Health Care Coverage
Why This Measure?
Access to medical care is a vital component of a healthy community. Given the high cost of medical services, treatment is often prohibitively expensive for those without health care coverage. While some people may obtain medical treatment through Medicare or other government-sponsored programs, many members of our community in particular females, young adults, the working poor have no coverage and do not use medical services because they cant pay. The consequences of inaccessible health care are serious: wellness care (regular checkups) can prevent many health problems; illnesses relatively inexpensive to treat with early diagnosis may, without medical intervention, escalate to emergency status at great personal and financial cost. Lack of medical services also breeds isolation among people who may already feel alone and abandoned.Lead Indicator
Source: Montana BRFSS, 1998
Health Care Access
No health insurance
Couldn't afford doctor
in past year
All Adults :
< High School
$10,000 - $19,000
$20,000 - $34,000
$35,000 - $49,000
Non-white or Hispanic
Source: Montana BRFSS, 1998How are we doing?
Holding steady with too many still underinsured. In 1998 17% of Montana adults reported they were uninsured. (Remember that only 1% of adults 65 and older are uncovered due to Medicare). Missoula’s population is growing, so the number of people without coverage is growing too, even if the percentage remains the same. Once again, those with less income and education are less insured. Programs like Missoula’s Partnership Health Center which provides health care to underinsured and Covering Kids (Missoula’s approach to CHIP-the Children’s Health Insurance Plan) are helping. But many health care needs are going unmet, and health continues to be compromised as a result .
Trend Same Data Rating Availablevv Reliablevv Relevantvvv
In 1996, 56% of Missoulians had dental insurance. However, 35% of Missoulians did not visit a dentist that year due to cost.
The 1997 Missoula BRFS Survey indicated the length of time since currently uninsured Missoulians had had coverage:
612 months 15%
12 years 9%
25 years 20%
5 or more years 34%
Source: Missoula BRFSS, 1997
Sources of Missoula Health Care CoverageSource: Missoula BRFSS, 1997no health insurance and relied on self-pay, county and local programs, or charity.
Your employer 55%
Others employer 18%
Private plan 17%
Medicaid 4% (the state indicates about 6500 are enrolled in Missoula County-7% of current population)
Indian Health Service 1%
The Medicaid program has grown in both size and complexity since its inception in 1965.The program now accounts for about 15 percent of all health care spending ($188 billion in 1999) and covers 36 million people, primarily with four major types of coverage:
1. acute medical insurance coverage
2. coverage for the disabled, including residential care for the long-term mentally disabled
3. long-term care for the poor elderly (those who have "spent down" to poverty level and need nursing home care)
4. state Medicaid programs paying the Medicare Part B insurance premiums for poor elderly and disabled (known as dual eligibles)
Sixty-five percent of people enrolled in Medicaid are in the first category, and 65 percent of the money is spent on the 35 percent in the last three categories. As that spending tends to fall outside of the traditional acute care model, it is difficult to include in managed care programs.
A series of legislated eligibility expansions in the late 1980s, followed by the 1990-1992 recession, increased the number of people covered by Medicaid from 23 million in 1987 to 36 million in 1996. Currently, about 28 million people use Medicaid as their primary source of health insurance (our model counts the dual eligibles in the Medicare numbers). Federal legislation in 1996 gave states far more freedom to alter Medicaid plans, both in terms of implementing new benefit arrangements and in changing eligibility levels. Meanwhile several states, notably Tennessee, had already moved their Medicaid population into managed care programs. Most other states have announced an intention to do the same, and we forecast that about 60 percent of Medicaid recipients will be in managed care plans by 2005, although they will account for only 35 percent of spending.
The 1997 Balanced Budget Act also gave the states funding to increase the number of children covered by health insurance. States may use these funds to increase Medicaid eligibility levels for children or they may create separate child health programs.
Source Robert Wood Johnson Foundation: Health & Health Care 2010
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