A quarter of all Americans faced health coverage gaps last year

Take a look around you and pick out four adults. One of them did not have health insurance coverage for all or part of 2011, according to a new report by The Commonwealth Fund. Twenty six percent of adults age 19-64 experienced some type of coverage gap last year, usually due to job change or loss, and the gap often lasted a year or more.

That means they were less likely to get preventive care, have a regular doctor or stay up to date with recommended screenings– and the longer they went without insurance the higher this likelihood became. Chances are, someone you know had to make a choice between paying the mortgage or going to the doctor; feeding the family or getting the expensive prescription refilled. In 2014, some new provisions of the Affordable Care Act will kick in, making this scenario much less probable; insurance exchanges, free or low cost plans, expansion of coverage through Medicaid, and government subsidies will help millions more to obtain health insurance – and keep it, regardless of employment status.

It seems almost criminal that people should have to choose between paying the heating bill and paying the doctor bill. How do we as a nation rationalize this?

There are people on one side of this debate (and why is this even a debate?) that say the Affordable Care Act is too expensive, and that it should be up to the private sector to regulate coverage. They view health care much as they view a doorknob, or car, or any other commodity. Wait a minute – Isn’t this the same private sector that likes to drop people that get serious illnesses like breast cancer, right in the middle of treatment? Or raise rates so high that coverage becomes a pipe dream? Or refuse to cover obvious life-saving treatment because an actuary said the cost-benefit ratio was off?

Health care isn’t a commodity; not if you actually need to use it. Because unlike the doorknob from Home Depot, there is no a fixed production cost. It all depends on who, what, and why. Prices and fees change based on variables like how well a patient responds on a certain drug, or sticks to his wellness plan, or how quickly she recuperates after surgery. Does Mr. Brown need more physical therapy? Will another statin work better, with fewer side effects on Mrs. Riley? Or, will what worked for Ms. Jones also work identically for Ms. Smith? Not likely. That’s a lot different than choosing the Ford or the Chevy.

I wonder if anyone who is so determined to repeal ACA has ever had to pay COBRA premiums to ensure continuity of coverage between jobs? I have, as have many others I know. It’s a budget buster I hope I never experience again.

The “private sector” argument conveniently ignores exactly what this Commonwealth Fund report confirms: no insurance means no preventive care, delays in screenings and non-compliance with medication regimens. As a result treatment – if it happens – occurs later, costing more per person; when the situation is more dire, or even life threatening. For example, compare survival rate, options and costs for a simple PSA test and timely treatment for stage one or two prostate cancer (see Warren Buffett, Ryan O’Neal ) compared with no preventive screening, no early detection and treatment, more expensive and extensive care for a later-stage disease – not to mention higher risk of death.

Warren Buffett will never have to be concerned about gaps in his insurance coverage, or being able to pay for potentially life-saving preventive screenings, or getting the right kind of medical care in a facility of his choosing. Neither will members of Congress. Yet, it’s this very faction in Congress, and their supporters, that cry “foul” whenever there’s an attempt to level the playing field. I don’t understand how or why there is opposition to everyone having access to good affordable care, and to insurance coverage that won’t disappear if they lose their job or get sick. Isn’t that what insurance is for?

One-quarter of all Americans. Shame on us.

Health costs jump again – is it 2014 yet?

It got big play in the media today but a new Kaiser Family Foundation survey on the rising cost of health insurance is not breaking news to many Americans, including many of my friends and colleagues that are in untenable positions. NBC led their news tonight with a report on Kaiser’s study, it’s featured prominently in.The New York Times and other major media.

Premiums for employer sponsored health coverage jumped 9 percent in the past year, three times more than in 2010 — squeezing both employers and employees and some really hard decisions.

The Kaiser survey found that family plan premiums jumped 9 percent, hitting $15,073 on average, while coverage for single employees grew 8 percent to $5,429, according to a survey just released by the Kaiser Family Foundation and the Health Research & Educational Trust.

Workers paid an average of $921 toward the premium of single coverage and $4,129 for family plans.

The new health care law has made an impact; 9 percent is a far cry from the outrageous increases I previously wrote about before many of the law’s provisions kicked in. However, any increase in this wounded economy hurts. Employees are being asked to contribute more, yet salaries remain flat. Businesses, especially small businesses, have shifted more costs on to workers and many are seriously considering dropping health benefits all together.

Many analysts say the health law’s regulations that are already in effect — including allowing parents to keep children on their plan until age 26 and banning insurance carriers from dropping sick patients, did not have much impact on this year’s premium increases. However, to employees that are working more hours for the same or less money, and for businesses that are doing all they can to survive, it is yet another economic hit that again illustrates the real need to control health costs before care is out of the reach of anyone except the wealthy.

It’s a story of simple math and one that I would hope will garner more media coverage. If people cannot afford or lose their health insurance, they will not get preventive care or effectively manage chronic diseases. That means waiting until they are really sick and ending up in an emergency department or free clinic — ultimately costing more to treat.

And who pays for this? It’s no secret that these costs get passed back to those with insurance or those that can afford to pay out-of-pocket. Another chunk gets deducted by hospitals through tax credits. So we all wind up paying.

That is why 2014 can’t get here soon enough. I realize that many people are not happy with the insurance mandate. However unless everyone has coverage and we all share the risk, fewer businesses and employees will bear the costs of rising premiums. The gap between those that can afford care and those that can’t will continue to widen. Tax credits for the middle class and small businesses, affordable premiums through health insurance exchanges, and increased access to care will help to make sure that most Americans have some sort of health care coverage.

Politicians that talk about class warfare have yet to acknowledge that battle is already happening; it’s between the haves and have-nots. This is an angle that cries out for more media attention.