Access to health care for the uninsured: the perspective of the American Academy of Family Physicians

In the United States today, over 37 million people (12 percent of the population) are not covered by any form of health insurance. Consequently, these individuals are unlikely to seek medical care until their health deteriorates significantly. Due to their inability to pay for needed medical services, they are more likely to generate bad debts or require charity, and they are more likely to die from complications arising from limited access to health care. The majority of the uninsured are poor and working-class people who are not covered by Medicaid (only about 40 percent of the population with incomes below the federal poverty level are covered by this program). The American Academy of Family Physicians (AAFP) has presented a prototype plan for restructuring the health insurance system which would, according to its analysis, significantly improve access to health care for low- and middle-income families, while sharing the economic burden more or less equally between the private and public sectors. The fundamental changes required by the AAFP plan would be a requirement that all employers (with more than a predetermined minimum number of employees) provide health coverage for their full-time employees, and Medicaid would be expanded to allow full coverage for individuals and families with incomes up to 100 percent of the federal poverty level. Persons with incomes between 100 and 200 percent of the poverty level would be given a buy-in opportunity with a sliding subsidy based on income. The cost of implementing this program is estimated to be $18.3 billion (exclusive of administrative costs). It would cover approximately 83 percent (26.7 million) of the adults and children who are currently without medical insurance. (Consumer Summary produced by Reliance Medical Information, Inc.)