The Crisis of Uninsured Children in America - Research Paper Example

Underinsured immigrants and American children and the insured children in the United s Of late, there are an increasing number of people who arenot insured as far as health is concerned. This has been highly contributed by the informal sector that a large number of Americans are now in. The biggest insurer of the people is the employer and thus the lack of formalized jobs has made the employer not much accountable for the health of the workers. In this group of uninsured people there are children who are dependent on parent to make effort to have a policy for the child. The government is trying to ensure that all the citizens are covered by the insurance schemes that are financed by the government (U.S. Census Bureau 2). According to census report 2007, there were approximately 45.7million uninsured people in the country which the entire world view as the world’s economic giant. This paper will look into the differences between the underinsured immigrants and American children, and the insured children in the United States. Depending on one’s definition of underinsurance, 8 to 26% of privately insured population under 65 years of age is underinsured. Enrollees with group insurance constitute 90% of persons with private insurance and they are a substantial majority of the underinsured (U.S. Census Bureau 1). However, from one-third to two-third of all groups of enrollees are underinsured. Under some definitions of underinsurance, women and their dependants are underinsured at about twice the rate for men and their dependants. Even though vulnerable populations are more likely to need healthcare services, many are not able to access them. A number of reasons are cited for this phenomenon, but one of the most problematic is the lack of healthcare insurance. More precisely, in 2007, more than 45 million people in the United States did not have health insurance benefits. These groups are particularly affected by escalating healthcare costs and reductions in service within a community. The elderly, poor children and growing numbers of individuals who are not properly represented in employment are the most affected (Sered and Fernandopulle 19). According to the Child Health web page of the Children’s Defense Fund’s web site, of the nine million uninsured children, 40.8 percent are White, 31.7 percent are Hispanic, 19.8 percent are Black, 5.1 percent are Asian or Pacific Islander and 2.6 percent are American Indian or Alaskan Native. According to United States Census Bureau website, the population of Miami Dade stands at 3.7million. Of this population, 21% of the people are not insured. Of this uninsured, the number of children constitute 38%, by children we mean those people under the age of 19 years. In this percentage of uninsured children, above 50% can qualify for the government sponsored policies namely; Medicaid and the State Childrens Health Insurance Program (SCHIP) if they can only apply for it. According to the 2006 U.S. Census, 15.8% of legal U.S. inhabitants had no health insurance. More children are uninsured than there were in 2005. Texas has the highest uninsured rate of 24.1%; thus, nearly one in every four Texans has no insurance. The United States is the only industrialized nation not to offer comprehensive health coverage to all of its citizens and it is by far the richest nation in the world (U.S. Census Bureau 3). Children’s access to health care depends on several financial and nonfinancial factors. Financial factors include insurance status (insured or underinsured); the nature and extent of insurance coverage, including cost-sharing requirements such as copayments and deductibles; family income; and the costs of care. Among many nonfinancial factors, the availability and proximity of providers; types of coverage accepted by providers; logistical difficulties in scheduling and transportation; racial, ethnic and cultural backgrounds of providers and families; and parental health beliefs have been shown to influence access to care (Sered and Fernandopulle 20). As a matter of principle, all children should have appropriate access to coordinated, efficient, child-appropriate, and effective care, including generally accepted preventive services; acute care for short-term illnesses and injuries; ongoing care for children with chronic medical conditions; rehabilitative care, including allied health services for children with disabilities; and care for children with special needs, such as speech disorders. In the United States, the private sector provides health insurance for the majority of children and adults, mainly through employer-sponsored coverage. This is in contrast to other developed countries which rely primarily on public-sector financing for health insurance. In the United States, public-sector financing for children’s health insurance is mainly through Medicaid, a program financed by the federal and state governments and administered by the states. Other sources of public insurance include military health care and Medicare. However, these other sources provide coverage for fewer than 5% if insured children (Center for Health Economics Research 24). Children residing in nonmetro areas are more likely than children in metro areas to be underinsured. They are more likely to be white, residing in the South and in the least generous Medicaid states and living in two-parent families. They are likely to be as healthy as or healthier than children in metro areas, as measured by mortality, acute and chronic conditions, bed days and drug use. Many spiteful myths persist about the uninsured or the underinsured: They do not work and are destitute, or conversely they are wealthy and can afford to pay privately for their care; they can get care when they really need it and at no cost to them; they are mostly illegal immigrants. In truth, eight out of ten uninsured Americans come from a working family and two-thirds of the uninsured are from low-income families; 79% are American citizens. Over a third of the uninsured postpones or neglects medical care needs and when they do go for care, they are billed and pay out of pocket. Most of the uninsured, along with a significant number who are insured, can not afford the high costs and many, uninsured and insured, file for personal bankruptcy as a result (American Medical Association 102). There is more to the underinsured story: the Census Bureau does not count the millions who are underinsured. If one is insured sporadically in a given year, he is counted among the insured. To be underinsured, mean that one is insured only part of a year or that one have some insurance but it does not adequately meet his health needs. Insurance coverage, tied to employment is the admission ticket to health services. While there are several governments programs to provide services, substantial numbers fall into the ‘near poor’ and uninsured or underinsured groups. Patients are reluctant to seek care without insurance and providers/facilities are reluctant to provide care since services may not be reimbursed. Insurance reform is a health policy issue currently under discussion at the federal and state levels to stimulate investment in health care for all Americans. Reimbursement levels for health services have been a major discussion for providers and health care facilities (American Medical Association 149). While government programs and private insurance companies have attempted to implement cost containment and reasonable reimbursement, significant gaps exist and exacerbate the barriers that populations at risk experience. Health care coverage for low-income lawfully present immigrant children has become a state-by-state patchwork, with tragic results. In many states, there is not coverage at all for large numbers of these children. The policy of denying federal health care to lawfully present immigrants is unfair and unwise. It is unfair because immigrants pay the same taxes as all others and deserve the same access to health care that those taxes buy. If fact, immigrant taxes are more than sufficient to pay for the health care needs and all other expense associated with immigration. The average immigrant contributes $1,800 more each year in taxes than the government pays out for him, including the costs of roads, infrastructure and education, as well as all government services (Center for Health Economics Research 72). The balanced Budget Act Refinement and Access to Care proposal recognizes that some of the cuts to health care providers made in the name of balancing the budget went too far. In this time of surpluses, as Congress considers proposals to eliminate the excesses of those budget cuts on behalf of health care providers, Congress should also restore services to lawfully present immigrant children and pregnant women who sacrificed as much as anyone under the budget balancing legislation. Despite the concerted efforts of many people, the number of underinsured Americans has continued to grow. Recent studies have shown that underinsured Americans are less likely to have a usual source of care, are more likely to delay seeking care, and are less likely to use preventive services. In addition, underinsured Americans are four times more likely than insured patients to require both avoidable hospitalizations and emergency hospital care. Despite unprecedented economic growth and record low unemployment in recent years, in 1998 there were more than 11 million children under the age of 18 who lacked health insurance coverage in the United States. Children represent approximately 25% of all uninsured. Two out of three of these children, or over 7 million, live in families with household incomes below 200 percent of the Federal Poverty Level. Lack of health insurance for millions of American remains one of the great challenges facing the nation. In 1997, President Clinton worked with Congress to create the bipartisan State Children’s Health Insurance Program (SCHIP), the single largest expansion of children’s health insurance. SCHIP is a state partnership that gives states three options for covering uninsured children: designing a new children’s health insurance program; expanding its current Medicaid program; or a combination of both strategies (General Accounting Office, 97). Every State and Territory has responded to the opportunity provided by SCHIP to expand health insurance to low-income children. SCHIP builds upon the Medicaid program, which currently provides health coverage to most very low-income children. Change has also transformed the Medicaid program. Despite these encouraging improvements, millions of children are still eligible for Medicaid and SCHIP but are not enrolled. About 3 million low-income uninsured children are eligible for SCHIP and about 4 million are potentially eligible for Medicaid but are not enrolled. Barriers to enrollment persist, including parents’ lack of knowledge about insurance options, cultural and language barriers, special fears among immigrant families, complicated application an enrollment process and the stigma associated with so-called welfare programs. Most uninsured children can be found in schools and since most parents consider schools a trusted conduit for important information, schools are a critical link in outreach. Children without health insurance are more probable to miss the regular / normal heath care that involves the routine medical checkups. This will give chance to diseases to develop in the body of the child without being noticed. Most of the diseases are efficiently curable when detected early enough and may lead to death at latter stages. The underinsured children are more likely to suffer from such diseases than the insured. If the disease does not kill the child, the entire life of the child will be affected by the disease. An example of such diseases is epilepsy, which can be cured at early age but in later development cannot. When the child gets sick, there is tendency that he will get delayed medical attention. They are also more likely to buy medicines from the shops or chemists for personal medication. The danger with the above two practices is that they may end up using the wrong medicine. These can have a life lasting effect on the life of the child. Some diseases are known to “hind” themselves in the body more so when a medicine is used whether is the right one or not and manifest themselves later in life in a more life threatening way an example of these diseases include Amoeba. There are immunizations that are supposed to be undertaken in various stages in a child’s life. However, the underinsured child is more likely to miss this immunizations they subject themselves to future chances of contracting diseases. The diseases that are mostly immunized include polio, hepatitis B, diabetes, cardiovascular disease, end-stage renal disease, human immunodeficiency virus infection and mental illness. The underinsured often avoid preventative care which can result in poor medical treatment. When they do seek care, their illness frequently has progressed, so the cost is generally higher because the treatment is prolonged or hospitalization is needed. In many instances, appropriate care is not given because certain tests or treatments are avoided due to cost. There are lasting effects on the entire society the affected child becomes unproductive in the future and thus becomes more of a liability to the people (Committee on Health Insurance Status and Institute of Medicine 9). Recent data from CDC’s National Immunization Survey suggest that at least for expensive vaccines such as Vericella, there is a substantial differential in immunization rates between insured and underinsured children. This analysis, however, did not control for confounding variables, such as income and education and, therefore, may be misleading. A recent Partnership for Prevention estimates that 21% of privately insured children aged 0-5 have private insurance that excludes immunization. This suggests that 3.5 million children aged 0-5 are underinsured, 38% of this age group. Some of these underinsured are covered through state universal purchase programs in 14 states. On the other hand, this estimate excludes the children who are covered by insurance for immunizations but face prohibitive copayments and deductibles. The proportion of children and adults without immunization coverage may increase as a result of current trends in insurance benefits and the increasing cost of the recommended vaccines on the immunization schedule. Insurance coverage and patient cost sharing are among the important factors influencing rates of immunization (General Accounting Office 129). The current vaccine financing system is fragmented and prone to funding delays; the result is missed opportunities, institutional barriers to immunization. Public vaccine financing programs have led to some crowd-out of private immunization coverage, and attempts to limit crowd-out have met with mixed success. Increasing vaccine costs, crowd-out of private-sector financing, and federal finding lags place significant stress on state financing mechanisms, prompting limits on state contributions to immunization programs. It is well known that across the globe, millions of children are not being immunized. Although the United States is among the most progressive countries in terms of health care, its immunization statistics are grim. Children who are uninsured or underinsured are, perhaps, the most affected victims. They are also the most vulnerable to a host of illnesses due to malnutrition, poor living conditions and the like. The growth in the number of uninsured children reflects the corresponding decline in the private health insurance coverage of children since 1977, which was due to the difficulty that two-parent, single-worker households had in maintaining their standards of living. Children with two working parents had the highest rate of private coverage (Committee on Health Insurance Status and Institute of Medicine 29). One-third of children in households with employed single parents were covered by public insurance, but this figure has been declining substantially. Despite having much higher rates of private insurance, poor and low-income children in two-parent households are more likely to be without health insurance than poor and low-income children in single-parent households. This is largely due to greater accessibility of Medicaid to children of single parents. Although Medicare and Medicaid provide benefits to a significant number of people, they do not cover all the medical costs for the eligible low-income population. These programs fail to provide coverage for all of the underinsured. While it is true that the unemployed and their children are highly likely to be underinsured, the employed and their children comprise three quarters of the underinsured. Some states and localities are already contracting directly with health maintenance organizations on behalf of specific uninsured group. These public approaches include direct payments to providers for uncompensated care, direct subsidies to individuals to purchase services/coverage; expanded coverage through existing public and private insurance mechanisms; direct offering of government organized groups for health insurance purposes; and government contracts with private entities for services, particularly for managed care systems. Although Medicaid was enacted to finance and improve access to health care for the poor, it has developed into the largest public funder of long-term care for the elderly, and is thus regarded as an inadequate response to the needs of children. The policy is unwise because it is not counting on the immigrant children to join with all other children in contributing to the American dream. They cannot do so if they are hindered in their early years because they could not obtain health care. And it is unwise because it shifts the responsibility for immigrant health care from federal to the state government, rather than maintain a shared federal-state responsibility. The patterns of children’s health insurance coverage among children by race and ethnicity are not uniform. In general, children of color are disproportionately more likely to be uninsured. Most children with employer-based coverage are white; and most white children have employer-based coverage. Among Black children, fewer than 40% have employer-based coverage; close to half have Medicaid coverage, and about one in six have no insurance. More than one in four Hispanic children are uninsured, whereas 35% have private insurance and about 37% have Medicaid coverage. All private health insurance is obtained through the workplace, which leaves many gaps. National survey data show that more than 9 million employed people are uninsured. With their uninsured children, they account for three quarters of those lacking coverage. The uninsured unemployed tend to be young, less educated or self-employed, non-white, unmarried, working in agriculture or service jobs. They tend to use fewer medical services even when they need them, but pay more for what they get than those who are insured. There is growing interest in seeing that such people get insurance, although it is not clear how that might be arranged. When compared with insured children, underinsured children are more likely to be sick as newborns, less likely to be immunized at appropriate ages, less likely to receive medical treatment when they are injured, and less likely to receive treatment for illnesses such as acute or recurrent earaches and asthma. Children’s health insurance status is the single most important influence in determining whether health care is accessible to children when they need it. For uninsured or underinsured children, access to health care is often unaffordable or otherwise out of reach. Unable to pay for needed care, their parents may decide to delay treatment and hope that a medical problem will resolve on its own. Health problems that are minor in their early stages can escalate to serious and costly medical emergencies and delays in access to health care can increase the burden of suffering from disease. This is especially true for children with special needs and chronic diseases. Financial resources are not unlimited and that purchasers and policymakers must set priorities in order to make reasoned and equitable decisions about spending. However, costs of treatment and coverage for children vary according to their health status and can be difficult to determine from the information available in the public domain. There are many areas of disagreement and uncertainty about the specific services to which children should have access. Providers, parents and insurers often have different attitudes and positions about which services are essential and what expenditures and sources of payment are reasonable (General Accounting Office 102). The limited scientific evidence and professional consensus do not clearly indicate which specific diagnostic tests, treatments, procedures, drugs, specialist and other services should be available to children, any more than is the case for adults. There is tremendous variability in the structure and scope of health care benefits for children according to the source and the type of insurance coverage. In the current health care system, employers’ states, parents and others who purchase coverage on behalf of children bear the responsibility for ensuring their purchasing decisions reflect the specific needs of children as much as possible within the existing resources (Institute of Medicine 32). Health insurance alone does not guarantee utilization of appropriate care. Studies have shown that logistical difficulties for parents, such as transportation and child care, differences in the racial, ethnic and cultural backgrounds of providers and parental health beliefs can affect children’s access to care. For children who live in medically underserved urban and rural areas, the availability and proximity of providers can present barriers to access. Even with insurance, it can be difficult to obtain health care. According to American health data website, there are currently 8.1million uninsured children in America. The figure is huge due to ignorance that the guardians and the parent have. Statistics have proved that over 50% of the children are eligible for government insurance policies if only they can apply. It is the parent who holds the responsibility to apply for the policy on behalf of the child. If he or she doesn’t apply the sufferer is the child. Years of experience with Medicaid indicate that there are many reasons why children who are eligible for the program may not be enrolled. For instance, parents or other caretakers may not be aware of the program, may not know they or their children are eligible, or may not want to accept public aid. Other parents have experienced difficulties in trying to enroll in the program, including denials of applications for procedural errors or incomplete information, or because of cultural factors such as the need for translation. States designing and implementing new SCHIP programs have learned from these experiences and are improving their procedures. With the new children’s health insurance programs and other initiatives, more efforts are being made to help parents learn about the different programs and make enrollment easier, including having common application forms and streamlining the application and enrollment process. The elements to consider within the design and administration of health benefit packages for the underinsured include eligibility, financing, the benefit package, cost controls, the use of managed care, quality of care and administration. One of the first initiatives that the government and other civil societies should embark on is massive education campaigns to enlighten those people who are not aware of the available government policies that are cheap and affordable to the common man .They should be educated on the need and advantages of having a health insurance policy (Institute of Medicine 2). It is also important to note that the process of registering in government sponsored programs is long and complicated process that can be simplified. For example, the application forms can be made available in all private and public hospitals and freely distributed. They can be completed by using ones tax returns documents. The issue of parents not knowing about the availability of the programs could also be solved if the government really wanted to appropriate adequate resources to provide health insurance to them. The money is there, its just not always used in the most efficient ways. The availability of public health care for eligible children is something that should be actively advertised. Public schools could send notes home with children. Hospitals could explain the program and help parents enroll newborns before they leave the hospital. The IRS could send information to families with qualifying incomes. If the enrollment process became straightforward and simple, and parents were made aware of the availability of the programs, our country could have 3 million children without health insurance instead of 9 million. Thats a big difference. There are programs that have been put in place to try and teach the common man on the benefits of the policies as well as letting him realize that failing to buy a policy for the child is violation of the child’s legal right. They include; Insure Kid Now, Children Defense Fund, Leave No Child Behind, this is also referred to as Children health insurance program (CHIP) that has the sole goal of supplementing the available and established Medicaid. This policy is made to cover those people whose income is high that they don’t feel well covered by Medicaid. The program was initiated by Robert Wood Johnson Foundation and supported by President Bush, as one of the programs of Leave No Child Behind Campaign. The current regime should follow these footsteps in their mission to enlighten (Rushing 52). The health bill that was passed in February 2010 is seen as a land marking the campaign on the breakthrough for the health of the Americans but politics have taken center stage and covered the intended effect. People have started to term the move as a President Obama campaigning model and this has made the bill to be ineffective so far. Americans should learn how to separate politics from important issues like this. This will give confidence to the people about this policy and other existing policies. The responsibility to ensure that the children are fully insured lie with the entire population in different capacities. Every one of us should play his /her role, however noble it may appear. On the other hand, prevention is better that cure and as far as policies are adopted to ensure that the country has good and affordable health care services/ policies, prevention should always be the first initiative to be embraced by everyone. A country is dependent on its population for continuity, thus the need for a healthy population cannot be overemphasized. When children are insured, it becomes cheap and easy to care for their health problems because the parent does not incur additional costs in treating them. Underinsured children are generally at more risks of contacting diseases than insured children because their health issues are not taken care of. The government should, therefore, implement policies that are aimed at ensuring that all children (be they immigrants or citizens) are insured. One of the first initiatives the government and other civil societies should embark on is massive education campaigns to enlighten those people who are not aware of the available government policies that are cheap and affordable to the common man. The issue of parents not knowing about the availability of the programs could also be solved if the government really wanted to appropriate adequate resources to provide health insurance to them. The money is there, its just not always used in the most efficient ways. The availability of public health care for eligible children is something that should be actively advertised. Works Cited American Medical Association. Caring for the uninsured and underinsured: a compendium from the specialty journals of the American Medical Association. New York: The Association, 1991 Center for Health Economics Research. Access to Health care: Key indicators for policy. Princeton, NJ: Robert Wood Johnson Foundation, 1993. Committee on Health Insurance Status and Institute of Medicine. Americas uninsured crisis: consequences for health and health care. New York: National Academies Press, 2009. General Accounting Office. Health Insurance for Children: private coverage continues to deteriorate. GAO/HEHS-96-129. Washington, D.C., 1996. Institute of Medicine (IOM). Emergency Medical Services for Children. Washington, D. C.: National Academy Press, 1993. Rushing, Elizabeth Susan.(2005).The crisis of uninsured children in America - is lack of health insurance really the problem? New York: s .n. publishers, 2005 Sered, Susan Starr and Fernandopulle, Rushika J. Uninsured in America: life and death in the land of opportunity. California: University of California Press, 2006. U.S. Census Bureau. “Health Insurance Coverage.” U.S. Census Bureau, 2007. Web. 20/4/2011 Read More