The profession of social work has long been linked with efforts for health reform. At dawn of 20th century, Jane Addams, Lillian Wald, and others advocated reforms to prevent spread of communicable diseases in urban areas and raised concern about high rates of infant mortality. During 1930s Frances Perkins, a settlement house worker, became secretary of labor and advocated compulsory universal health insurance. Social workers also played central roles in enactment of Medicare and Medicaid, and during 1990s, NASW developed its own legislative proposal for health care, which Senator Daniel Inouye (D-HI) introduced in 1992 (Moniz & Gorin, 2003). The 1999 Delegate Assembly enacted a policy statement committing NASW to a national health policy that ensures right to universal access to a continuum of health and mental health care (NASW, 2003, p. 172). The failure of efforts to reform health system during 1990s led to a period of disillusionment about nation's ability to expand coverage to uninsured population (Gorin, 1997). In recent years, however, interest in this issue has resurfaced. Since 2001, Institute of Medicine has released a series of in-depth studies on problem of health coverage in United States (http://www.iom.edu/project.asp?id=4660). The National Coalition on Health Care (NCHC), which consists of large businesses, labor unions, religious organizations, health providers, and others representing least 150 million Americans, has advocated fundamental reforms aimed at instituting universal coverage (NCHC, 2004, p. 2). Other groups, such as Universal Health Care Action Network and Physicians for a National Health Program have accelerated their efforts for reform and universal coverage. Despite this, serious problems remain with our health system, particularly in terms of access and coverage. Tens of millions of individuals lack health coverage for an entire year, and millions more have only partial or inadequate coverage. Despite efforts by Clinton administration to enact policies for universal health care, United States remains only industrialized nation that does not provide universal access to health care. Problems with health system have only grown worse during Bush administration. This National Health Line column examines current status of health coverage, considers proposals for expanding coverage, and concludes with a discussion of implications for social workers. HEALTH CARE COVERAGE IN THE UNITED STATES The precise number of individuals without health coverage is open to debate (Congressional Budget Office [CBO], 2003). The figures most often cited come from U.S. Census Bureau's Current Population Survey (CPS), which every March asks individuals about their insurance status during preceding year (CBO). By this measure, in 2003 (the most recent year for which we have figures), 45 million individuals went without health insurance for entire year (U.S. Census Bureau, 2004). However, some analysts believe that these figures exaggerate scope of problem (Institute of Medicine, 2001). Although CPS ostensibly captures information about individuals who were without coverage for an entire year, data from other surveys suggests that it really measures number of people who lack coverage at time of survey (CBO). According to CBO estimates, in 1998 between 21 and 31 million people were without coverage for entire year, whereas between 39 million and 42.6 million were without it at a particular point in time; between 56.8 million and 59 million individuals were without coverage at some time during year. By CPS measure 43.9 million people were without coverage in 1998, and 45 million were without it in 2003, so we can conclude that CBO estimates for 1998 are roughly comparable to 2003. In any event, however one measures it, the number of uninsured Americans is substantial and increasing (Institute of Medicine, 2001, p. …
Read full abstract
Mar 9, 2010
Open Access