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Poor Families in America's Health Care Crisis examines the implications of the fragmented and two-tiered health insurance system in the United States for the health care access of low-income families. For a large fraction of Americans their jobs do not provide health insurance or other benefits and although government programs are available for children, adults without private health care coverage have few options. Detailed ethnographic and survey data from selected low-income neighborhoods in Boston, Chicago, and San Antonio document the lapses in medical coverage that poor families experience and reveal the extent of untreated medical conditions, delayed treatment, medical indebtedness, and irregular health care that women and children suffer as a result. Extensive poverty, the increasing proportion of minority households, and the growing dependence on insecure service sector work all influence access to health care for families at the economic margin.

Abstract Background Extreme income or asset loss as severe form of financial hardship (FH) has been linked to worse survival outcomes in cancer patients. This study aimed to assess the incidence, risk factors, and impact of severe financial hardship (SFH) on survival among working-age cancer patients in Taiwan’s universal healthcare system, using an objective measure for SFH. Methods This study analyzed linked national longitudinal data for patients aged 20-63 years diagnosed with cancer between 2007 and 2018. Severe financial hardship was defined as household net income falling below the poverty threshold post-diagnosis. Propensity score matching (1:4) was used to balance baseline characteristics between SFH and non-SFH groups. Cox proportional hazard models were used to estimate the hazard ratio (HR) of outcomes. Results Among 400 229 working-age cancer patients, the incidence of SFH was 4.7 per 1000 person-years (95% confidence interval [CI], 4.6-4.9) over a mean follow-up of 5.7 ± 4.3 years. Severe financial hardship was associated with younger age, male sex, advanced stage, and intensive treatments. Patients with SFH within 1 year of diagnosis had significantly lower survival, with an adjusted HR of 1.64 (95% CI, 1.56–1.72) for all-cause mortality compared to those without SFH. Notably, early stage patients with SFH faced a higher relative mortality risk than advanced-stage patients. Conclusions Severe financial hardship substantially increases mortality among cancer patients in Taiwan, highlighting gaps in financial protection. Addressing SFH through implementing targeted policies and enhancing support mechanisms is essential to improve survival outcomes and reduce disparities in cancer care.

People uninsured for any part of 2008 spend about $30 billion out of pocket and receive approximately $56 billion in uncompensated care while uninsured. Government programs finance about 75 percent of uncompensated care. If all uninsured people were fully covered, their medical spending would increase by $122.6 billion. The increase represents 5 percent of current national health spending and 0.8 percent of gross domestic product. However, it is neither the cost of a specific plan nor necessarily the same as the government's costs, which could be higher, depending on plans' financing structures and the extent of crowd-out. [PUBLICATION ABSTRACT]

The State Children's Health Insurance Program (SCHIP) was established by Congress to provide health insurance to uninsured children whose family income was too high for Medicaid coverage but too low to allow the family to obtain private health insurance coverage.

When all of the insurance and health care reforms of the ACA are fully implemented, some public financing needs for behavioral health services will remain. This commentary outlines a number of the residual functions of the public mental health system in an ACA world, and it identifies opportunities for expansions of service areas not covered by traditional insurance or the health delivery reforms for behavioral health services within the scope of the ACA.

America's Children is a comprehensive, easy-to-read analysis of the relationship between health insurance and access to care. The book addresses three broad questions: How is children's health care currently financed? Does insurance equal access to care? How should the nation address the health needs of this vulnerable population? America's Children explores the changing role of Medicaid under managed care; state-initiated and private sector children's insurance programs; specific effects of insurance status on the care children receive; and the impact of chronic medical conditions and special health care needs. It also examines the status of \"safety net\" health providers, including community health centers, children's hospitals, school-based health centers, and others and reviews the changing patterns of coverage and tax policy options to increase coverage of private-sector, employer-based health insurance. In response to growing public concerns about uninsured children, last year Congress voted to provide $24 billion over five years for new state insurance initiatives. This volume will serve as a primer for concerned federal policymakers and regulators, state agency officials, health plan decisionmakers, health care providers, children's health advocates, and researchers.

The Bush administration has proposed expanding insurance coverage as well as community health centers (CHCs) to increase access to care for uninsured people. This paper examines the relative effects of insurance coverage and CHC capacity on access to care. Communities that have both high insurance coverage and extensive CHC capacity tend to have the best access, although the former appears more important. Funding of insurance coverage expansions is likely to produce greater gains in access than if an equivalent level of funding were invested in CHCs. Policymakers should consider CHC expansions as complementary to insurance coverage expansions rather than as a substitute. [PUBLICATION ABSTRACT]

The shocking statistic is that forty-seven million Americans have no health insurance. When uninsured Americans go to the emergency room for treatment, however, they do receive care--and a bill. Many hospitals now require uninsured patients to put their treatment on a credit card--which can saddle a low-income household with unpayably high balances that can lead to personal bankruptcy. Why don't these people just buy health insurance? Because the cost of coverage that doesn't come through an employer is more than many low- and middle-income households make in a year. Meanwhile, rising healthcare costs for employees are driving many businesses under. As for government-supplied health care, ever higher costs and added benefits (for example, Part D, Medicare's new prescription drug coverage) make both Medicare and Medicaid impossible to sustain fiscally; benefits grow faster than the national per-capita income. It's obvious the system is broken. What can we do? In The Healthcare Fix, economist Laurence Kotlikoff proposes a simple, straightforward approach to the problem that would create one system that works for everyone--and secure America's fiscal and economic future. Kotlikoff's proposed Medical Security System is not the \"socialized medicine\" so feared by Republicans and libertarians; it's a plan for universal health insurance. Because everyone would be insured, it's also a plan for universal healthcare. Participants--including all who are currently uninsured, all Medicaid and Medicare recipients, and all with private or employer-supplied insurance--would receive annual vouchers for health insurance, the amount of which would be based on their current medical condition. Insurance companies would willingly accept people with health problems because their vouchers would be higher. And the government could control costs by establishing the values of the vouchers so that benefit growth no longer outstrips growth of the nation's per capita income. It's a \"single-payer\" plan--but a single payer for insurance. The American healthcare industry would remain competitive, innovative, strong, and private. Kotlikoff's plan is strong medicine for America's healthcare crisis, but brilliant in its simplicity. Its provisions can fit on a postcard--and Kotlikoff provides one, ready to be copied and mailed to your representative in Congress. We're electing a new president in 2008; let's choose a new healthcare system, too--one that works.

This report summarizes the proceedings of a workshop convened in June 2010 to critically examine the various databases that could provide national and state-level estimates of low-income uninsured children and could be effectively used as criteria for monitoring children's health insurance coverage.