defenses, if realistically liable/guilty, will just throw money at the problem, file appeals, and make the case so time-consuming and expensive for the plaintiff, that they may back down. This, in turn, severely stresses the Court system...I do not mean to imply that this is always relevant, but it is an aspect.

I am interested to know if insurance rates rise in relation to the number of claims filed, or merely with the judgements of liability? Anyone care to fill me in?

[zimv20]

There should be some incentive for you to provide affordable insurance to your employees.
it is a business expense, that's one tangible. as mentioned, there is the intangible of retaining employees. i would be in favor of some sort of additional incentive, beyond expensing, maybe a tax break.

that stelliform, as a company owner, gets his health insurance through his wife is imo a scathing indictment of how difficult it is for small business owners to compete on a benefits scale.

if it's unclear, i'm a fan of small business.

[Chip NoVaMac]

it is a business expense, that's one tangible. as mentioned, there is the intangible of retaining employees. i would be in favor of some sort of additional incentive, beyond expensing, maybe a tax break.

that stelliform, as a company owner, gets his health insurance through his wife is imo a scathing indictment of how difficult it is for small business owners to compete on a benefits scale.

if it's unclear, i'm a fan of small business.

Sorry that I did not make myself clearer. I meant some sort tax break as one possibility.

[zimv20]

Sorry that I did not make myself clearer. I meant some sort tax break as one possibility.
righto. totally agree.

[Frohickey]

Right diagnoses, wrong prescription, IMO.

I'm not opposed to tort reform, but to place blame on lawsuits for these massive increases in health care costs, without even mentioning the 25-35% of our health care dollars that go straight to the insurance industry (and provide no health care at all), is to miss the main event.

Another reason that I have heard is that with the rise of medical malpractice lawsuits, doctors would rather subject you to the whole battery of tests and procedures, which end up costing a lot of money, than rely on their judgement and run the risk of missing a condition, and a lawsuit.

[zimv20]

Me too! :) I think the economy is quickly becoming one where the majority of people are employed by a small business.
here (http://app1.sba.gov/faqs/faqIndexAll.cfm?areaid=2) are some fun facts from the Small Business Association:

Small firms...

Total approximately 23 million in the United States, with roughly 75 percent of the firms having no employees.
Represent 99.7 percent of all employer firms.
Employ half of all private sector employees.
Pay 44.3 percent of the total U.S. private payroll.
Generate 60 to 80 percent of net new jobs annually.
Create more than 50 percent of nonfarm, private grossdomestic product (GDP).
Are employers of 39 percent of high tech workers (such as scientists, engineers, and computer workers).
Made up 97 percent of all identified exporters and produced 29 percent of the known export value in FY 2001.




(This speech should be in the why I am a conservative thread. :)
i was a small business owner for 5 years, now i'm self-employed. i don't see pro-small business as a dem/gop issue. w/ the gop in control of congress and the WH, how many pro-small business measures have you seen passed?

i see both parties as geared towards larger businesses, if for no other reason than the lobbying money. it's a shame, imo, especially given the data above. i see entrepreneurialism as more american than big business, but i don't think everyone agrees with me.

and since it is a healthcare thread...

do you feel your business would be easier to run and compete if there was a national healthcare plan? what would you change in your business?

[Frohickey]

and since it is a healthcare thread...

do you feel your business would be easier to run and compete if there was a national healthcare plan? what would you change in your business?

No. I feel that my business would be easier to run if instead of having to offer health care plans to my employees, I would just write them a single check on payday, and it would be up to the employee to provide their own health care out of their own paycheck. (Same as the employee has to provide for their own auto insurance, auto payment, home mortgage, gasoline money, lunch money, etc.)

I also feel that my business would be easier to run if I did not have to do tax withholding, and its up to the employee to declare and pay their tax due on or before April 15th.

What is easier? Hiring an employee for $X dollars an hour, hiring an accountant to figure out how much taxes I have to withhold, hiring a HR person to find a health care plan, and write 3 checks, each for less than $X * number of hours worked, and another check to the government.

Or.

Cutting a single check for $X * number of hours worked on payday for the one employee.

[IJ Reilly]

Another reason that I have heard is that with the rise of medical malpractice lawsuits, doctors would rather subject you to the whole battery of tests and procedures, which end up costing a lot of money, than rely on their judgement and run the risk of missing a condition, and a lawsuit.

It's called "defensive medicine," but I wonder how many doctors actually practice it, especially in the current environment where the HMOs tell the doctors what tests they can perform and what medicines they can prescribe. In any case if you're saying that the incentives in medicine are all on the wrong side of ledger, then I'm hardly going to disagree with you. I'd support a whole package of reforms that would shift the incentives back where they belong, towards making and keeping people healthy. We seem to have lost track of those goals long ago.

[Neserk]

That was me :D

I now have school health insurance. It is a huge relief because if I end up with bronchitis or a sinus infection I don't have to pay an arm and a leg to see a doctor for an antibiotic.

Other than that the health insurance is pretty worthless. Oh, if I die, I'm covered! ;)

[Thomas Veil]

I'm sure a big chunk of the blame also goes to pharmaceutical and medical equipment companies. I don't buy the drug companies' claim that the reason for exorbitant prices is that it costs so much to develop new drugs, for two reasons.

One is the prices are often that high only in this country. (Heck, I've even heard that pets can get the same drug much cheaper than you or I can.)

The other is that, in a country where everyone else is getting laid off, seeing his salary erode, etc., drug and medical equipment manufacturers seem to be stubbornly immune to this phenomenon. If you worked at a hospital, like I did, you'd be appalled to see the sales reps driving BMWs and wearing $600 suits. The companies are doing quite well, thank you, and they sure don't seem to be cutting back on employee levels or on their salaries. Hospitals pay for that, and pass the costs on to you.

The same applies to a lot of the companies that manufacture MRI machines and such. When was the last time you heard about them having mass layoffs?

As a general comment, it's alarming to see the rate at which employees are being asked to pay for a large chunk of their health insurance, or losing it altogether (because so many full-time jobs are being replaced by part-time ones). It's ironic that conservatives complained about national health care, but it's looking like we'll have it anyway, simply by default. Because before you know it, employers won't be able to offer it at all, and then the government will have to take up the slack.

[zimv20]

No. I feel that my business would be easier to run if instead of having to offer health care plans to my employees, I would just write them a single check on payday, and it would be up to the employee to provide their own health care out of their own paycheck.
that sounds like a 'yes' to me. i.e. it would make your business easier if you didn't have to provide healthcare to your employees.

maybe i'm behind the times, but do you own a business w/ employees?


I also feel that my business would be easier to run if I did not have to do tax withholding, and its up to the employee to declare and pay their tax due on or before April 15th.
if your employees are all 1099, then you get your wish.

[Voltron]

If you read the tax rule, if they look like an employee then they are an employee. They are only 1099 if they can be reasonable expected to go and come as they please, and they provide their own equipment to work with. Unfortunately I don't have a link, but just go read the instructions for the 1099 form or the W2 form if you want to see what I am talking about.

I also just cut one check for my entire payroll. I use a payroll service that charges $20 a check. They do all my withholding and deductions like the health insurance. They direct deposit the checks for me, and they provide me with reports that have a breakdown of each payroll. They have made my life so much easier!
I don't know 20 bucks per employee per pay period sounds a tad bit expensive to me.

[zimv20]

They are only 1099 if they can be reasonable expected to go and come as they please, and they provide their own equipment to work with.
yeah, there's a few rules the IRS uses to classify employees. i wasn't suggesting frohickey break any (if he even has a business, i think he's just playing devil's advocate), only that it's possible to have such employees.

[zimv20]

I know, I am a stickler for following the IRS rules. I think I am in the minority when it comes to following the rules though...
you and me both. i had many letter of the law vs. spirit of the law debates w/ my former business partners.

[Chip NoVaMac]

Another reason that I have heard is that with the rise of medical malpractice lawsuits, doctors would rather subject you to the whole battery of tests and procedures, which end up costing a lot of money, than rely on their judgement and run the risk of missing a condition, and a lawsuit.

Keep in mind we now have many more conditions that look like other ailments (Lime Disease and others).

[Chip NoVaMac]

I don't know 20 bucks per employee per pay period sounds a tad bit expensive to me.

You need to look at the math before saying something like this. Not a slam, but some numbers need to be looked at. Stelliform has a total of 4 employees. Even if he pays every week, this is only $80 a week or $4,160 a year.

Even if the rate of $20 does not change with more employees (I doubt it, but maybe Stelliform has some knowledge here), a shop that has 150 employees would end up paying $78K a year. That sounds like a lot, but that function for a company of that size may require two people to maintain properly. In my area that $78K would maybe pay for the two employees.

[Frohickey]

It's called "defensive medicine," but I wonder how many doctors actually practice it, especially in the current environment where the HMOs tell the doctors what tests they can perform and what medicines they can prescribe. In any case if you're saying that the incentives in medicine are all on the wrong side of ledger, then I'm hardly going to disagree with you. I'd support a whole package of reforms that would shift the incentives back where they belong, towards making and keeping people healthy. We seem to have lost track of those goals long ago.

How about keeping lawyers out of medical offices and hospitals? I mean that literally. Lawyers are to be denied medical care, its not like we have a shortage of living lawyers. :o

[Frohickey]

One is the prices are often that high only in this country. (Heck, I've even heard that pets can get the same drug much cheaper than you or I can.)

The other is that, in a country where everyone else is getting laid off, seeing his salary erode, etc., drug and medical equipment manufacturers seem to be stubbornly immune to this phenomenon. If you worked at a hospital, like I did, you'd be appalled to see the sales reps driving BMWs and wearing $600 suits. The companies are doing quite well, thank you, and they sure don't seem to be cutting back on employee levels or on their salaries. Hospitals pay for that, and pass the costs on to you.

The same applies to a lot of the companies that manufacture MRI machines and such. When was the last time you heard about them having mass layoffs?

As a general comment, it's alarming to see the rate at which employees are being asked to pay for a large chunk of their health insurance, or losing it altogether (because so many full-time jobs are being replaced by part-time ones). It's ironic that conservatives complained about national health care, but it's looking like we'll have it anyway, simply by default. Because before you know it, employers won't be able to offer it at all, and then the government will have to take up the slack.

1) We have had the discussion already about why drug costs in the US are higher than in other countries with govt-mandated price ceilings. If you want to read more about it, go here (http://www.thehighroad.org/showthread.php?s=&threadid=89205&perpage=25&pagenumber=3).

2) You need to get that Green-Eyed-Monster-Of-Envy-bite looked at. I think penicillin might work, or is that only for syphillis. :p

3) There is demand for MRI machines. I think instead of wishing for layoffs at MRI machine manufacturers, you want to see a hiring spree. That way, they can make more MRI machines, enough to satisfy demand, and the price of MRI machines would go down.

4) Lets see. Employers pay you for doing a good job. Why can't you pay for your own health care. Actually, you already are. I wish that I could have the option of 'employer-paid-health-insurance premiums' OR 'no-health-insurance-premiums-but-a-raise-instead'. I would like to have a raise instead.

[Frohickey]

I also just cut one check for my entire payroll. I use a payroll service that charges $20 a check. They do all my withholding and deductions like the health insurance. They direct deposit the checks for me, and they provide me with reports that have a breakdown of each payroll. They have made my life so much easier!

Wouldn't it be better to not have to worry about the $20 a check?

Thats $20 per employee profit that your company could use to grow the business, hire more productive workers instead of paperpushers. Plus, your employees would be happier too, they get a larger check, and they can pay Uncle Sam his due on April 15, instead of giving him an interest-free loan.

That $20 cost better be tax-free, since your business is now incurring a cost (federal withholding) that the government should be paying for. Why can't IRS tax collectors go door-to-door collecting bags of wheat instead. :p

[IJ Reilly]

How about keeping lawyers out of medical offices and hospitals? I mean that literally. Lawyers are to be denied medical care, its not like we have a shortage of living lawyers. :o

Okay, you keep the lawyers out, and I'll keep out the insurance company bureaucrats. Deal?

[pseudobrit]

4) Lets see. Employers pay you for doing a good job. Why can't you pay for your own health care. Actually, you already are. I wish that I could have the option of 'employer-paid-health-insurance premiums' OR 'no-health-insurance-premiums-but-a-raise-instead'. I would like to have a raise instead.

You're a healthy adult then?

A short visit (about three hours) to the ER in March cost my insurance company over $1700. That's eight stitches and a CT scan, with each service costing over $800. The stitches were done by a resident (read: slave)

If it wasn't 11:00 at night, my regular doctor could have put the sutures in for maybe $100 and ordered an X-ray for another $100.

I would have had to bleed from my face for a day and a half to wait that long, though.

I think I would have lost any benefit from my raise by having to pay $1700 in full for one night of emergency medical care.

[Frohickey]

You're a healthy adult then?

A short visit (about three hours) to the ER in March cost my insurance company over $1700. That's eight stitches and a CT scan, with each service costing over $800. The stitches were done by a resident (read: slave)

If it wasn't 11:00 at night, my regular doctor could have put the sutures in for maybe $100 and ordered an X-ray for another $100.

I would have had to bleed from my face for a day and a half to wait that long, though.

I think I would have lost any benefit from my raise by having to pay $1700 in full for one night of emergency medical care.

You would not lost any benefit from your raise by having to pay $1700 in full in one night of emergency medical care if you had used your raise to buy yourself medical insurance.

Maybe I would not have lost any benefit from my raise if I used it to enroll myself and my roommate to an EMT course and extra classes on proper suturing of wounds.

I thought slavery was abolished. :eek: Maybe that 'resident' willingly untook the long hours and insufficient pay in order to train themselves V-O-L-U-N-T-A-R-I-L-L-Y.

[Chip NoVaMac]

You would not lost any benefit from your raise by having to pay $1700 in full in one night of emergency medical care if you had used your raise to buy yourself medical insurance.

Nice argument if your "raise" is enough to get insurance. I know our HR Director spent 9 months looking for the best combination of "features" and price. As the workforce ages, group policies from your employer are the best options in many cases.

[Frohickey]

Nice argument if your "raise" is enough to get insurance. I know our HR Director spent 9 months looking for the best combination of "features" and price. As the workforce ages, group policies from your employer are the best options in many cases.

It could also be that your HR Director spent 9 months looking for the lowest rate that will give the company the highest rate of return on investment, because the company is the one paying for the health care insurance.

Otherwise, the HR Director could just be fired, the Employer just give everyone a blanket increase in pay for everyone, enough to provide for a single person's health care insurance premium, and call it a day.

If you think about it, a single person with no dependents is the way to maximize what the company keeps if the company is the one paying for health care insurance. Married or people with dependents cost more.