Uninsured need coverage

By Mat Despard

With the number of uninsured North Carolinians at 1.4 million and counting, the need to act has never been greater.

The uninsured receive less preventive and primary care and are diagnosed at later stages of illness.

The leading cause of personal bankruptcy in the U.S. is unpaid medical bills, while the price tag for uncompensated care costs now exceeds $40 billion a year, most of it taxpayer-financed in the form of hospital payments.

Absent any movement at the federal level to offer a solution, a growing number of states are acting to increase health coverage of the uninsured.  Only two states – North Carolina and Nevada – do not currently have any specific strategies such as high-risk pools, reinsurance or Medicaid waivers to expand insurance coverage, according to the State Coverage Initiatives program of the Robert Wood Johnson Foundation.

Fortunately, the North Carolina Institute of Medicine has been working on state policy recommendations to increase coverage, such as a state high-risk pool, so our lawmakers will have fresh and innovative ideas for covering uninsured North Carolinians.

However, citizens and community leaders must be prepared to consider what can be done at the local level.

Stimulated in part by the Community Voices initiative of the W.K. Kellogg Foundation’s and the Communities in Charge initiative of the Robert Wood Johnson Foundation, launched in 1998 and 1999, respectively, important lessons have emerged from the experience of these communities, such as Ingham County, Mich., and Jacksonville, Fla.

Communities have demonstrated that there are creative ways to finance and deliver health care for the uninsured at the local level.

Physicians accept discounted payments for services; hospitals donate services or provide financial support in lieu of state and federal Disproportionate Share Hospital payments; small businesses and their employees pay affordable premiums; and local government and private philanthropic entities finance the remaining cost of coverage.

The guiding principle of such “three-share” approaches is that no one entity should alone bear the costs of caring for the uninsured.

Encouraging use of preventive and primary care and offering care management services to persons with chronic illness are common cost-containment approaches in offering services comparable to traditional insurance plans through such efforts.

Philanthropy can plan an important role, but it will take an unconventional approach — providing long-term, sustainable funding for a community asset, as opposed to a program or organization for limited amount of time, that can impact lives in multiple ways.


Mat Despard, is a project coordinator with the Health Inequalities Program of the Center for Health Policy at Duke University in Durham, N.C.

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