Providing Care to the Uninsured

Providing Care to the Uninsured


The US health care system has one of the most complex systems of financing. Majority of Americans finance their health care needs through private insurance mostly offered through employers. Approximately 55% of Americans rely on employer sponsored insurance. A small proportion of the American population, less than 20%, relies on private individual insurance plans. This has left a big section of the population uninsured. It is estimated that over 16% of Americans are not insured.

This paper has explored various proposal made in a report by Collins, Davis & Kriss (2007) for addressing the uninsured problem. The article identifies three main strategies for addressing the problem of the uninsured. These strategies include; instituting reforms in the national health insurance system; expansion of existing public insurance systems or reinforcing the existing employer based health insurance system. The three proposals have varied outcomes in terms of people covered and cost of getting cover.

The AmeriCare Proposal

The AmeriCare proposal recommends the expansion of the existing public insurance system in order to incorporate all individuals with the population (Collins, Davis & Kriss, 2007). Currently, the American health care system is financed through a complex partnership between private and public players. Those who are employed are able to obtain cover through their employers while those who can afford, purchase cover directly from the insurance company.

The remaining section of the population is covered y public programs. Currently, there are two main public health financing programs; Medicare and Medicaid (Collins, Davis & Kriss, 2007). Medicare is responsible for providing services to the populations of the elderly while Medicaid provides care to the vulnerable groups.

The proposed AmeriCare system seeks to expand these two public financing systems in order to incorporate all Americans (Collins, Davis & Kriss, 2007). This implies that the country will have to do away with private insurance program. Like in most industrialized economy, the government will provide universal financing of health care needs through a tax system. The proposal was suggested by Representative Stark. This proposal would increase spending on health care by the federal government by $154.5 billion.

However, this proposal would lead to massive savings in various areas.  One area in which savings would be realized is the national health expenditure. The proposal would reduce national health expenditure by an estimated $ 60 billion. The proposal would also reduce insurance administration expense by an estimated $74 billion by spreading risks across a large pool of people. AmeriCare would also reduce cost of care by enabling the government to negotiate prices of drugs with the pharmaceutical companies.

Reinforcing the Employer Sponsored Insurance

The second proposal involves reinforcing the existing employer based system (Collins, Davis & Kriss, 2007). This is where individuals purchase insurance cover as groups through their employers. This proposal was brought forward by George Bush. This proposal suggests the equalization for tax treatment of employer and individual coverage. This system will deduct a fixed amount of money from workers income. The amount deducted would be influenced by the consumer price inflation index. This proposal is estimated to expand insurance coverage to an additional 9 million Americans.

However, this proposal is considered as short term fixed to the problem. This is because this system results in increased coverage in the first year followed by subsequent drop in the number of the insured. The drop in the number of the insured is attributed to rise of premiums beyond the cap making it expensive for payers.  This proposal would increase government deficit by $70.4 billion in the first year on inception (Collins, Davis & Kriss, 2007). However, the system would result in a government surplus 10 years after inflation. On the other hand, this proposal would result in savings worth $ 11.7 billion. Household tax would also reduce by an estimated $31 billion.

Reforming the National Health Insurance System

            This proposal suggests a complete overhaul of the existing national health insurance system (Collins, Davis & Kriss, 2007). This proposal recommends the formation of partnership between state and federal governments in the provision of health finances. This proposal would lead to a substantial increase in the number of the insured Americans. Increased coverage would be realized as the system sets a minimum level of acceptable health benefits and overall reduction of out-of-pocket costs of health care. This system would increase government spending by $165 billion (Collins, Davis & Kriss, 2007).

The system would also increase expenditure as individuals will be expected to cash preexisting health insurance benefits. This system would lead to savings worth $4.5 billion (Collins, Davis & Kriss, 2007). This proposal would result in decline in healthcare spending among the low and middle income groups. The average spending on health care among families earning less than $10,000 per annum would decline by estimated $980 every year per family. On the other hand, health care expenditure would increase by $1,263 per annum for households with a yearly income of over $ 150,000.

Impacts of not Having Insurance

            Having a large population of uninsured individuals is a significant problem to the patients, providers and the society. For the patient, lack of insurance limits his ability to receive quality care (Collins, Davis & Kriss, 2007). Most of the uninsured individuals rarely seek medical care unless the conditions become severe. Thus lack on insurance threatens the wellbeing of individual. It also increases economic burden on individuals. Financing health care out-of pocket is very costly. This increases economic burden to the uninsured especially when considering that most of the uninsured come from low income groups.

A large number of an insured also has a cost implication on providers. This is because providers the pool of the insured in reduced thus, limiting the ability of providers to spread the risks adequately (Collins, Davis & Kriss, 2007). The insured also become a problem to the society. In the US, the large number of the uninsured has been responsible for the increase in government expenditures and deficit (Collins, Davis & Kriss, 2007). The government had to intervene through programs such as Medicare and Medicaid in order to ensure that this group of citizens gets access to healthcare. The consequences of increased expenditures and government deficit on the country’s economy are dire.


The American healthcare system is one of the most complex systems in the world. Health care costs within the system are mainly financed through private insurance obtained through employers. A small section of the American population purchases individual insurance plan directly from the insurers. This system of financing leaves a large section of the population uninsured. Collins, Davis & Kriss (2007) have explored some of the proposal made to congress for addressing the problem of the uninsured. Three main proposals were identified. These proposals entailed; instituting reforms in the national health insurance system; expansion of existing public insurance systems or reinforcing the existing employer based health insurance system. This paper has evaluated these proposals.


Collins S. Davis K. & Kriss J. (2007). An Analysis of Leading Congressional Health Care Bills. Part 1. Essential Reading in Health Policy and Law

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