Editor`s Opinion: Knowledge is Power

  While people continue to debate — or argue in court — the need to reform health insurance coverage, the number of Americans going without it has increased substantially. In September, the US Census Bureau1 reported that the percentage of people without health insurance increased from 15.4% in 2008 to 16.7% in 2009. In real numbers, the situation is even more troubling. For the first time since comparable health insurance data were collected (1987) and despite a substantial population increase since that time, the number of people with health insurance decreased from 255.¹ to 253.6 million. In large part, this is due to employer-based health coverage going the way of the dinosaur. In 2000, 64% of the population had health insurance through their employer; this number has declined every year since and in 2009 only a little more than half (55%) of the population had this type of coverage.

  Ironically, while reform costs remain a topic for lively debate, the percentage of people covered by government (federal and state) health insurance programs also reached an all-time high not seen since 1987. In 2009, these programs covered 30.6% of the US population. Individual states have been particularly hard hit, as the percentage of persons covered by Medicaid increased from 14.1% in 2008 to 15.7% in 2009.¹

  Of course, these numbers do not include the millions of persons who are underinsured. In a September 16, 2010 press release from Physicians for a National Health Plan (PNHP), Dr. Olveen Carrasquillo, PNHP board member and chief of general internal medicine at the University of Miami's Miller School of Medicine, observed, “Not having health insurance, or having poor quality insurance that doesn’t protect you from financial hardship in the face of medical need, is a source of mounting stress and poor medical outcomes for people across our country. New research has found that about 14.1 million children and 25 million nonelderly adults were underinsured in 2007, a figure that is likely much higher today.”²

  As 2010 draws to a close, these numbers will get worse, not better. Results from a Kaiser Family Foundation survey³ of the growing number of persons with individual health insurance plans shows that on average their most recent premium increased 20% and that they spent an average of $1,690 out of pocket during the past 12 months.

  Healthcare professionals are caught in the middle. Our own premiums are increasing (especially if you own or work in a small practice) and our patients are struggling and stressed about their health insurance and ever-increasing co-payments. Care is delayed, appointments are cancelled, and prescriptions remain unfilled. Meanwhile, pressure to reduce payments for care is mounting and newspapers across the country are reporting that insurance companies are using the window between what occurs now and the implementation of healthcare reform to increase their bottom line. For example, this summer Aetna®⁴ (Hartford, CT) reported a record increase in net income for the second quarter of 2010 ($494.6 million for the second quarter of 2010 compared with $362.8 million for the second quarter of 2009) despite a 2% decrease in premium revenue due to membership decreases. This was achieved in part through “favorable developments in healthcare costs.” In other words, they paid less. To wit, I just received a letter from the company announcing an interim premium increase of 14% for our individual healthcare plan because of “increasing healthcare costs.” Really? Didn’t you just announce the healthcare costs you paid were less than in 2009? American Medical Association (AMA) Immediate Past President J. James Rohack, MD, quoted in Amednews.com, stated, “Huge premium hikes and windfall earnings from the health insurance industry are out of step with the latest figures showing the slowest rate of growth in US healthcare spending in nearly 50 years. Spending for physician and clinical services grew 5%, the slowest rate of growth since 1996.” Finally, chances are that our immediate future will include even more patients anxious about healthcare reform. Aetna’s rate increase letter also includes (in large font) an interesting note that describes how a decision to change plans “could add to your premium costs now and in the future” because a new plan would be subject to all (underlined) changes in the recently passed healthcare reform act. Are you scared yet?

  It is truly tempting to consider the throw-in-the-towel option or to run for the hills until the dust has settled. However, a teenager with autism I worked with today reminded me that we have a much better option: knowledge. The young man and I had just finished a health education session and I wanted to find out what he had learned. Despite serious limitations in his ability to communicate and comprehend information, he proudly proclaimed, “I feel powerful.” And so it is. I am grateful he reminded me!

This article was not subject to the Ostomy Wound Management peer-review process.

1. DeNavas-Walt C, Proctor BD, Smith JC. US Census Bureau, Current Population Reports P60–238. Income, Poverty, and Health Insurance Coverage in the United States: 2009. US Government Printing Office, Washington, DC, 2010. Available at: www.census.gov/prod/2010pubs/p60-238.pdf. Accessed September 16, 2010.

2. Physicians for a National Health Plan. Press release September 16, 2010. Available at: www.pnhp.org/news/2010/september/number-of-uninsured-skyrockets-43-million-to-record-507-million-in-2009. Accessed September 16, 2010.

3. Kaiser Family Foundation. Survey of people who purchase their own insurance. June 2010. Available at: www.kff.org/kaiserpolls/upload/8077-R.pdf. Accessed September 10, 2010.

4. Aetna Reports second quarter 2010 results. Available at: http://phx.corporate-ir.net. Accessed September 12, 2010.

5. American Medical News. Health plans’ huge earnings spark fallout from politicians. Available at: www.ama-assn.org/amednews/2010/08/16/bisb0816.htm. Accessed September 14, 2010.