Dr. Lynn Blewett
Appearances
Health Chatter
Access to Health Care
So states are really where a lot of the incremental approaches to increasing access are. And so we leverage the federal data to provide states information on health insurance coverage, access to care. We do a lot in social determinants of health. And provide that in a easy, accessible way for people to understand sort of what do we know about our systems of care.
Health Chatter
Access to Health Care
And so we have a nice, and maybe I'll include that after we're done, you can put it on your resource lists, what we call state health compare, it's a state It's a dashboard that you can look at different measures and compare across states or compare to the national average or get a map. And a lot of researchers use our data.
Health Chatter
Access to Health Care
A lot of state policy people use our data to provide information to policymakers and decision makers. So our kind of motto is we want to inform decisions and discussion. And to do that, provide the best data available and try to be a new, even though I'm an advocate for universal coverage, I try to be an advocate for objective data, good data, reliable data. And that's what we've been known.
Health Chatter
Access to Health Care
We have a good reputation for that, that people can trust our data to be unbiased and the best available on this topic.
Health Chatter
Access to Health Care
You know, that's a really good question and probably something that the university and my center has done less well. We're really engaged with states and state decision makers and people who run the Medicaid programs. On a community basis, we have done some work with the Blue Cross Blue Shield Foundation to provide... county level information on insurance and coverage.
Health Chatter
Access to Health Care
And then they've used that with community health workers and navigators. But like when they're in a certain area, they know where the uninsured are and what they look like, what their characteristics are. But, you know, we could certainly do a better job of reaching out to more community groups.
Health Chatter
Access to Health Care
And I take that as a good reminder as I'm working my way towards retirement, that that's something we could do better at.
Health Chatter
Access to Health Care
Yeah. So... You know, our capitalistic system that we have in the U.S. is also a foundation of our healthcare system. And part of that is having choice of provider, choice of health insurer, and then having consumers making informed decisions, and then having that market open up every year. And so health plans and providers compete for members.
Health Chatter
Access to Health Care
So that's part of our, you know, our strategy is to have a private, private public hybrid with some elements of competition rolled in. So that open enrollment allows for that competition. And then as an employer, you know, we have bids and the plans come like they compete to have the university's business. And so that's opened up.
Health Chatter
Access to Health Care
We have a contract for maybe three to five years and that's opened up every three to five years. But yes, it's a very, and in Medicare, things are changing a lot because of the managed care plans. And so you have to be,
Health Chatter
Access to Health Care
you really have to know a lot of information when you go into open enrollment or get help in discerning among the different plans that are, are being offered and what they offer and how they changed from last year. And yeah, it's kind of, but that's the, that's that's this element of competition, which is you have informed consumers and then you have multiple consumers.
Health Chatter
Access to Health Care
supply and that you can make informed choices of the best you know for and again this is sort of the the ideal theory you make you know the best plan high quality plan at a reasonable cost and that's then you have to assume that consumers have all that information which i think the whole thing falls apart because exactly don't have that information or they don't need it's a little bit flawed yeah or even if they had the information they wouldn't understand it
Health Chatter
Access to Health Care
That's a good point. Yeah, really a good personal example. Thank you.
Health Chatter
Access to Health Care
No, it's such an important question. And, you know, if you. It's in our country, it's not a right. You know, we have 26 million people who are uninsured. And so and so and they struggle to get and people who are insured may be underinsured, which is they still they have a high deductible plan and they can't.
Health Chatter
Access to Health Care
So and there's nowhere there's no way there's nowhere in our Constitution, in any legislation where health care is listed as a right. We have the right to. what is it right to what is health and health and wellbeing and happiness or whatever, or the right, but we don't have a technical right to healthcare. Now, president Biden often says it's a right.
Health Chatter
Access to Health Care
But if you go, if you have a legal scholar on here, there would be, there's no right. And until that is something that everybody agrees to, or we have some kind of, you know,
Health Chatter
Access to Health Care
amendment, which is, you know, it's very frustrating for people who work in the field because if it was a right, we'd have another lever, you know, to get, we'd get those people who are not covered into some kind of system of care.
Health Chatter
Access to Health Care
what it is that they have a right to and you know whether it's universal coverage or whatever it is and you know there's there's a part of our country that just does not like government um public programs per se and so the role expanding the role of government even increment even just incrementally like the affordable care act did it just a tiny
Health Chatter
Access to Health Care
you know, input into reducing the uninsured was just, you know, it's just been a huge lift and very controversial, but there's people who's like, I don't care if I'm uninsured. I don't want government public funded program. I want, you know, it's just a very, you have to remind them that their Medicare program is government.
Health Chatter
Access to Health Care
Well, if you're suffering a heart attack, You know, this is so terrible. I would, you know, have your loved one take you down to the ER. Once you're in the ER, they have to, there's a law that requires them to assess you. And if you are an emergency patient, If it's emergent, they have to treat you at the hospital. They can't transfer you or say we're not going to treat you.
Health Chatter
Access to Health Care
So if your heart attack is imminent, get you down there. Now, I kind of stopped short of saying take an ambulance because I'm thinking the ambulance would probably charge you for that ride. So if you need an ambulance, absolutely go get it.
Health Chatter
Access to Health Care
They have to get to an ER and then they'd assess whether it's emergent or non-emergent. And if it's not emergent, they can deny you care or send you down to HCMC, which does happen. So if it's non-emergent, you can go, if someone came to me and said, I'm having these heart issues, I'd say go to Westside Clinic or the Northside one. And that's a FQHC and get assessed by a primary care doc there.
Health Chatter
Access to Health Care
And they can help you with a treatment plan and figure out what you need to do.
Health Chatter
Access to Health Care
Well, and the ER does become the default for many people because it's open 24-7. It's open on the weekends. It's, you know, it's visit where you know a hospital has one.
Health Chatter
Access to Health Care
Well, I think... You know, we're kind of, I think the Affordable Care Act was probably the last federal piece of legislation that we're going to have for a long time. And so I think the next iteration or the next incremental changes, I think our healthcare system has, as I've learned over time, it's been, we make changes kind of incrementally.
Health Chatter
Access to Health Care
And that's, we make progress, but we also complicate the system more. So we build on what exists rather than fixing the problems and then changing them. So one of the reasons everything's so complicated is because you know, we add on to what we already have, but that's just the way it is. So, you know, so we expanded Medicaid. That's part of the Affordable Care Act.
Health Chatter
Access to Health Care
We established these marketplaces. And now it's like, okay, how can we like just open that up just a little bit more to add more people? You know, so we increase the eligibility levels or we open it up to additional people. So Minnesota just passed, not this year, but the prior legislative session, health insurance coverage, a Medicaid type program for undocumented.
Health Chatter
Access to Health Care
So that's, you know, for children and adults. So that's a huge incremental. Now, we don't get any federal money for that. That's a state only. Feds will not pay for undocumented people health care through Medicaid or through the marketplaces. So that's and there's about six or seven states who are doing that now saying these people are here. They're contributing to our economy.
Health Chatter
Access to Health Care
They're showing up in our ER without any health insurance. We're going to extend a program for them and pay for it. So there will be some premiums. There'll be some cost sharing, but that's, you know, so states are sort of like, where's the pockets?
Health Chatter
Access to Health Care
How can we address these pockets of uninsured and trying to, you know, trying to get those, you know, get those last people who are not covered into some kind of healthcare system.
Health Chatter
Access to Health Care
Well, in 2010, when it was passed, we had 50 million people uninsured. Now we have 30 million. So it reduced the uninsurance bite. It provided coverage for 20 million people, in essence. That's a lot. Yeah. So it's not a... it was a significant impact on our system.
Health Chatter
Access to Health Care
But we still have 30 million people and we accept that as a country.
Health Chatter
Access to Health Care
Well, I was just wondering, so there are... there are grants and support for what we call navigators or enrollment assisters and your community group should know that they exist. And there's a list with phone numbers and they can help, you know, explain the process and help you walk through the application process. And they, you know, that's something, um,
Health Chatter
Access to Health Care
that we should make sure the community groups get, because there is- And understand, Lynn.
Health Chatter
Access to Health Care
Well, a lot of times people start with health insurance coverage and that this is like the mechanism to get you in to see a doctor if you have health insurance coverage. And then you, so sometimes when people talk about access to care, they're talking about access to health insurance coverage.
Health Chatter
Access to Health Care
I agree. I think the Medicare program, I mean, I'm grateful for the Part D. So that's the prescription drug.
Health Chatter
Access to Health Care
And that's where we spend a lot of time in terms of using survey data and information to understand who's covered and by what type of health insurance and then who's not covered. And that's kind of the vehicle to get access. What you really care about is that people have access to a healthcare provider to get the care that they need.
Health Chatter
Access to Health Care
You know, it's wonderful, but you have to buy a separate plan. So it's, I've walked my dad through this, it just was almost impossible to sort through all that information and figure out the right thing for him to do.
Health Chatter
Access to Health Care
But again, there are a lot of resources. So senior language and there's a lot of resources again, but I take it.
Health Chatter
Access to Health Care
Well, that's a hard one. You know, maybe that, well, maybe that there are, There are people that are working on these issues that healthcare and healthcare financing, insurance access are complicated, but there are people who are devoted and dedicated to continuing to work towards universal coverage. And then students that are coming up in my program in public health are there. I mean, they are...
Health Chatter
Access to Health Care
they don't want any of this mess. Like they want things to change. And so I'm, I'm a little bit hopeful. I guess I thought we would be further along than we are now in terms of change. And
Health Chatter
Access to Health Care
you know, it's, it's, it's the way we do things in this country is incrementally it's complex, but there's also people that are, are, um, advocates and are working on it and you've got to find those networks and, you know, you can participate if you want.
Health Chatter
Access to Health Care
But usually, you know, I would say most people will start like, do you have health insurance coverage and what kind of health insurance coverage? And then who's in your network and who can you, you know, who do you have access to see when you need care?
Health Chatter
Access to Health Care
Thank you. Thank you for that summary. I think that's really it. And stay tuned. Hang in there and stay tuned. Very good. I couldn't, I couldn't.
Health Chatter
Access to Health Care
Yeah, and maybe I'll just preface to say that we have one of the more complicated health care systems in the world.
Health Chatter
Access to Health Care
That most, you know, most countries do provide universal access through different mechanisms. But we have kind of a patchwork of insurance and most people in this country don't. get their health insurance, especially under age 65, get their health insurance through their employer. So about 50% of people get coverage through their employer.
Health Chatter
Access to Health Care
And then you have your kind of supplemental coverage, which is Medicare, Medicaid. And then for those people who are working, but don't have access to employer sponsored insurance. So that could be like artists or self-employed people, or, you know, people who work on their own. They have access to what's called direct purchase.
Health Chatter
Access to Health Care
So that's just if you called up Blue Cross Blue Shield and said, I need a health insurance plan, what do you have to offer? So that's kind of the overview. And then, of course, we have the Veterans Administration's Indian Health Service, the military, TRICARE. And those are also important components, but probably less, not as many people. So-
Health Chatter
Access to Health Care
Yes, I would say the elderly and probably the disabled, the elderly and disabled. And many of those people, especially if they're poor, will be on either Medicare or Medicaid if they're poor. And those are where the high cost, high expense people are. And the public does provide public programs for their needs, Medicare and then Medicaid.
Health Chatter
Access to Health Care
Yeah. Yeah. Thank you for that question, Clarence. And I I missed one important part of our sort of coverage framework, which is there are about 8% of people across the country, which is, let me just check my number, 26 million who don't have health insurance coverage. And so there is what we call a safety net
Health Chatter
Access to Health Care
which provides free or low-cost care, and that's through federal and state funding, so federally qualified health centers or community health centers. We have rural immigrant programs, and then like HCMC, the public hospital, which is funded by state and federal grants and financing. And Medicaid does pay for some of those people in those programs, but they're very community-based, local-driven.
Health Chatter
Access to Health Care
And if you don't have health insurance, you should be able to find one of those and get either low-cost or no-cost care. Many of them don't provide access to specialist care, but they may be able to help you find somebody who would be willing to take somebody at a discount.
Health Chatter
Access to Health Care
Well, you know, I like to, I don't like to use the term single payer because it, it polarizes people.
Health Chatter
Access to Health Care
Single payer means, you know, government run, government sponsored health care. And there are some models. So, you know, England has a universal care program with public, funded by public dollars, and most of the health system is publicly supported. But there are also other systems where there's a combination of public and private entities.
Health Chatter
Access to Health Care
And so I like to refer to universal care and different ways to get to universal coverage or 100% coverage. There's different ways to get there. And I, you know, I, it's so hard to, I'm 100% supportive of universal coverage. And I think the United States could get there. But
Health Chatter
Access to Health Care
in this political environment and for the political environment we've had for many years now, it's just a huge roadblock to get there. So I'm 100% supportive. I was 100% supportive of Bernie Sanders, who was advocating for Medicare for all. I think there's different ways to get there. One thing I do I do kind of come back to is the states that have tried, single payer have done studies.
Health Chatter
Access to Health Care
So Vermont was kind of, states have advanced this and Minnesota kind of goes and fits and starts on a model of universal coverage. And Vermont was a state that went kind of ahead of all the other states. And the problem was, is that transferring private funded healthcare services to a public funded system requires an increase in taxes.
Health Chatter
Access to Health Care
And so when people see that explicit tax amount that costs are, you know, that would be needed to fund our healthcare system, right now our employers, so 50% of people get their insurance through employers. We call that private insurance, right?
Health Chatter
Access to Health Care
But they get a subsidy on that, on what they contribute to. There's a huge subsidy transfer to them, but we don't see it. It's like implicit. So even though we're, you know, it's tax supported in many, many ways, we don't think of it as tax supported. So as soon as you make that explicit and say, okay, private sector, you're not responsible for healthcare anymore.
Health Chatter
Access to Health Care
We're going to move it to the public domain. And then we have to raise the taxes. So the employer's maybe, you know, they in Vermont, it was like a 40% increase in employer taxes, because that's how much they contribute. And they get, you know, benefit from contributing to health insurance.
Health Chatter
Access to Health Care
So my, you know, my bottom line is, I don't want to lose that private sector contribution to our health care coverage, which is right now provided through employers. And in some ways, You know, it's not an economist speaking now, but I don't care if it's implicit.
Health Chatter
Access to Health Care
You know, sometimes we have to hide the taxes because we, you know, that is our foundation of our healthcare system is our employer-based healthcare. And it makes it complex and it's all, you know, I can hardly... describe the tax subsidy that they get, but it's really important that the private sector contribute to the cost of the system.
Health Chatter
Access to Health Care
And if we move it into a public domain, then it becomes a political issue and very explicit. And that's, the economists wanna reduce that tax deduction that the employers get to make it explicit, but, um, but then we have to pay for it and we have to vote on paying for it. And so, um, so I guess that's a long winded way of saying I'm supporting universal coverage.
Health Chatter
Access to Health Care
I don't want to lose the employer contribution to our health insurance coverage. And is there a way to get there, um, by, by sustaining that and, um, One answer is Germany. That's how Germany and maybe Austria supports their health insurance is by having employer mandate. Employers have to provide insurance. And then the government subsidizes the low income and people who are not working.
Health Chatter
Access to Health Care
So I think there's a way to get there. There's lots of different models. But I think for our country, you know, it's going to have to be, I don't know, a I don't know what, like a huge, a huge, I don't know what the word is, transformation or a huge shift or a huge outcry. Like it's time. And there are different parts, you know, there have been different moments, like maybe this is it.
Health Chatter
Access to Health Care
When there was a time when employers were like, we don't want to pay for healthcare. We don't understand it. It's too costly. The costs keep going up. And if employers start to sort of,
Health Chatter
Access to Health Care
bang the drum and you know other people advocates who have been there all the time you know there may be a point where we get some some movement and some outcry like this is and it feels like after COVID and now things are costs are still going up and you know so maybe I don't know
Health Chatter
Access to Health Care
At the end of my career, I'm thinking, probably not in my... I tell my students, maybe not in my lifetime, but hopefully in your lifetime.
Health Chatter
Access to Health Care
Well, you know, we... We leverage all the federal survey. There's about five or six federal surveys that provide information on health insurance coverage. And of course, they measure it all different ways and have different purposes. But we leverage that for mostly for state health policy, because at the federal level, and especially now, Congress, I mean, they don't do anything.