Millions of Gulf South Children and Families without Health Coverage

By Fred Kammer, S.J.

The Quest for National Health Care Reform

Having been in Washington in the 1990s working as health policy analyst for the U.S. bishops’ conference and then for health care reform at Catholic Charities USA, I am very familiar with the downfall of the effort to reform the U.S. healthcare system during the Clinton Administration.  That was only the most recent major effort at healthcare reform in the last century, a matter urged by the U.S. bishops as early as their proposal for a Program of Social Reconstruction in 1919.  Powerful interests combined to block reform in the last decade and they are committed to doing so again.  In the early nineties, some thirty-two to thirty-four million Americans were without health coverage.  Since then the number of uninsured has grown by about a million people a year and now is estimated to be forty-seven million without health care (and a whopping 86 million uninsured at some point in the 2007-2008 period)(see below)!

The bishops repeatedly have reminded us that health care is a fundamental human right, one which we all share and which we all have a duty to promote for the common good.  At their November 2007 General Meeting, the U.S. bishops restated their position on reform as follows:

Affordable and accessible health care is an essential safeguard of human life and a fundamental human right.  With an estimated 47 million Americans lacking health care coverage, it is also an urgent national priority.  Reform of the nation’s health care system needs to be rooted in values that respect human dignity, protect human life, and meet the needs of the poor and uninsured, especially born and unborn children, pregnant women, immigrants, and other vulnerable populations.  Religious groups should be able to provide health care without compromising their religious convictions.¹

Health care as a basic human right of everyone should shape the contours of the national debate:

• from shouting “hands off my health coverage!” to asking “how do we care for all of our sisters and brothers, especially the poor?”
• from “is it fair for government to compete with health insurers?” to “is it just to continue a market-driven system which is increasingly unaffordable and unavailable?”
• from trashing the Canadian and European health delivery systems to recognizing their successes in access and cost control;
• from hysterical misrepresentations about governmental “death panels” for the elderly and disabled to recognition of the importance in medical ethics of appropriate end-of-life care and decision-making by patients;
• from decrying non-existent “rationing” in proposed legislation to recognizing that insurance companies currently “ration” paying for procedures and 47 million people are “rationed” out of health insurance coverage completely by the current system.

Those who have been involved in health reform discussions over the past decades know that real reform must deal with at least several key issues simultaneously: access, costs, coverage, and quality.   This means that the various partial efforts of the past that did not address all these factors—employment-based health insurance, managed care, quality control, Medicare, Medicaid, S-CHIP—still left us with spiraling health care costs, emergency room primary care, denial of coverage for preexisting conditions, limitations on insurance benefits, increasing co-payments, reduced employer coverage for employees, and one million more people a year without coverage!  Market-driven health care and our employer-based system have failed to deal comprehensively with the key core issues which face us.  The nation needs a comprehensive reform effort and, frankly, without the public option which has been proposed, it is unlikely that we can move in that direction.

Catholic Church Concerns

Recently, the Catholic bishops of the United States inaugurated a website to focus directly on the health care reform and to bring together the voices of Catholics concerned about health care, social justice, protecting human life, and the rights of immigrants.  On the website and in communications to members of Congress and the Administration the bishops have highlighted four core elements of their position on health care reform:

• a truly universal health policy with respect for human life and dignity;
• access for all with a special concern for the poor and inclusion of legal immigrants;
• pursuing the common good and preserving pluralism including freedom of conscience and variety of options; and
• restraining costs and applying them equitably across the spectrum of payers;

Included on this site is a direct reference to the July 17, 2009 letter to Congress from Bishop William Murphy, chair of the bishops’ Domestic Justice and Human Development Committee, in which Bishop Murphy spells out the above four points and addresses specific concerns arising from them. 

The site also refers concerned readers to the bishops’ comprehensive statement on health care reform approved by the full body of bishops in 1993 entitled A Framework for Comprehensive Health Care Reform: Protecting Human Life, Promoting Human Dignity, Pursuing the Common Good.  The criteria which were enunciated by the bishops in 1993 still very much apply to the renewed debate over health care reform in which we are now engaged:

CRITERIA FOR REFORM

Applying our experience and principles to the choices before the nation, our bishops' conference strongly supports comprehensive reform that will ensure a decent level of health care for all without regard to their ability to pay. This will require concerted action by federal and other levels of government and by the diverse providers and consumers of health care. We believe government, an instrument of our common purpose called to pursue the common good, has an essential role to play in assuring that the rights of all people to adequate health care are respected. We believe reform of the health care system which is truly fundamental and enduring must be rooted in values that reflect the essential dignity of each person, ensure that basic human rights are protected, and recognize the unique needs and claims of the poor. We commend to the leaders of our nation the following criteria for reform:

• Respect for Life. Whether it preserves and enhances the sanctity and dignity of human life from conception to natural death.

• Priority Concern for the Poor. Whether it gives special priority to meeting the most pressing health care needs of the poor and underserved, ensuring that they receive quality health services.

• Universal Access. Whether it provides ready universal access to comprehensive health care for every person living in the United States.

• Comprehensive Benefits. Whether it provides comprehensive benefits sufficient to maintain and promote good health; to provide preventive care; to treat disease, injury, and disability appropriately; and to care for persons who are chronically ill or dying.

• Pluralism. Whether it allows and encourages the involvement of the public and private sectors, including the voluntary, religious, and nonprofit sectors, in the delivery of care and services; and whether it ensures respect for religious and ethical values in the delivery of health care for consumers and for individual and institutional providers.

• Quality. Whether it promotes the development of processes and standards that will help to achieve quality and equity in health services, in the training of providers, and in the informed participation of consumers in decision making on health care.

• Cost Containment and Controls. Whether it creates effective cost-containment measures that reduce waste, inefficiency, and unnecessary care; measures that control rising costs of competition, commercialism, and administration; and measures that provide incentives to individuals and providers for effective and economical use of limited resources.

• Equitable Financing. Whether it assures society's obligation to finance universal access to comprehensive health care in an equitable fashion, based on ability to pay; and whether proposed cost-sharing arrangements are designed to avoid creating barriers to effective care for the poor and vulnerable.

While the current reform effort is sixteen years after the bishops’ statement, the issues are basically the same and the applicable moral and ethical principles continue to apply.  What is new is the acuteness of the national health care crisis and the additional fifteen million people without coverage.

Closer to home, this month the outgoing and incoming Archbishops of New Orleans—Most Rev. Alfred C. Hughes and Most Rev. Gregory M. Aymond—issued a joint public statement on “pressing need for health care reform.”  They underscored the fact that, “Too many American citizens lack basic health care coverage and the cost of health care is becoming prohibitive for many more.”

Two further reports highlight the impact of a defective health care system on children and individuals in the Gulf South and the nation.

2.6 Million Gulf South Children without Health Insurance

Despite the gains made for low-income children through Medicaid and its expansion in 1997 through the SCHIP²  programs, as of 2006 eleven percent of U.S. children ages 18 and below (9,016,000 kids) were without health insurance coverage. Over twenty-nine percent of these children—2,614,000—live in the five Gulf states.  The breakout is reflected in the table below:

Source: KIDS COUNT DATA BOOK, Annie E. Casey Foundation

Americans At Risk: One in Three Uninsured (March 2009, Families USA)

To find out how many people are affected by being uninsured, Families USA commissioned The Lewin Group to analyze data from the Census Bureau’s Current Population Survey (CPS) and its Survey of Income and Program Participation (SIPP), as well as from the Medical Expenditure Panel Survey (MEPS), which is conducted by the Agency for Healthcare Research and Quality. This analysis found that 86.7 million people—one out of every three Americans under the age of 65—was uninsured for some period of time during 2007 and 2008. These Americans have had to pay for medical care out of their own pockets, or they have had to delay needed care altogether. In the Gulf South states, the figures are equally shocking for the same two year period during which 18.6 million people were uninsured at some point.

In each of the Gulf South states, 70% (Alabama) to 80% (Texas) of those uninsured during this period were uninsured for at least six months.

Persons in these states concerned about the health of these children and adults and the future of their communities have added reason to advocate for comprehensive health care reform now.

1. United States Conference of Catholic Bishops, Forming Consciences for Faithful Citizenship, November 2007, No. 80.

2. SCHIP or the State Children’s Health Insurance Program which began in 1997 expanded to cover 6.7 million poorer children in 2006 and 7.4 million by 2008.  See annual growth of the program from 1997 to 2008, http://www.cms.hhs.gov/NationalCHIPPolicy/downloads/CHIPEverEnrolledYea….