Affordable Health Insurance for All

by KAREN DAVIS & CHRISTINE HARAN

Over the last year, lawmakers of both parties have embraced the importance of improving access to health care. Not only is health insurance emerging as a major issue in the 2008 presidential campaign, but state governors and legislatures are also pointing the way toward reform with innovative programs for their residents. In addition, business, labor, and consumer coalitions have endorsed moving forward on coverage for the uninsured. Together, these developments suggest the time is ripe for the discussion of practical approaches to providing high-quality, affordable health care coverage to all Americans.

A Growing Problem
The renewed attention to health coverage reflects the growing urgency of the situation. There are currently nearly forty-seven million uninsured Americans—an increase of seven million since 2000.2 An estimated sixteen million more adults are considered “underinsured” because they have high out-of-pocket health care costs relative to their income. Where someone lives, as well as their income, is very likely to affect his or her insurance status. For example, the rates of uninsured non-elderly adults vary from eleven percent in Minnesota to thirty percent in Texas; two-thirds of all low-income adults ages nineteen to sixty-four lack  insurance or are underinsured.

Yet, the inability to afford health insurance affects both lower-income and middle-income households. Both groups have been affected by marked declines in employer coverage. For example, the percentage of non-elderly adults at 400% of the federal poverty level that spend at least ten percent of their disposable income on family out-of-pocket medical costs and premiums rose from seven percent in 1996 to ten percent in 2003.

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