Healthcare in America - Finally did my Homework

I am currently taking Dr. Ezekiel Emanuel of the University of Pennsylvania's course, Health Policy and the Affordable Care Act at coursera.org.

It's a pretty simple and well put together course (from Week 1, at least!) and most importantly - promotes independent learning through readings he provides with enough structure to spur critical thinking on these subjects. Once again, I wonder to myself, what I missed by not going to college in the United States. 

The following is my  response to his questions for the Week 1 homework assignment. I must say, what an excellent way to get you to think and use the data from this weeks readings. I never realized how much you can learn by just asking the right questions. Go Socratic Method!! 

I really want to write a post on the SCOTUS ruling and my analysis of it, as well as a post about a Bharka Dutt 'We the People' debate on the proposed Exit Bond for J1 Visa seekers to the US, but I'm too tired! And hungry. Blah Blah. 

In other news, I established today that I am an unabashed geek. I doubt that any of you had any doubt about that, but I fight it at times. Today, I embrace it. *Solemn look of resolve*

I love this class and my non-job profession even though it's causing me to age pre-maturely and be chronically single etc.

Here's the assignment. 

Describe the typical uninsured American in terms of age, employment status, socioeconomic status, race, health status, and duration of uninsurance. Public discourse often represents health care reform as being about giving access to the poor. Is this accurate? 

The typical uninsured American is a nonelderly adult. About 80% of the uninsured are adults, while only 19-20% are children. While the uninsured are distributed across all age groups, the largest group of uninsured Americans (32%) are young adults between the ages of 19-29. Many young adults are from families with at least one working person. However, because of low salaries, access to insurance is limited. Adults in the age group of 35-54 also make up an equally significant part of the uninsured (33% - Fig 4). Importantly, the typical uninsured American is of working age.

The typical uninsured American is part of a working family and has no education beyond high school. Specifically, although 77% of uninsured Americans belong to a working family (with 66% having a full time worker and 16%, a part time worker), 63 of 100 uninsured have no education beyond high school. This is significant because with rising costs of employee sponsored insurance ($13,770/year with workers now paying upto 30% of premiums), employers cover only 57% of their workers. Therefore, it is becoming essential that people are not only employed, but also competitive; with a higher degree of education.

The typical uninsured American is comes from a low to middle income family. This means that 9 out 10 uninsured persons have a family income of less than 400% of the federal poverty line. In fact, 40% of the uninsured are below poverty line and an additional 38% are between 100-250% of the poverty line. Further, 36% of those below FPL are uninsured, compared with 27% of 100-250% FPL, 13% of 250-399% FPL and 5% of those 400+ FPL. This is a clear indicator of the correlation between lower income and uninsurance levels.

The typical uninsured American is a minority race - meaning, a non-white American. Non-Hispanic White Americans, while the racial majority, have a 14% uninsured rate. Compare this to an uninsurance rate of 34% in Hispanics, 28% in American Indians, 23% in Black Americans and 18% in Asians. (Only 12% of multiracials are uninsured). This may be confounded by the fact that racial minorities have also have a lower income rate than white Americans.

The typical uninsured American has been without insurance for more than 1 year and is in worse health than the privately insured American. About half of the uninsured non-elderly have a chronic health problem and two times as many uninsured report being in poor-fair health as compared to the privately insured. Further, most uninsured persons (51%) have been without insurance for 3 years or more. The majority (72%) have had no insurance for over a year. Interestingly, in a 2009 study, 17% of the uninsured have had no insurance for less than 6 months.

Higher rates of uninsurance are related to lower income levels. Further, though 40% of the uninsured are below the poverty line, the remaining 60% of the uninsured remain above the poverty line and 77% of the uninsured belong to a working family.

 Health care reform is not solely about giving access to the poor, regardless of the tenor of public discourse. In fact, the higher rates of uninsurance amongst the poor are a symptom of larger problems in our health care industry and economy, namely, increasing costs, unfair insurance regulations and a weaker economy.