Four years ago, after the newly elected President George W. Bush’s inaugural address, 40 million people were without health care coverage in our nation. At that time, the Catholic Health Association of the United States called for a series of reforms and a sharing of responsibility for health and well-being that would bring about a significant reduction in the number of people who are uninsured. The terrorist attacks of Sept. 11, 2001, had not yet occurred. The national budget had a surplus that could help cover the cost of health care for those who had little or no access. We had not yet turned our national priorities to homeland security, the pursuit of terrorists and the wars in Afghanistan and Iraq.
Then some hard realities quickly changed the picture, and the hopeful signs that had led to our optimism early in 2001 disappeared. According to the latest U.S. Census Bureau reports, the number of uninsured had increased to nearly 45 million by 2003, and the percentage of those who received coverage through their employer fell to 60.4 percent—the lowest level in a decade. As if that were not enough of a crisis, the nonprofit research group Families USA recently conducted a study of the nonelderly that revealed that nearly 82 million people—one out of every three persons under age 65—lacked coverage at some time during 2002-3, two-thirds of whom were uninsured for six months or more.
To put that number of nearly 45 million in perspective, one could add up the Census Bureau estimates of the population of the 18 states that are located between the west bank of the Mississippi River and the Pacific Ocean, north of California, and south to the New Mexico-Texas line. Then throw in Arkansas, Hawaii and West Virginia. Take away health care coverage from every man, woman and child in that vast area, and you have almost as many people as were without health insurance in 2003. If the total is closer to 82 million over two years, you can add in all the people living in California and New Mexico as well.
The situation is unconscionable; and while the numbers of uninsured have increased, the money that might help them has disappeared. In 2000, the Congressional Budget Office estimated the federal budget surplus at $236 billion. Just four years later, the C.B.O. estimates the federal deficit hovers around $413 billion, and even more if you include costs of the war in Iraq. This is a decline of at least $650 billion, and the C.B.O. says the deficit will continue to worsen. We are also once again confronting double-digit inflation, which also drives up health care costs. The massive tax cuts approved by Congress and the administration have further depleted the coffers. Whether or not the tax cut stimulated the economy, the Catholic Health Association believes the nation would have benefited from addressing other domestic priorities first. The prescription drug benefit for the elderly, although helpful, has deflected political attention from the greater problem of covering the millions of uninsured. To find any money to fund health care reform, legislators will have to look within existing programs, since the current system requires a pay-as-you-go approach. There is no new funding. There is only reallocation.
What has not changed in four years is the moral imperative that obliges Catholic health ministry to seek to change the deplorable conditions that allow millions of our neighbors to live without health care coverage. Over the long term, we are committed to transforming the health care system to create access to affordable, high-quality health care for all. The C.H.A. board recently agreed to embark on an initiative to foster a social movement that will leave no political choice except to bring about the necessary changes to the health care delivery system.
In the shorter term, we cannot sit around and wait. We are working as partners across the health care ministry to demonstrate our commitment and to do what we can now to improve the situation. We not only work to sustain, expand and enhance current programs that provide health care coverage; we are also looking at where there may be gaps in our own workplace and what we can do ourselves. We know we cannot achieve the solution alone, so we work in collaboration with others, including the Robert Wood Johnson Foundation, Catholic Charities USA and the U.S. Conference of Catholic Bishops, to raise public awareness of the problems related to lack of health insurance, as well as to increase sympathy and support for steps to reach a solution.
Additionally, the Catholic Health Association and the American Hospital Association have developed a specific proposal that would cover 27 million people who do not have health insurance. This proposal would expand insurance coverage through a combination of approaches: a mandate that all children under age 19 have health insurance coverage, including expanded eligibility under Medicaid and the State Children’s Health Insurance program; subsidies and tax credits to assist small employers in offering coverage to their employees, as well as premium subsidies and tax credits for individuals to help them purchase private health insurance. These initiatives would provide coverage to 97 percent of the children currently without health insurance and would also extend coverage to 25 percent of all uninsured low-income adults.
President Bush’s re-election campaign promises included a plan that would cover 8.2 million people, reducing the current number of uninsured by 17 percent. His plan called for expanding coverage by boosting enrollment in existing publicly financed health programs, including a campaign called Cover the Kids to enroll children who are eligible for existing public programs. Immediately after his victory, the president noted that medical malpractice reform was among his top priorities, along with expanding private-sector coverage through tax credits and use of such consumer-driven coverage options as health savings accounts and association health plans.
With both houses of Congress under tight Republican control, the president should be able to pursue his plan successfully. Several of his approaches are similar to those of our proposal. We firmly believe, moreover, that the first steps toward solving this national crisis should be covering all children under age 19 and providing incentives to help purchase coverage for uninsured adults. But Congress itself may be the greatest barrier, since many congressional Republicans are fiscal conservatives. There has been growing acrimony in Congress recently, making it ever more difficult to achieve significant public policy focused on domestic programs. With a growing deficit, the estimated $227.5 billion price tag for the president’s health plan may be a sticking point.
Even if our proposal were adopted in full or the Bush plan enacted, this would be only the first step toward covering the nation. The United States would still face a crisis that depletes both the personal health of its population as well as the nation’s financial health. Just before Election Day, the 2004 Health Confidence Survey was released. The survey reported that most people are dissatisfied with the U.S. health care system. They are concerned about their ability to afford quality health care in the future, and they are dipping into their savings accounts and saving less for retirement so that they can pay for health care. About 25 percent of those surveyed have used almost all their savings to pay for health care, and 15 percent have borrowed money to pay health care bills. Nearly 20 percent must struggle to pay for food and housing because of health care bills. Those who have no health care insurance rely on expensive emergency room visits for their primary care. Their physical health and well-being are much more at risk, and their rate of premature death from preventable and treatable illnesses is much higher.
Catholic health care providers believe in the dignity of human life at every stage—from conception to natural death. We believe that we have a responsibility to ensure the common good and to meet the needs of those who are less fortunate. We further believe that health care is a basic human right—not a commodity—and we are pledged to work toward a health care system in the United States that provides for everyone. Informed by the teachings of the Catholic Church on human dignity and social justice, we remain committed to pursuing our guiding principles for a transformed health care system that:
• Makes health care available to all, regardless of employment, age, income or health status;
• Makes a defined set of basic benefits available to all;
• Shares responsibility for health among all—individuals, families, health care providers, employers and government;
• Bases health care spending on appropriate and efficient use of resources;
• Shares responsibility for financing among government, employers and individuals;
• Promotes the continuous improvement of health care services;
• Encourages effective participation in decision making by patients and their families.
Concern about terrorism and security remains a strong priority, but we believe the nation must again focus on key domestic priorities, like health care reform, before the uninsured population reaches 50 million or more. Taking the first steps to increase coverage for those most in need would be a move in the right direction for the nation. It should be on the top of the list for President Bush and the 109th Congress.
Our ultimate goal is affordable, accessible health care for all. As we go into the 109th Congress, the Catholic health ministry is launching a campaign, called Cover a Nation, that is focused on fomenting a national movement—a demand for social reform—that will transform health care delivery and ensure that every person in the United States can obtain necessary health care services. We will begin by working with others, building effective coalitions, conducting public dialogues both to raise awareness of the issues and to find strength through collaboration. We will continue to work closely with other Catholic organizations, especially the national bishops’ conference, to expand support throughout the Catholic family.
This crisis is more than just an issue for the nation’s Catholic health care providers. For as it continues to grow, the crisis affects one of every seven people in the United States. It impairs the health status of our nation, the vibrancy of our communities and the well-being of our neighborhoods. In the long run, it could alter our own lives or the lives of those we love.