Census Bureau Statistics
The Census Bureau reports that 45.8 million Americans were without health insurance in 2004, up from 45 million in 2003. While the increase is statistically small, it means that “an additional 860,000 Americans live without the safety net of health insurance,” J. Edward Hill, M.D., president of the American Medical Association, said in a statement. “As the decrease in employment-based health insurance continues, the AMA renews its call for health insurance solutions that put patients in the driver's seat, along with their physicians,” Dr. Hill said. Some of these solutions may include refundable tax credits inversely related to income and individually selected and owned health insurance, he said. In other statistics, the number of people with health insurance increased by 2 million to 245.3 million between 2003 and 2004. Those covered by government health insurance rose from 76.8 million in 2003 to 79 million—driven by increases in the percentage and number of people covered by Medicaid.
Split on the Benefit
Patients' optimism of Medicare's new prescription drug benefit has improved over the last few months, although beneficiaries remain split on their support, an August poll conducted by the Kaiser Family Foundation indicated. About one in three seniors (32%) has a favorable impression of the benefit and an equal number (32%) have a negative one. This figured can be compared with April, when only one in five (21%) had a favorable impression of it. Comprehension of the benefit has improved: Overall, 37% of seniors now say they understand the new benefit “very” or “somewhat” well, up from 29% in April. Six in 10 seniors (60%) say they don't understand the benefit well or at all. Slightly more than one in five seniors (22%) say they plan to enroll in the benefit, up from 9% in April. The poll represented 1,205 adults aged 18 and older, including 300 respondents aged 65 years and older, interviewed by telephone by Princeton Survey Research Associates, on behalf of Kaiser.
Driven Into Debt
An estimated 77 million Americans aged 19 years and older—nearly two of five adults—have had difficulty paying medical bills, have accrued medical debt, or both, according to an analysis of the 2003 Commonwealth Fund Biennial Health Insurance Survey. Working-age adults incur significantly higher rates of medical bill and debt problems than adults aged 65 and older, with rates highest among the uninsured. “Even working-age adults who are continually insured have problems paying their medical bills and have medical debt,” the analysis stated. Two-thirds of people with a medical bill or debt problem went without needed care because of cost—nearly three times the rate of those without these financial problems.
Walter Reed to Close
Walter Reed Army Medical Center in Washington, which has cared for hundreds of thousands of soldiers and dignitaries for the past 96 years, is slated to close as part of the base realignment and closure process. The medical center was tapped by the Department of Defense to be closed, and that recommendation was recently approved by members of the Defense Base Realignment and Closure Commission. The commission sent its final report to President Bush on Sept. 8. If the President agrees with the recommendations he will send the entire list to Congress for a vote. Congress must accept or reject the list in full, but they cannot amend it. If the closure is approved, most of the staff and services from the army hospital will be combined with services at the National Naval Medical Center in Bethesda, Md., and renamed the Walter Reed National Military Medical Center. Other services will be moved to Fort Belvoir, Va. Closures and realignments must begin within 2 years of Congressional approval and must be completed within 6 years, according to the Base Realignment and Closure statute.
Obesity Rankings
It pays to live in the mountains and ski: Trust for America's Health reported that Mississippi has the “heaviest” obesity rate in the country, Colorado the lightest. More than 25% of adults in 10 states are obese, including Mississippi, Alabama, West Virginia, Louisiana, Tennessee, Texas, Michigan, Kentucky, Indiana, and South Carolina. Rates have stayed the same in Oregon. A majority of governors have taken steps to initiate antiobesity programs for state employees. But most state initiatives aimed at the general public are limited to information campaigns, said Trust for America's Health, a nonprofit organization that focuses on disease prevention.
Impact of Concierge Care
Due to their small numbers, it is unlikely that concierge care practices will contribute to widespread access problems for Medicare beneficiaries, the Government Accountability Office reported. In a recent survey, GAO identified 146 concierge physicians and analyzed responses from 112. According to the survey, most concierge practices are located on the East and West coasts, and nearly all respondents reported practicing primary care medicine. Annual patient membership fees ranged from $60 to $15,000 a year, with about half of respondents reporting fees of $1,500-$1,999. The Department of Health and Human Services has determined that concierge care arrangements are allowed as long as they do not violate any Medicare requirements. For example, the membership fee must not result in additional charges for items or services that Medicare already reimburses. Some concierge physicians reported to GAO that they would like more HHS guidance.