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Who are America's Uninsured?
For those Americans with health insurance, private insurance remains the leading source of coverage, accounting for nearly 70% of the insured 64-years-of-age and under according to the U.S. Department of Health and Human Services National Health Statistics Reports. The remaining number of insured gain their coverage through public sources, such as the military. 12.6% of Americans are uninsured.
The debates over national healthcare, like many issues, remains largely in the hands of policy makers, their party affiliations, and agencies engaged in the research.
When asked how the government should provide health insurance coverage, 36% of Americans say it should be provided through a single national government program, while 26% say it should continue to be provided through a mix of private insurance companies and government programs. This is a change from about a year ago, when nearly equal shares supported a “single payer” health insurance program, 30%, and a mix of government programs and private insurers, 28% (Pew Research Center).
Pew mentions the “change from about a year ago,” but it really is a marginal change from a sampling of 15,406 people who participated in the Active Trends Panel (PRC methodology). Even as policy makers look to expand government intervention into health care, most Americans believe a form of mixed private insurance and government programs are necessary, with fewer believing in a single-payer national program.
Although the Pew article suggests “36% of Americans believe insurance should be provided through a single national government program,” that opinion goes against the majority opinion of Americans, where “53% favor a health system based on private insurance; 43% believe in a government-run one” (Gallup). For the most part, Americans seem to see the importance of a private and government component to health care.
Americans continue to hold a nuanced view of the U.S. healthcare system, with a majority saying the government should ensure that all Americans have coverage but preferring that the system be funded privately. Partisans have fundamentally differing views on how healthcare should be delivered in the U.S., with Democrats indicating support for a system where the government not only guarantees coverage but provides healthcare, while Republicans remain wedded to the current system of private coverage and healthcare (Gallup).
Companies, large and small, that provide private insurance for their employees remain central to this discussion as policy makers try to address America’s 28-million uninsured and those most impacted.
One’s sex and education level are highly correlated with the uninsured. Those without a high school degree, for instance, are more likely to be uninsured (36.9%) then they are to have private insurance (30.7%). Those with a high school diploma or GED are in a much stronger position, with 57.2% holding private insurance and 18% being uninsured.
Males remain at the top of the list when it comes to those less likely to graduate high school, earn a GED, matriculate to and graduate from a two or four year college, and carry health insurance.
For students in places like California, there are even more options for affordable healthcare as California universities require health coverage for all its students and provide affordable options. Only 43% of full-time undergraduate students are male and only 44% of community college students in California are male.
Information compiled by the Boys and Men’s Well-Being Index (BamIndex.org) shows there is a male health-insurance-deficit for those 20 to 64 years-of-age, approximately 3.3 million fewer uninsured males nationwide. Further analysis indicates that the problem begins early, as those 20-29 are the ones least likely to carry insurance as a percent of their population.(It should also be noted that uninsured males 19 to 64 years-of-age are less likely to receive Medicaid. “Medicaid covered 18% of adult women ages 19 to 64 in 2021, compared to 14% of men.”)
Because males are less likely to graduate high school and matriculate to higher forms of education, they are particularly vulnerable. Government plays an integral role in solving the problem in a variety of ways that go beyond government health plans and toward stable employment in the private sector with incentives for employers, large and small, who provide health insurance to their workers.
The government is sorely in need of a Men in Apprenticeship and Nontraditional Occupations (MANTO) program in the Department of Labor to help partner private industry and education with programs that lead to stable well-paying jobs, the type of jobs that include healthcare coverage, strong wages, and retirement benefits. These industries, for instance, include manufacturing, welding, automotive repair, construction, nursing, education, and a host of other fields where the labor is needed, where men gravitate toward, and where men are under-represented.
MANTO programs should begin in high school and continue into community colleges, particularly in areas where there is a high concentration of poor educational outcomes and students in need of opportunities that lead to gainful employment and the necessary health benefits that facilitates preventative healthcare as well. Preventative healthcare needs to play a more significant role when it comes to male health and insurance is part of the solution.
Government needs to reward employers and do more than simply allow employers to deduct insurance premiums from their bottom line. Government should add incentives. Small businesses (like family owned restaurants and even larger small businesses) struggle in part because they are at much higher risk when it comes to market shifts that impact their revenues. With less capital, small businesses do not have the reserves of larger companies. This, however, does not mean larger businesses do not face their own challenges wrestling with healthcare costs as part of employee benefits.
Small business owners know that healthcare cost plays a significant role in their bottom line. One small-business owner I spoke with mentioned the costs are worth it for his employees, while recognizing the cost makes it hard for his business when times are slow and seasonal, often eating into the owner’s ability to make ends-meet and provide for his own family. Another person I spoke with in the restaurant business shared the same thoughts. Most small business owners, who see these challenges and opportunities, are less vocal, not wanting to draw attention to their business and give the impression of challenging times yet see the need for rewarding private businesses nationally that pay a healthy portion of healthcare across the United States. Most of the owners I’ve spoken with employ fewer than 10 employees while one person I spoke with has worked with companies that employed much larger numbers of people. One former CFO I spoke with put it this way.
“Who decided companies have to provide healthcare? We do it as incentives for our employees and also because there is a moral component to it. But government needs to incentivize this process. It cannot be all stick and no carrot.”
According to the Commonwealth Fund,
There are an estimated 30.7 million small businesses (defined as those with fewer than 500 employees) in the United States, employing approximately 60 million people. Small firms make up 99 percent of U.S. employers, and these businesses create 66 percent of new private-sector jobs. Small businesses, like their larger counterparts, have not been shielded from the increasing cost of health care. Without advantages such as a larger pool of insured employees, more bargaining power with health insurance companies, and the benefit of full-time human resources personnel, small-business owners are often left with little recourse and few options when a health insurance carrier hikes costs (emphasis added).
Some in the field of medicine see the need for programs like Medicare and Medicaid but are concerned because reimbursement efforts on behalf of those programs do not cover all services, particularly some preventative services. And programs like Medical pay a fraction of the cost of services.
If health-insurance coverage is placed on employers, more needs to be done for them. Preventative medicine, employer incentives, and increasing the employment in industries that do not require four year degrees should play a critical role in helping to expand coverage and lower cost.
Since men are the ones least likely to have health insurance and tend to their health, it’s important the nation look to gainful employment as a viable option when it comes to healthcare coverage. It’s also important to recognize that many men are employed in the types of professions that take a physical toll on the body and lead to greater health risks.
Long-haul truck drivers, for instance, are at much greater risk than the national working population, and the trucking profession is predominately male (90%). Sixty-nine percent of long-haul truckers suffer from obesity, more than double the national working population. And “truckers are less likely to have health insurance, 15% uninsured versus 10% for all workers” (U.S. Census Bureau).
Working with business and incentivizing business are important considerations to improving healthcare cost and coverage.
Some Solutions to Employer/Employee Incentives and Healthcare Costs
Make yearly physicals (already covered by insurance) an incentive program as well. Reward individuals with a $500 yearly-physical-employer-reimbursement for adults and a $250 reimbursement for children 18 and under, deducted from the employee’s monthly health care payment and reflected in the employees paycheck. For a family of four, that is a 1,500 yearly savings. For employees who do not complete a physical, there should be a $500 family premium increase. And privacy laws can stay in affect for this incentive. Employees do not need to share the results of their physicals, merely have a physician’s form that states the employee completed a physical.
Educate employees on the importance of preventative healthcare. Preventative healthcare plays a significant role in lowering healthcare costs and premiums, and males are the ones least likely to engage in preventative healthcare.
Give a tax-credit to small businesses of 20% above the cost of healthcare for each employee. For every $8,000 in health care costs (the average cost of insurance for a single person) the business receives an additional $1,600 tax-credit. Employers could save $4,400 on family plans; the average family plan is $22,000. And, there could be a program cap of up to 100 employees. For companies with over 100 employees, the rate would drop to 12.5% for every full-time employee over 100. This approach could encourage more comprehensive coverage and allow employers to invest a portion of their savings into other employee incentives, like retirement, more robust healthcare plans, and keeping the business up and running. As one small owner told me, “the first few years of a small business are really hard. It’s just about covering costs and trying to become profitable.”
Expand healthcare pools that allow small businesses (with fewer employees and no-full-time human resources personnel) to align and gain more bargaining power.
If business is willing to take on the burden of private health insurance, government needs to do more to help alleviate cost to businesses and incentivize businesses to cover employees.
While most Americans want a marriage of mixed private insurance and government programs, the reasons seem logical. Many Americans worry about vulnerable populations, like the elderly and children, and see the need for government to step in and help in those instances.
Although there are many ideas, there is little doubt education in trades that lead to good paying careers plays a vital role, particularly for those least likely to go on to higher education and most likely to lack health-insurance.
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Full table of uninsured.