Diane Rowland

Race, Ethnicity, and the Health Care System: Public Perceptions and Experiences

To assess the public’s perceptions and attitudes about racial and ethnic differences in health care, the Kaiser Family Foundation surveyed a nationally representative sample of 3,884 whites, African Americans, and Latinos in 1999. The survey found that the majority of Americans are uninformed about health care disparities—many were unaware that blacks fare worse than whites on measures susch as infant mortality and life expectancy, and that Latinos are less likely than whites to have health insurance. Views on whether the health system treats people equally were strikingly different by race. For example, most minority Americans perceive that they get lower quality care than whites, but most whites think otherwise. Nonetheless, more minority Americans were concerned about the cost of care than racial barriers. Efforts to eliminate disparities will need to improve public awareness of the problems as well as address racial and financial barriers to care.

Uninsured and underserved: inequities in health care in the United States.

quality and most sophisticated systems of medical care in the world. Most Americans take for granted their access to this system of care. In times of emergency or illness, they can call upon a vast array of health resources-from a family physician to a complex teaching hospital-assured that they will receive needed care and that their health insurance coverage will pick up the tab for the majority of bills incurred.

Health Care for Black Americans: The Public Sector Role

Most of the improvement--both absolute and relative--in the health status of black Americans over the past two decades can be traced to major gains in access to health care services. Public payment programs, most notably Medicaid and Medicare, have not only reduced financial barriers, but have also combatted those of racial discrimination. Other federal programs supporting targeted local services have been especially effective in reducing infant mortality. But the redistributive effects have been uneven and unequal across populations; many categorical gaps remain and increasing numbers are potentially without access to essential primary care services.

Gaps in Health Coverage Among Working-Age Americans and the Consequences

This paper examines health coverage and access to care among working-age adults using the Kaiser/Commonwealth 1997 National Survey of Health Insurance. One in three (52 million) working-age adults were either uninsured at the time of the survey or had a recent gap in their health coverage in the past two years. Having even a temporary gap in health coverage made a significant difference in access to care. Compared to the elderly, who are continuously covered by Medicare, working-age adults have greater problems paying their medical bills and gaining access to care and are less satisfied with their health insurance coverage.

Dx For A Careful Approach To Moving Dual-Eligible Beneficiaries Into Managed Care Plans

Policy makers are moving rapidly to develop and test reforms aimed at doing a better job of managing the costs and care for people dually eligible for Medicare and Medicaid. This commentary underscores the importance of pursuing new initiatives to address care coordination and spending concerns. It then focuses on key issues raised by proposals that would shift dual-eligible beneficiaries into managed care plans. The paper describes the heterogeneity and complexity of this population, emphasizing the need for approaches closely tied to the needs of particular subgroups of dual-eligible beneficiaries. It warns against moving too quickly, noting the time and resources required to build capacity to serve patients, secure provider networks, and develop an infrastructure for integrating and managing both Medicare and Medicaid services. The commentary cautions that optimistic savings assumptions might not materialize, raises questions about how savings will be allocated, and highlights the need for accountability as new models are being developed and tested to improve care for a population with complex needs.

Holes In The Health Insurance System-Who Lacks Coverage And Why

Catherine Ho&an Diane Rowland Alicia L. Carbaugh ack of health insurance coverage is a large and growing problem for millions of American families. Rising health care costs L and economic insecurity continue to threaten the bedrock of the health insurance system employer-sponsored coverage while states’ fiscal situations and the escalating federal deficit complicate any efforts at reform. Providing health insurance coverage to the millions of uninsured remains a major health care challenge for the nation and understanding the current health insurance environment, who the uninsured are, and why they are uninsured is critical when considering health care reform. This paper aims to define the problem of the uninsured, providing an overview of the uninsured in America and the roles and l i i i ts of private and public insurance. Following this discussion, the paper describes the current health insurance environment and examines the prospects for improving coverage.

Medicare Financing Reform: A New Medicare Premium

The original and continuing promise of Medicare can be preserved only through a complex package of fiscal reforms. Central to this should be a merger of Hospital Insurance and Supplementary Medical Insurance into a single Medicare trust fund, financed in part through income-related beneficiary premiums. Benefits could be expanded, while improving access and equity.

America's Uninsured: The Statistics and Back Story

This article provides an overview of why health insurance matters, a profile of the uninsured, and a discussion of the roles and limits of private and public health insurance as sources of coverage. It concludes with reflections on the current health insurance environment and prospects for reform.

Medicaid's Role in Health Reform and Closing the Coverage Gap:

Medicaid coverage matters for millions of low-income Americans, and especially for those with ongoing and serious health challenges. A source of comprehensive and affordable coverage, Medicaid has long been a cornerstone of federal and state efforts to improve access and health outcomes for very poor and medically vulnerable populations. The Affordable Care Act (ACA) leveraged Medicaids role in serving the poor to broaden the programs reach to millions of low-income uninsured adults, and positioned the program as a fundamental component of the newly established continuum of public and private coverage. Looking ahead, if more states embrace the Medicaid expansion, there is the potential to build on this progress to significantly reduce the number of uninsured Americans.