Washington State Planning Grant (SPG) on Access to Health Insurance

HRSA State Planning Grant

2001 Washington Health Legislative Conference

Coverage Matters
The Uninsured Live Sicker, Die Earlier

SPG Accountable to Federal Government for:

  • Profile of Washington's uninsured
  • Options/strategies for improving access to affordable coverage and adequate benefits
    Report Due March 2002
  • SPG + Communities: any single effort may represent small steps for small feet but collectively and eventually the efforts of many will turn into the giant leap needed for all

Washington SPG research work includes:

  • Profiles -- Detailed profiles of the uninsured population are being matched to detailed profiles of the current coverage and care pathways, including rigorous analysis of the gaps, overlaps and barriers.
  • Strategies -- Analysis of the strengths and weaknesses of a universe of potential coverage and access options is being cross-walked to a similar analysis of strategies historically tried or in place in Washington (including, where appropriate and achievable, quantifiable impacts of strategies on specific uninsured and at-risk populations).
  • Linkages -- Detailed assessment is being conducted of the links between identified gaps, overlaps, and barriers to coverage and care (in specific populations and circumstances) and the analysis of improvement strategies.
  • Individual Affordability -- Significant energy is being devoted to understanding what individuals can afford to pay for coverage and care, compared to the reality of what's available to them. We consider this a "lynchpin" issue for crafting future coverage and access strategies.
  • System Affordability -- Significant effort is also focused on administrative simplification strategies and partnerships, including options for reducing the currently complex array of insurance products (while still maintaining choice and variety). Creating a more affordable system via strategies that avoid unnecessary costs, reduce provider administrative burden, and set the stage for effective consumer-driven buying is directly relevant to improving access.
  • Community Partnerships -- Building partnerships with community-based efforts and organizations addressing related issues is also a focus of our work. Mutual understanding of the issues faced, the solutions contemplated, and the flexibilities and accountabilities needed on all sides are part of this work.

Status: Deep into the data collection, analysis, and foundation-building phase of the work.

Greatest challenges at this time:

  • Time: Not enough of it (requesting time extension beyond initial one year award)
  • Relevance: Think to future without losing relevance to today
  • Money: It is about money, priorities, and trade-offs. Or is it?
    WHY THE FOCUS ON INSURANCE COVERAGE? COMPARED TO THE INSURED...

The uninsured have reduced access to health care (process measure)

  • Less likely to have regular source of care
  • Less likely to have had recent physician visit
  • Less likely to use preventive services
  • Less likely to receive follow-up care after hospital discharge
  • More likely to delay seeking care
  • More likely to report they have not received needed care
  • More likely to use pharmacist than physician for medical triage
  • The uninsured have poorer medical outcomes & lower quality of life (outcome measure)
    Higher mortality in general and higher in-hospital mortality in particular (e.g., up to 3X more likely to die in-hospital)
  • More likely to experience adverse health outcomes, e.g., more likely to be diagnosed with cancer at a late stage with lower survival rates (colon, melanoma, breast, prostate)
  • Women w/ breast cancer: 49% higher adjusted risk of death
    Pregnant women: 31% higher likelihood of adverse hospital outcome
    Chronic back pain: Much less likely (2.7X) to get back to work quickly
    More likely to require emergency hospital care and have avoidable hospitalizations, e.g., diabetes, hypertension, pneumonia, bleeding ulcers, asthma
    Less likely to undergo certain high cost or discretionary procedures, e.g. coronary bypass surgery, total hip replacement
  • Women: more likely to be at higher risk of cardiovascular disease

MYTHS ABOUT THE UNINSURED ARE WORTH SHATTERING

  • Myth - most uninsured are not working
  • Truth - majority of uninsured are workers or their dependents
  • Myth - young adults are uninsured by choice (young and immortal)
  • Truth - when offered coverage, young adults are only slightly less likely than older workers to participate; 7 of 10 young adults regard health insurance as a very important factor when choosing a job
  • Myth - getting children covered is sufficient for their obtaining care
  • Truth - parents coverage is important to kids getting care – kids whose parents are not covered are less likely to get the care they need – affects whether kids receive care at all and how much care
  • Myth - uninsured get the care they need
  • Truth - see above - Uninsured Live Sicker, Die Earlier