Outlook 2006: Uninsured Americans Increase, as Congress Struggles with Budget and Cuts in Health Funding

by Carolynn Race

As the first session of the 109th Congress draws to a close, it is somewhat uncertain how Congress will act on health care policy in the second session. In late December, Congress came one step closer to passing a conference report on its budget reconciliation spending reduction packages (HR 4241/S 1932), which would reduce federal spending for mandatory programs, including Medicaid and Medicare, by as much as $40 billion over five years. When the House of Representatives reconvenes on January 31st, an extremely close vote is expected on the spending cut package.

What is clear is that health care and the issue of the uninsured are of paramount importance. As the most recent U.S. Census Bureau data highlights, 45.8 million people were uninsured in 2004, an increase of 800,000 people since 2003. The uninsured rate remained constant at 15.7 percent, with the uninsured rate for children at 11.2 percent.

As the Kaiser Family Foundation noted, the number of uninsured under age 65 increased by nearly six million between 2000 and 2004, primarily due to a decline in employer-sponsored insurance. As employer-sponsored coverage continues to decline and health care costs remain high, how will individuals and families be covered in the coming years?

If this year's budget battles over entitlement spending are any indication, Congress will continue to grapple with how to fund health care programs - including Medicaid, Medicare, and the Children's Health Insurance Program - in the years to come. As Christopher Lee noted in The Washington Post, U.S. Census Bureau figures released this month highlight the federal budget situation: the federal government spent $2.2 trillion in 2004, an increase of 5 percent from 2003. Nearly half of the 2004 spending - more than $1 trillion - was on Social Security, Medicare and Medicaid, popular entitlement programs whose costs are growing each year. If employer-sponsored health care continues to decline and if Congress works to decrease spending on Medicaid and Medicare, while health care costs continue to rise (between 2001 and 2004, the cost of medical care increased by almost 14 percent), we will face increasingly grave consequences of a nation that is uninsured and underinsured.

Why are we not seeing significant action on Capitol Hill to address the issue of health care for all? One way of encouraging Congress to take action on this issue is to speak out - to your congregation, your family, your friends, and elected officials about the need for all to have the opportunity to have life - and have it abundantly.

Below please find helpful ways to get involved by sharing your health care access stories and concerns with others - including elected officials:

The Citizens Health Care Working Group was created by Congress in 2003. It is mandated with engaging the public in a nationwide discussion of options for reforming America's health care system. To carry out that mission, individuals are encouraged to fill out an online survey and participate in a series of community meetings scheduled over the next several months in localities across the nation.

Our Healthcare Future, a new innovative initiative sponsoring dialogues on health care, was developed by representatives from the St. Joseph Health System, NETWORK: A National Catholic Social Justice Lobby, and faculty from Georgetown University. Their initiative offers an opportunity for individuals from a variety of backgrounds to participate in a grassroots effort to transform health care. They note: "Dialogue helps create conditions for change. It builds community, uncovers common ground, and offers hope for the future." Materials are available at the Website listed above to engage in small group discussions in your congregations that will lead to potentially transformative and values-driven dialogues about what a health care system should be in our society.

The National Coalition on Health Care, is composed of almost 100 organizations, including the Presbyterian Church (U.S.A.), employing or representing about 150 million Americans. Members are united in the belief that we need - and can achieve - better, more affordable health care for all. The Coalition developed specifications for health care reform.

The Universal Health Care Action Network has developed a resource for health care advocates in faith communities - "Seeking Justice in Health Care: A Guide for Advocates in Faith Communities." Information about ordering the resource is available.

In the coming session of Congress, we can also expect action on the following issues:

Medicare Part D Prescription Drug Coverage. On January 1, 2006, Medicare began a voluntary prescription drug benefit, authorized by Congress in 2003. As the program gets underway, expect Members of Congress to offer legislation to make adjustments to the program. Members have been watching to see how beneficiaries are impacted by the program, including dual eligibles (those eligible for both Medicaid and Medicare), how states fare, and the cost of the program.

Medicaid. Last year, President Bush proposed reducing Medicaid spending by $60 billion over 10 years. The spending reduction plan expected to be voted on in the House of Representatives on February 1 would reduce Medicaid spending by $4.3 billion over five years. Expect more action on Medicaid through the Congressional budget process. In addition, much action is occurring at the state level through the 1115 waiver process. As Kaiser Family Foundation notes, "Section 1115 waivers give states federal approval to alter the way they provide coverage and/or deliver services to the low-income population outside of the federal standards and options and still receive federal matching funds. That is, they allow states to use federal Medicaid funds in ways not otherwise allowed under federal law. States have used waivers to test and try a variety of changes affecting program coverage and costs throughout the 40-year history of the Medicaid program."

Mental Health Parity. HR 1402, a proposal to broaden mental health parity protections, was introduced in March by Rep. Patrick Kennedy (D-RI). The bill was referred to the House Energy and Commerce Committee, but not acted on.

HIV/AIDS. On the domestic front, Congress has yet to reauthorize the Ryan White Comprehensive AIDS Resource Emergency (CARE) Act. The CARE Act funds programs that have worked with municipalities and community-based organizations to provide services to more than 500,000 HIV-positive individuals who do not have sufficient health care coverage or financial resources to treat their HIV disease. Advocates hope for action on reauthorization in 2006. On the international front, in 2005, Congress appropriated $2.8 billion for programs to prevent, treat, and control global HIV/AIDS, along with tuberculosis and malaria. Of the total, $450 million went for the Global Fund to Fight AIDS, Tuberculosis and Malaria. As the world continues to grapple with the HIV/AIDS pandemic - with an estimated 40.3 million people living with HIV/AIDS worldwide - advocates will continue to push for more action and funding to curb the spread of HIV/AIDS, to provide treatment for people living with HIV/AIDS, and to work towards a cure.

Avian Flu. A new issue that Congress is addressing is preparation for the avian flu. In the Department of Defense Appropriations bill, $3.8 billion was provided for an avian flue preparedness plan, the majority of which would go to a public health and social services emergency fund to improve pandemic preparedness.

Embryonic stem cell research. Last May, the House voted to pass HR 810, a bill to expand federal funding for embryonic stem cell research. The Senate has yet to take action on a companion bill, S 471. However, Senator Arlen Specter (R-PA), the sponsor of S 471, announced last fall that he had reached an agreement with Senate Majority Leader Bill Frist (R-TN) to hold a vote in early 2006.

The Citizens Health Care Working Group has a wealth of information about health care in America, and proposes to send Congress and the President a citizens' roadmap about how to make health care work for all Americans. The Working Group will hold community meetings throughout the United States beginning in December 2005, reflecting geographic differences, diverse populations, and a balance among urban and rural groups on key topics. (See their section on Community Meetings.)