Issue Brief

Access to Health Care

Background

Our health care system is the most expensive in the world.  Yet as a system, it fails to come close to providing the best health care in the world.  Medical costs currently consume 16 percent of our national income and are expected to grow to 20 percent by 2015.  This has become a heavy economic burden that adds significantly to the cost of virtually every product and transaction in our economy.  Studies now report that the average family pays between $10,500 and $12,000 each year for health insurance.  Many employers are trying to shed this cost by shifting the cost of health insurance to their employees or by abandoning health insurance coverage altogether.  Thus, a growing percentage of people living in the United States are uninsured, and families on tight budgets are increasingly at risk. 

In Pennsylvania, most considered upper-income have excellent health insurance and excellent access to medical care.  Many veterans have good access through the network of physicians and services administered by the Veterans Administration.  The elderly and the disabled have adequate access to medical care through Medicare and in recent years, most children have gained adequate access to medical care through the expansion of the Children’s Health Insurance Program (CHIP).  Around 485,000 very low-income adult Pennsylvanians who suffer from a chronic illness, are disabled or pregnant, or who have young children have limited access through Medical Assistance.  Another 55,000 low-income adults have limited access through the AdultBasic Program. 

Despite all these programs, there are still approximately 955,000 adult Pennsylvanians, below age 65, that do not have any health insurance and are not eligible for government-funded insurance.  Many access health care primarily via emergency rooms, which they utilize when medical problems are acute.  If they suffer from a chronic disease, a medical professional does not manage their treatment.  The un-insured often cannot fill their prescriptions or, if they do, they cannot afford to take prescription drugs in the recommended dosages.  They are usually forced to pay retail prices for both medical treatment and medications which they often cannot afford.  When costs pile up, many choose bankruptcy as the way out.

Another big chunk of the population has insurance but it is not adequate to provide the protection they need.  Over 2.2 million Pennsylvanians (21 percent of the under-65 population) live in families that pay at least 10 percent of their pre-tax income for health care.  Because of high deductibles, co-pays, payment limits and exclusions in their health insurance plans, these individuals find themselves responsible for thousands of dollars of health-related costs.  For families on a tight budget, this kind of insurance forces people to avoid medical care until they are in crisis.