Covering The Uninsured In 2008: Current Costs, Sources Of Payment, And Incremental Costs

Abstract

People uninsured for any part of 2008 spend about $30 billion out of pocket and receive approximately $56 billion in uncompensated care while uninsured. Government programs finance about 75 percent of uncompensated care. If all uninsured people were fully covered, their medical spending would increase by $122.6 billion. The increase represents 5 percent of current national health spending and 0.8 percent of gross domestic product. However, it is neither the cost of a specific plan nor necessarily the same as the government's costs, which could be higher, depending on plans' financing structures and the extent of crowd-out. [Health Affairs 27, no. 5 (2008): w399-w415 (published online 25 August 2008; 10.1377/hlthaff.27.5.w399)] E x pan d i n g h e a lt h i n s u r an c e c ov e r age is a major issue in the 2008 presidential campaign. This study addresses three sets of questions that are critical to the policy debate. First, how much care do the uninsured receive? Second, how much of their care is "uncompensated," and who pays for that care? Third, if the uninsured were covered, what would be the cost of the additional medical care they would use? The first two questions set the baseline for the policy debate and identify payment sources that might be tapped to help fund expanded insurance coverage. The third question focuses on the additional resource cost to society. Importantly, this cost is not the cost of a specific plan to expand coverage, nor is it a measure of the cost to government.n Study data and methods. Following earlier studies, we used two distinct and independent methodologies to develop estimates of the uninsured's current medical U n i n s u r e d I n 2 0 0 8

Unauthorized Immigrants Prolong the Life of Medicare’s Trust Fund

“…[42][43][44] A few provide fully state-funded Medicaid benefits to unauthorized elderly immigrants. While our analysis is limited to the impact on the HITF trust fund, it is important to mention that unauthorized immigrants incur an estimated $5.5 billion in non-Medicare publicly funded health care expenses annually (author's analysis based on available data 5,11,45 ), mostly funded at the state and local level. However, immigrants also contribute substantially to state and local taxes; in addition to non-FICA state payroll taxes they pay property (they pay rent) and sales taxes; some estimates place the contributions of unauthorized immigrants to state and local taxes at over $10 billion.…”

The healthcare system in Saudi Arabia: How can we best move forward with funding to protect equitable and accessible care for all?

“…There is also evidence from the USA that this system is still associated with increasingly greater costs. [50] In fact, during the 1990s and early 2000s, the costs of healthcare to the USA government were much higher than for the Canadian government, in spite of all healthcare being provided publicly in Canada. [51] It could be argued that this represents better healthcare being available in the USA, but the World Health Organization (WHO) rankings would seem to disprove this, with Canada ranked 7 places above the USA.…”

“…[52] The main explanation may be due to the high proportion of the population which are not insured, for whom the government must pick up the costs. [50] This is also added to shifts in the population distribution which have increased costs of social insurance schemes, for example with an ageing population leading to Medicare spending increasing consistently. [53] In fact, there are moves in progress to address this, with the introduction of Obamacare, which seeks to improve the current system.…”

“…[57] There is also the benefit that people are forced to pay into the system, unlike in the USA, which should lead to less people being left without coverage, which is a source of much government spending at present. [50] PPPs can possibly lead to inequalities and poor levels of care for some segments of the population. [55] Conflicts of interest can also see huge profits generated for investors, with individuals or the government ultimately bearing the costs, as seen in examples such as PFIs in England.…”

Regulator Leniency and Mispricing in Beneficent Nonprofits

“…Teaching hospitals, for instance, are required to have state-of-the-art technology, research facilities, and specialized services, which add to the already substantial cost of maintaining a residency program (Cooper, 2007). In a similar manner, for many nonprofit hospitals, state and federal subsidies to cover the cost of providing care for the uninsured typically only cover part of a hospital's cost (Hadley et al, 2008). In cognizance of this, regulators attempt to provide additional support by exercising the latitude provided to them in the interpretation of regulation.…”