Historically, health care for the poor has been the responsibility of charitable institutions. At the turn of the century, free care was provided by religiously affiliated hospitals (for example, Mt. Sinai, St. Barnabas, St. Mary’s and Swedish Hospitals), physicians and dispensaries funded by cities or private charities.
The federal government established the Veterans Administration to provide health care services for WWI veterans and in authorized grants to states for maternal and child health programs.
Creation of the private health insurance system began in 1929 with the first group health insurance plan. By the late 1950s, nearly two out of every three middle-class Americans had some coverage for hospital care.
President Franklin D. Roosevelt’s attempt to create national health insurance as part of the original Social Security Act was thwarted by stiff opposition that forced withdrawal of the proposal.
National health insurance became over time the only major part of the New Deal-Fair Deal system of economic and social programs that was not enacted. Creation of the Medicare and Medicaid programs in 1965 greatly expanded health coverage for the poor and the elderly, but too many people, particularly the working poor, are still without it.
THE UNINSURED
The best estimates of the number of Americans without public or private health coverage range from 31 to 36 million people. Nationally, children and young adults are more likely to be uninsured. More locally, 370,000, or 8.6 percent of the state’s population, were uninsured for all or part of the year. An additional 366,000 Minnesotans are “underinsured” and have individual policies with high deductibles and stringent underwriting policies. In Hennepin County, an estimated 60,000 people are currently uninsured.
Many studies have shown that the uninsured tend not to have a primary source of care, nor do they receive preventive services such as immunizations or blood pressure checks on a regular basis. As a result, emergency rooms and urgent care clinics become the usual provider of care resulting in needless overcrowding and high costs. Most importantly, the health of the uninsured is worse for lack of basic care and immunizations.
Insurance for workers and dependents provided by employers has also eroded dramatically in recent years. In 1987, over three fourth of the uninsured were employed or dependents of employed individuals, primarily in the service industry.
The United States currently spends 12% of its gross national product on health care. In 1989, national health care spending was $604.1 billion — a 128 percent increase since 1980. One way or another, we are all paying for the cost of care for the uninsured; insurance premiums include some of the costs of care for the uninsured. Paying patients subsidize nonpaying patients. Society as a whole pays the price for care not provided to those who fail to get prenatal care and immunizations.
STATE OFFERS BOLD INITIATIVE, GOVERNOR REJECTS
The State of Minnesota has been moving to create a statewide program of health insurance. Prior to the New Deal states like Minnesota, Wisconsin and California tested social security, child labor laws and other major initiatives prior to passage of national legislation. Minnesota is now acting as a “laboratory of democracy” to test and perfect an essential new element of our structure of basic services.
During the past legislative session, a number of proposals to improve health care access were debated by the Legislature. Ultimately, F.F.2, the Health Care Access Bill was passed by the DFL controlled Legislature and then vetoed by Governor Carlson. The Hennepin County Board is on record supporting the Health Care Access Bill. This bill proposed to create the Minnesotan’s Health Care Plan, a state sponsored pool for the uninsured, the under-insured and employers. In addition, the legislation proposed a number of reforms for insurance underwriting practices that currently limit the ability of small groups and individuals to purchase affordable coverage.
$32.5 million was to be appropriated during the ’92-’93 biennium, funded by increased taxes on cigarettes, to be phased in over two years. The allocation covered premium subsidies for 37,500 low income Minnesotans, the cost of establishing the program, rural health initiatives, and increased costs in Medical Assistance and General Assistance Medical Care, due to increased referrals to these programs.
Overall, the legislation would have been an effective first step towards improving the health care system. We need to rally behind the Health Care Access Bill when the Legislature reconvenes in January. There are too many of our neighbors and fellow Minnesotans who have gone without basic health care for too long. We must become advocates of change.
