Some 47 million U.S. residents have no health insurance,
and the numbers keep growing. Because employers
increasingly are moving in the direction of providing Wal-Mart-style
health coverage by shifting health care costs to employees,
America’s workers struggle to pay higher premiums, deductibles and
co-payments—if they can afford such coverage at all.
Of the 47 million Americans without health
insurance, 8.7 million are children. Read
the AFL-CIO Executive Council's call for a universal health care
system based on Medicare.
Working families are experiencing double-digit
increases in the costs of health insurance, more out-of-pocket costs
for doctor visits and skyrocketing prices for prescriptions, forcing
many to delay getting needed medical care or worse—to decline
coverage for themselves or their families because of cost. Health
care costs are rising .
According to the Center for Studying Health System Change,
health care spending rose 10 percent in 2002 and that followed a
slightly more than 10 percent increase in 2001—the largest jump in
more than a decade. In the first six months of 2003, health spending
rose another 8.5 percent. Premiums for employer-sponsored coverage
increased nearly 13 percent in 2002. As employers refuse to pay
their fair share, this trend may result in millions of workers losing their employer-based
Employers are responding to growing cost
pressures by shifting more and more health care costs onto
workers, especially through larger co-pays and deductibles
that must be paid at the time treatment is sought.
demands to slash health care coverage for workers
was the major issue in the recent Southern California grocery
workers' strike and lockout in which nearly 60,000 workers
health care benefits and beat back employer demands to freeze
pension funds after holding strong on the picket line for five
grocery management’s original proposals, a worker making slightly
less than $20,000 a year would have had to pay nearly $5,000 to
maintain the same level of benefits they had in the previous
cost increases hitting workers include larger hikes in the cost of
family coverage, less access to needed prescription drugs through
stricter HMO formularies and higher prices for more comprehensive
coverage. See the Consumers Unions’ Health Care Plans and Managed
Consumers are using
more prescriptions, at younger ages and for more conditions, and
substituting newer, more expensive medications for established
products. As a result, pharmaceutical spending increased by 17.4
percent annually between 1999 and 2000 and another 16 percent from 2000 to
The lack of quality health care in
the United States also stems from our system’s lack of
comprehensive quality measure and assurance programs, which
unions now are
establishing with community partners.
Our most successful public
health insurance program, Medicare, is increasingly under attack
at a time when the lack of
access to health care is already a crisis in America. Most Americans
ages 65 and older rely on Medicare, which serves more than 40
million beneficiaries in the United States. Instead of strengthening
and modernizing Medicare to include a comprehensive, affordable
prescription drug benefit for all seniors, the Bush administration
in late 2003 strong-armed through Congress a Medicare prescription
drug bill that moves Medicare toward privatization. The
Medicare bill also:
32.5 million seniors and people with disabilities to pay higher
premiums and other Medicare costs.
coverage for out-of-pocket expenses between $2,250 and $5,100.
the federal government from negotiating lower drug costs and does
nothing to rein in soaring prescription drug prices.
the employer-provided drug benefits of millions of
Our health care system lacks safety controls that
endanger front-line workers and patients. Staffing levels are
dangerously low in hospitals, nursing homes and other health care
facilities. As a result, medical errors are rising—and account for
an estimated 44,000 to 98,000 needless death each year. See Medical Errors and
Patient Safety and 20 Steps to Prevent
Medical Errors from the Agency for Healthcare Research and
can we fix our health care system?
Require employers to pay their fair share. The U.S.
system of providing health care coverage is employer-based.
Unfortunately, this system leaves too many working families
uninsured or under-insured. Fifty-six
percent of uninsured workers worked full-time in 2002. New
incentives and rules can change this. Sen. Edward Kennedy (D-Mass.)
has proposed legislation to require employers of more than 50
workers to provide employees with health insurance, and in 2003, California passed a state law (PDF) that
requires employers to provide insurance for workers or pay into a
state fund to insure workers. With little federal action on health
care, more states are addressing health care issues.
Beware of new “defined-contribution” health care
coverage. Shifting health care costs onto working
families already is creating hardship at the doctor's
office and the bargaining table. Now, many employers are talking
about passing most or all of the risk of rising health care costs
onto employees by adopting "defined-contribution" plans (also
described with terms including "vouchers,” “consumer driven health
care,” “tiered benefits” and “fixed premiums”).
These defined-contribution plans can come in many
shapes and forms, but they share one feature that makes them
different and more harmful to working families than the traditional
"defined-benefit" plans, which guarantee a certain amount of
coverage. In a defined-benefit plan, employees are
guaranteed a fixed package of health insurance benefits.
But in a defined-contribution plan, the employer pays a
fixed amount toward the premium, regardless of how much it costs,
leaving it to the employee to pick up the rest. So under
a defined-contribution plan, a worker in poor health or
someone who has a family member with medical problems would have to
shoulder a much larger financial burden than a healthier person.
Learn more about these plans through health care
research group websites.
coverage for all children. To expand health coverage to
the 8.7 million children in America who today lack health
insurance, Congress in 1997 passed the State Children’s Health
Insurance Program (SCHIP) to work with the Medicaid program to
cover low- and moderate-income families. Bringing eligible families
into the program requires extensive education and
outreach, and unions are playing a key role. But
states are facing their biggest budget crisis since World War II.
Confronted with three-plus years economic downturn, and the Bush
administration’s cuts in state aid, coupled with larger financial
burdens imposed by new and under-funded federal mandates, states are
cutting back on health care programs such as Medicaid and
Help curb runaway prescription drug
prices by supporting state legislation
that gives lawmakers the power to negotiate drug discounts with
pharmaceutical companies just as HMOs and insurers do. States then
can pass savings to seniors covered by Medicare and to working
families who lack drug coverage and make less than 300 percent of
the poverty level.
loses when health care workers are forced to work overtime
and are exposed to life-threatening diseases because of unsafe
equipment. After years of struggle, health care workers won federal legislation to require safer needlesticks in
2000 and 24 states now have safer needlestick laws on the
books. States can pass their own legislation
mandating safety devices for needles.
Other Good Sources of
The Families USA website is a
comprehensive source of information on health care issues affecting
children, seniors and other family members and provides
opportunities for action. The uninsured includes separate sections
on the general population, children and immigrants. The site also
to Expand Coverage and an Advocate’s
Corner that offers media tips, a legislative action center and
other resources and tools for advocacy in the area of health care
The Robert Wood
Johnson Foundation is the largest U.S. foundation devoted to
improving the health and health care of all Americans. A related
site describes the Covering the Uninsured
Campaign comprising 12 national organizations working together
to seek solutions of the problems of the uninsured and help state
coalitions enroll more eligible families in SCHIP and Medicaid.
Defense Fund provides useful information about the SCHIP and
Medicaid program eligibility rules and way to boost outreach and
The National Partnership for
Women helps women navigate various aspects of the health care
The National Health Law Project
website is one of the most extensive resources for health care
consumers and advocates. It’s a particularly good resource on health
care issues affecting low-income families and the uninsured and
links to a comprehensive list of organizations and agencies around
See Consumers Union: Health
for information on a variety of health policy issues, including on
Care Affordability, Health
Care Reform, Health
Care Plans and Managed Care, Medical
Savings Accounts and Medicare.
Coalition on Health Care is a broad alliance of unions,
employers and advocacy organizations working to improve America’s
health care. It’s an excellent source for policy studies on health
care in the United States.
The Henry J. Kaiser
Family Foundation has conducted many studies on health care in
America and its website contains a wealth of information,
particularly from the Kaiser Commission on
Medicaid and the Uninsured. It also offers a news service providing
updates on critical health policy developments.
The Center for
Studying Health System Change is a nonpartisan policy research
organization that designs and conducts studies focused on the U.S.
health care system to inform the thinking and decisions of
policymakers in government and private industry. Its studies
contribute to the body of health care policy research that helps
decision makers to understand change and the market forces driving
The National Senior
Citizens Law Center website covers Medicare, Medicaid, long-term
care, nursing homes and other issues affecting seniors.