A Shared Destiny Community Effects of Uninsurance (2003) / Chapter Skim
Currently Skimming:
4 Economic and Social Implications of Uninsurance Within Communities
4 Economic and Social Implications of Uninsurance Within Communities
Pages 120-137
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 120... ...
The impact of uninsurance on the social and economic "glue" that binds a community together is difficult to assess because a community's social and economic resources are as likely to affect uninsured rates as the converse. In addition, the hypothesized relationships between the local uninsured rate and community resources may feed back on themselves in a cycle that amplifies their adverse impacts.
|
From page 121... ...
the loss of fiscal stability by health care institutions, due to high uncompensated care burdens, that may lead to the loss of this major component of the local economy. The fourth section explores new ways to think about potential effects of uninsurance on a community's social bonds and its social institutions in the context of the recent research literature on income inequality, social capital, and health.
|
From page 122... ...
· The first recession of the new century has already erased the gains in private coverage made in recent years. Current estimates released by the Census Bureau indicate that between 2000 and 2001, an additional 1.4 million persons became uninsured, raising the national uninsured rate for persons under age 65 from 15.8 percent to 16.5 percent, or a total of 41 million uninsured persons (Mills, 2002~.
|
From page 123... ...
Public support for health care services for uninsured persons places demands on state and local governmental budgets. Although the discussion in the previous section assumes that the increasing cost of health care and coverage will be met by increased spending, this is not always the case.
|
From page 125... ...
Given the range of strategies employed to finance uncompensated care and safety-net arrangements from community to community there is no generalized, simple relationship between a community's uninsured rate and its tax burden. An increase in uninsurance would be expected to be met by pressures to increase taxes and reallocate public funds (to the extent that legal structures of taxation and spending allow)
|
From page 126... ...
Medicaid program spending often takes priority over state health programs of direct services, including services for uninsured residents, in state budget allocation decisions because of its structure as an individual entitlement and the federal financial match for program expenditures by the state. Medicaid's federal match is designed to provide relatively greater federal support to those states with lower average personal incomes.
|
From page 127... ...
States with low per capita income or depressed economies, characteristics that are positively related to uninsured rates, have even more constraints on financing health care for uninsured residents than do more prosperous states. The entitlement nature of most state government support for health financing means that these programs tend to absorb whatever revenues may be available (Hovey, 1991~.
|
From page 128... ...
States including Arizona, New Jersey, and New York have devoted significant proportions of their tobacco settlement revenues to health care—either to their Medicaid programs, to support for safety net providers, or to expand public coverage (Bovjberg and Ullman, 2002; Dixon and Cox, 2002~. For example, New York has financed expanded coverage through its broad-based Health Care Reform Act of 2000 with a combination of tobacco settlement dollars and an increase in the cigarette tax; the programs intended to provide coverage are estimated to cost about $500 million over three and a half years (Coughlin and Lutzky, 2002~.
|
From page 129... ...
· In the spring of 2001, Cincinnati's safety net arrangements were reported to be under increasing strain due to a growing number of uninsured persons (Cincinnati Business Courier, 2001~. The city of Cincinnati had budgeted $13.4 million for health clinics, but one of the safety net providers in the city, the Cincinnati Health Network, citing empty financial reserves, was going to the city for another $300,000 to keep from having to turn away new uninsured patients.
|
From page 130... ...
How Uninsurance May Affect Communities' Economies A community's uninsured rate reflects the availability of employment-based insurance coverage for individuals and their families and of public insurance programs such as Medicaid and SCHIP, the viability of the market for individual nongroup insurance policies, and the costs of health care and insurance premiums in the local market. Changes in any of these factors may affect a community's uninsured rate, and the concentration or clustering of uninsured persons in a community may in turn affect its social and economic foundations.
|
From page 131... ...
Health Care and Uninsurance in Rural Economies The economic effects of uninsurance on the viability of health care providers and institutions are easier to measure in rural than in urban areas because the scale and complexity of rural economies is less than those of urban economies. Rural residents on average are older and have lower incomes than do urban residents; consequently public financing, particularly through Medicare and Medicaid payments, is particularly important for the rural health services infrastructure (Cordes, 1998; Mueller et al., 1999~.
|
From page 132... ...
For example, in Appalachia County, Kentucky, conversion of the local hospital into a clinic brought new funds into the community, as well as jobs and a new public insurance-based program intended to provide coverage to uninsured persons (Ziller and Leighton, 2000~. The county's high uninsured rate was one of many interrelated factors that made continued operation of the hospital impractical.
|
From page 133... ...
. The lack of insurance coverage represents a breach of that contract that, when experienced by large numbers of individuals in a community, may erode the social bonds that define and nurture functioning, healthy communities, as uninsured persons are made aware of their lesser claim on services and resources that are generally valued as essential to a dignified and secure life (Walzer, 1983; Miller, 1997; Faden and Powers, 1999~.
|
From page 134... ...
propose four overlapping aspects of social capital: collective efficacy, a psychological sense of community, neighborhood cohesion, and community competence. For example, in a community with many uninsured persons or with a high uninsured rate, residents may experience a weakening of their beliefs or confidence in their ability to effectively take care ofthemselves or their community (collective efficacy)
|
From page 135... ...
The relative income inequality hypothesis posits that the range and steepness of the socioeconomic gradient among residents in a community can affect the health of all members of the community, not only those at risk for poor health due to poverty or other barriers to receipt of appropriate health care (Wilkinson, 1997~. Three pathways have been proposed as ways that income inequality may adversely affect the health status of all community members, through · the disparity or relative deprivation created between the interests of lowerincome and higher-income persons (expressed in lower tax rates and levels of public spending on education and health services)
|
From page 136... ...
How does that burden compare to the tax burden that would be imposed if public insurance programs or subsidized coverage were expanded to reduce uninsured rates? How does the impact of public financing of health care vary across economic cycles?
|
From page 137... ...
A systematic analysis of the incidence of the federal, state, and local tax burdens for financing health care generally and for low-income and uninsured Americans in particular should be undertaken as part of any impact analysis of health care financing reform initiatives. 4.3 Uninsurance Effects on the Local Economy Does the adverse financial impact of uninsurance on local health services and institutions extend to the local economy overall?
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.