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National Information Center on Health Services Research and Health Care Technology (NICHSR)

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Introduction to Health Services Research : A Self-Study Course

Module 2: Brief History of Health Services Research (Page 35 of 40)

Today's Major Health Services Issues

Access to Health Care

The problem of the uninsured continues to elude federal policymakers. In spite of interim remedies like Children's Health Insurance, the rising number of Americans who must resort to emergency rooms or forego care altogether presents a major policy dilemma for Congress, the executive branch, states and localities.

The Uninsured

The U.S. Census Bureau indicates the nation’s official poverty rate rose from 12.1 percent in 2002 to 12.5 percent in 2003. The number of people with health insurance increased by 1.0 million to 243.3 million between 2002 and 2003. The percentage of the nation’s population without coverage grew from 15.2 percent in 2002 to 15.6 percent in 2003.

In 2005 the Bureau report titled, Income, Poverty, and Health Insurance Coverage in the United States: 2005, reported that the number of uninsured in the United States reached 46.6 million people up from 45.3 million people in 2004 (Income, 2006). Approximately one out of every six members of the U.S. population lacks health insurance at one time or another over a year.

Although some pieces of legislation on this issue have been introduced in recent Congressional sessions, formidable political obstacles remain which are likely to block any substantial legislative progress. However, past legislation of this scope has always required multi-year efforts, and this issue is likely to remain on the minds of federal policymakers for some time to come.

Cost Cutting in Managed Care

In the managed care arena, there have been a plethora of media reports on cost cutting over patients' needs; limiting access to services and specialists; and managed care entities benefiting from legislative loopholes allowing legal impunity.

Public opinion strongly favored HMO reform. Four states, California, Georgia, Texas, and Washington passed legislation allowing people to sue their HMO; however, in 2004 the Supreme Court ruled that the federal Employee Retirement Income Security Act of 1974 preempts state laws that allow patients to file such lawsuits because the decision is subject to ERISA Kaiser Daily Health Policy Report, 6/24/2004).

Universal Coverage? Not Yet!

State legislatures are examining affordable ways to cover the uninsured. So far, only Hawaii has passed legislation that comes close to providing universal health coverage for its resident population. California and New York passed legislation in 1999 that moved towards universal health care.

Universal health care coverage is still a dream although a few states have passed legislation to give residents single-payer coverage. Witness how Clinton's plan failed.

Children's Health Insurance Program (CHIP)."

About 1.3 million children from low-income families are getting healthcare benefits under CHIP.

When the program was established in 1997 as part of the Balanced Budget Act of 1997, an estimated 15% of all kids 18 and under were uninsured.

This program "enabled States to initiate and expand health insurance coverage for uninsured children. The funds cover the cost of insurance, as well as outreach services to get children enrolled and reasonable costs for administration." According to HHS, states anticipate providing health insurance to more than 2.6 million currently uninsured children by September 2000.

View Key Projects and Milestones in Health Services Research.

Discussion Questions

  1. Why has the number of uninsured grown over the past few years? Discuss.
  2. How can you tell if the Children's Health Insurance Program (CHIP) is making a difference in children's access to health care? Why do you suppose it was/is important to provide free or low cost health care to children?
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Q57 | Q58
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