The American populace has been sufficiently bombarded by information on the “health insurance crisis,” the “healthcare crisis,” the “community crisis.” Despite living in a country where everyone is supposedly entitled to equal access, another horrifying and dismal piece of information seems to be released almost everyday on the declining state of healthcare for the uninsured and underinsured,
The uninsured die more often, receive less preventative care, less therapeutic care, and are diagnosed at more advanced stages of disease than the insured. One-third of those who went without insurance did not receive a recommended test or treatment due to cost in 2004, three to four times the rate of the insured. Texas is the hardest hit, with 25% of its population currently uninsured, in some areas more like 33%. What we have to ask now, knowing we have a major problem on our hands, is what all this actually means for those who lack individual health insurance.
It means that hospitals, clinics, and emergency rooms are shutting down across the country, including in major cities like Dallas and Houston, due to lack of funding, in part because of covering the costs of treating uninsured who had nowhere else to go. It means you may not have an emergency room in your community next year.
The number of doctors no longer accepting Medicaid “the government’s free insurance program for the low-income” is climbing, and the number of those accepted to the program is decreasing, due to a 2006 Congressional approval of $46.1 billion in budget cuts to the program over the next ten years. That means those foregoing needed medical attention, including those in Texas, because they simply can’t afford it, is also on the rise. The extent of this situation is difficult to even estimate, because those who don’t have insurance are less likely to get checked, and those who don’t at least attempt to receive care don’t make it into most of the studies. That means if, like so many, you are uninsured, this could be you.
According to the U.S. Census Bureau, 46 million, or 15.7% of the population, went without health insurance in 2004. Almost one-third of the non-elderly went without in 2002-2003 – 43% for Texas – and millions more were considered underinsured in the same years.
Texas has the highest percentage of uninsured adults, working adults, and children, only a portion of whom are actually in poverty. According to the Institute of Medicine, a large percentage of the uninsured are working individuals who can sustain themselves, but who cannot afford health coverage due to rising costs; premiums alone have increased an average of 15% over the last five years nationally, and employee spending for healthcare increased by 143% between 2000 and 2005.
It’s difficult, particularly for young people, to conceptualize the consequences of not having individual health insurance until a catastrophe, even a small one, hits.
“Yeah, it’s horrible,” grumbles David*, a construction worker who has worked in Arizona, Texas, and New Mexico. “There’s always work in the Southwest because the weather is so great, but most of the time I can’t do it anymore because of this,” he says, aggravated, pointing at his midsection. “It’s not the worst thing that could have happened to me, but it’s definitely one of the more damaging to my career.”
David, 29, suffered a hernia four months ago, a condition that is usually not life-threatening, but inhibits a person from performing certain activities, including heavy lifting. With no individual health insurance of his own, the only way it will be treated properly is if he can somehow pay for the expensive surgery himself. “Medicaid won’t cover me because my average income is too high, workers’ comp won’t cover me because it didn’t happen on the job, and the hospitals won’t cover me because it’s not a life-threatening situation. I don’t have my own insurance because the premiums are too high. So what am I supposed to do? Construction is the only skill I have.”
What this translates into, practically, is that David now has to choose between the lesser of two evils. He risks serious injury by taking assignments requiring heavy lifting – almost all construction jobs – but not working means he can’t pay the bills. As a high school graduate who went directly into construction, he has little experience outside of the field, and no other skilled trades. “It’s either this or fast food.”
Texas, with the highest rate of uninsured and some of the strictest guidelines to qualify for Medicaid, is a prime example of how difficult receiving adequate healthcare is without coverage. While Medicaid and the State Children’s Health Insurance Program is largely the state’s responsibility for those who actually make the cut, care for medically indigent patients is the county’s responsibility, and funding across the state varies widely. Some counties only provide for those without any, or with extremely low, incomes – which means that cities like Dallas, Houston, San Antonio, and Austin are absorbing the cost of patients coming in from other parts of the state. But Texas cities have their own problems; 28% of Houston residents, for instance, are uninsured themselves.
And the problem is not just with healthcare, but with all the aspects of personal life and the economy that poor health can affect. Poor health, for a notable example, negatively impacts educational status, which, in turn, negatively impacts health. The problem is so urgent in Texas that a Task Force of ten of the state’s academic institutions was created to address the crisis. The Task Force concluded – among other things – that, “in the absence of vigorous initiatives” to correct the situation, hospitals and emergency rooms will continue to close, the state’s economic power will decrease, and both state and county budgets will spin into crises.
So what does this Code Red for Texas mean exactly? It means that if you’re uninsured, you have less access to care, lower quality of care when you get it, and a higher chance of the care you get being too little, too late. It means that if you’re unfortunate enough to contract cancer while uninsured, you are statistically more likely to get diagnosed at a later stage of disease, more likely to receive less therapeutic (i.e., effective) care, and, sadly, more likely to die. It means that if you’re uninsured and diagnosed with HIV, or diabetes, or high blood pressure, you will probably suffer a similar fate.
Texas’ Code Red also means that, under the current conditions of the economy and healthcare system, you’re statistically more likely to survive, or suffer less severe consequences of a disease, if you invest in health insurance. While the country, of course, needs to fight the dysfunction that created this terrible situation, you had best protect yourself. It could literally be a matter of survival.