So, how many uninsured is too many?

By Greg Bausch, President, Kentucky Rural Health Association
From Rural Health Update, Fall 2004

“Ranks of the Uninsured Grow in 2003,” exclaims the headline.

“Rural Uninsured Continues to Rise,” notes another.

And yet a third despairs that a “Report Examines Decline in Employment-based Health Coverage.”

According to these reports, a staggering 45 million Americans, 15.6 percent of our population, lacked health insurance during 2003, representing an increase of 1.5 million of our friends and neighbors since 2002. It is also alarming to note that rural Americans have an uninsured rate about 6 percent higher than our urban counterparts. So I ask you, “How many uninsured is too many?”

This decline is largely due to reductions in employer-sponsored coverage, which fell from 61.3 percent to 60.4 percent from 2002 to 2003. Unfortunately, the rates for employer-sponsored healthcare are 11.5 percent lower for the rural areas of our country as compared to urban areas, making this vulnerable population disproportionately affected.

We can point to countless businesses like lumber mills, agricultural operations, and Mom & Pop stores that offer no health benefits to even their fulltime employees. Why even at Wal-Mart, the largest employer in the country, only around 50 percent of employees have company-sponsored health insurance. So please tell me, how many people are too many without employer-sponsored health care coverage?

At my institution, we have seen our bad debt rate soar in the past couple of years, as have many other providers And while much of this problem is due to the growing number of uninsured, a whopping 40 percent of this increase at our system was from folks who have health insurance but were unable to pay the new higher co-pays and deductibles of their health plans.

That illustrates for me a significant rise in the underinsured and the financial stress that is being placed on our providers in caring for them. So I ask you again, “How many underinsured is too many?”

We cannot allow ourselves to get caught up in a numbers game about these issues. They are just too important for that. Access to quality health care for all Americans regardless of their location, ethnicity, or ability to pay should be a right, not a privilege for a select few.

Unfortunately, it appears that only a select few will be able to afford these services in the very near future without some drastic change to the health care system.

In my view, only a system of government-sponsored universal health coverage, funded largely with the premiums we’re already paying, can hope to correct the looming crisis. The efficiencies of a single-payer, non-profit system could make the difference.

So, how many is too many? My answer is this: “One is too many.”

Oh, and while we’re at it, since William W. McGuire, chief executive officer for UnitedHealth Group Inc., personally earned $94,177,531 (including exercised stock options) in 2003, we may also want to ask how much is too much?

Greg Bausch, Pharm.D., is president of the Kentucky Rural Health Association, a member organization that educates providers and consumers on rural health issues and advocates actions by private and public leaders to assure equitable access to health care for rural Kentuckians. He also is vice president for regional services at St. Claire Regional Medical Center in Morehead. (