Saturday, October 31, 2009

One of the Shames of Being a Texan

The old saw that "everything is bigger in Texas" is sometimes a dumb brag. One area we are the biggest in is the number of uninsured children. One in five children in this state is uninsured. These are not the children of people on the welfare roles as a recent Families USA report shows.

The Families USA report, titled “Left Behind: Texas’s Uninsured Children,” spotlights the following facts about uninsured children in the state:

  • 1.4 million children are uninsured in Texas—more than one of out five, or 20.5 percent of Texas’s children. These numbers place Texas first in the nation for the number of uninsured children, and first nationally for the percentage of children in the state without health insurance.

  • The number of uninsured children in Texas increased by nearly 33,400 between the three-year period 2003-2005 and the three-year period 2005-2007, and is likely to continue to grow due to the financial crisis.

  • Texas’s uninsured children come from working families. In Texas, the vast majority of uninsured children (89.5 percent) come from families where at least one parent works, and nearly three-quarters of uninsured children—or 73.9 percent—live in households where at least one family member works full-time, year-round.

  • Nearly two-thirds of Texas’s uninsured children, or 65.7 percent, come from low-income families (families with incomes below twice the poverty level, or $35,200 for a family of three in 2008) who are likely eligible for Medicaid or CHIP.
The majority of Texas republicans seem to think this situation is fine. Our illustrious governor and jaded legislature have turned down federal matching funds for increasing the expansion of CHIP repeatedly. I once discussed this subject with a top aid to one of our local State Senators when the legislature passed new rules that they knew would discourage parents form enrolling their children in the State CHIP program. He basically said that if the parents weren't willing to jump through these new hoops, like re-registering their children every six months, then they didn't deserve the aid. To which I replied "That logic would stand if the parents were getting the health care benefits but it is their helpless children who will do without the health care that their parents don't sign them up for". This type of thinking leads to further refrains such as those who say that these children will get good care in our emergency rooms. That is true in our pediatric hospitals emergency rooms and in those associated with academic medical centers but those are also the most expensive places to obtain any medical care. What could be dealt with in a $75 dollar office visit instead costs a minimum of $1500-$2000. Parents tend to wait until their children are much sicker before they take them to the E.R. and now a new study has shown that this has dire consequences in children.
"According to the Hopkins researchers, the study, to be published Oct. 30 in the Journal of Public Health, is one of the largest ever to look at the impact of insurance on the number of preventable deaths and the potential for saved lives among sick children in the United States....Using more than 23 million hospital records from 37 states between 1988 and 2005, the Hopkins investigators compared the risk of death in children with insurance and in those without. Other factors being equal, researchers found that uninsured children in the study were 60 percent more likely to die in the hospital than those with insurance. When comparing death rates by underlying disease, the uninsured appeared to have increased risk of dying independent regardless of their medical condition, the study found. The findings only capture deaths during hospitalization and do not reflect deaths after discharge from the hospital, nor do they count children who died without ever being hospitalized, the researchers say, which means the real death toll of non-insurance could be even higher.

"If you are a child without insurance, if you're seriously ill and end up in the hospital, you are 60 percent more likely to die than the sick child in the next room who has insurance," says lead investigator Fizan Abdullah, M.D., Ph.D., pediatric surgeon at Hopkins Children's.

Thus it follows that if 17,000 children die needless deaths a year because of lack of insurance then Texas has the greatest number of such deaths per capita in the United States. That is a number Texan's should be ashamed of.

Thursday, October 15, 2009

The House That Private Insurance Built

From The Washington Post's Ezra Klein
Following the old adage to never stop digging when you've created such a nice hole for yourself, AHIP is now touting a report (pdf) released by one of its member insurers: the Blue Cross Blue Shield Association. Like AHIP's report, Blue Cross Blue Shield finds that premiums will shoot into the sky with health-care reform. Like AHIP's report, Blue Cross Blue Shield leaves out little things like the insurance exchanges, the excise tax, the delivery system reforms and pretty much everything else in the bill. Like AHIP's report, Blue Cross Blue Shield argues for a stronger individual mandate, which makes policy sense, even if the conclusion is presented dishonestly. Like AHIP's report, Blue Cross Blue Shield does not present any options for funding a stronger mandate.

But what's interesting about the BCBS report is how clearly it shows that insurers have gotten themselves into this mess. Essentially, they've spent so long pricing the sick and the old out of the individual market that they don't really know what to do when they're allowed back in. Consider this paragraph from the analysis:

Insurance reforms alone will substantially increase claims costs in the individual market. The individual market “risk pool” will be less healthy than today and will drive higher insurance premiums. We estimate the average medical claims for the uninsured are 20 percent higher than claims in the current individual market. In addition, certain segments with high medical utilization who are now insured through other arrangements will enter the individual market as a result of guaranteed issue and modified community rating requirements. This includes people enrolled in state high-risk pools, people on COBRA through their former employers’ coverage, and other group conversion policies.

Or this one:

In most parts of the country today, insurers in the individual market are permitted to underwrite and design benefit plans with a variety of price points. This flexibility enables a stable, competitive insurance market. Perhaps most importantly, it offers the greatest affordability to attract younger and healthier members and helps encourage wider enrollment in health insurance.

This is the house they've built: an insurance market where plans are written for the healthy and all legal efforts are made to exclude the sick. That's meant premiums are somewhat lower than they'd otherwise be, but only because the people who most need health-care insurance aren't able to afford it, or in some cases, aren't able to convince anyone to sell it to them. Now that arrangement is ending and they're scared that they can't provide an affordable product to the people who need it. They may be right, but it's evidence of how deeply perverse their business has become, not of what's wrong with health-care reform. When they say that the individual market would be cheaper in the absence of health-care reform, they're saying the individual market would be cheaper if they could continue refusing to sell affordable insurance to people who need health-care coverage.

This isn't an argument against health-care reform. This is proof of its necessity.