There’s been lots of quotes regarding the latest Census data, including our comments in Victora Colliver’s article in the San Francisco Chronicle.
But the one that has gotten the most attention are those of John Goodman, speaking to the Dallas Morning News.
California still has the highest number – not percentage – of uninsured residents at 6.7 million, compared with 5.7 million Texans. The Texas number is up from 5.5 million in 2006.
But the numbers are misleading, said John Goodman, president of the National Center for Policy Analysis, a right-leaning Dallas-based think tank. Mr. Goodman, who helped craft Sen. John McCain’s health care policy, said anyone with access to an emergency room effectively has insurance, albeit the government acts as the payer of last resort. (Hospital emergency rooms by law cannot turn away a patient in need of immediate care.)
“So I have a solution. And it will cost not one thin dime,” Mr. Goodman said. “The next president of the United States should sign an executive order requiring the Census Bureau to cease and desist from describing any American – even illegal aliens – as uninsured. Instead, the bureau should categorize people according to the likely source of payment should they need care.
“So, there you have it. Voila! Problem solved.”
Amazing…a McCain advisor wanting to simply define away the uninsured… in a just world, that should get a public rebuke worse than Sen. Gramm suggesting that America was only going through a “mental recession.”
But even these rebukes don’t actually explicitly refute the misconception that Goodman’s comments are based on–so I will. Yes, Health Access California was founded 20-years ago, from a coalition working for a law that people are not turned away from emergency rooms based on insurance status. The eventually-passed federal version of that law, EMTALA, is important, but let’s be clear what it does, and doesn’t do:
* The law only requires emergency rooms to stabilize patients, not treat them. If you just had a car crash or heart attack, they will treat you, but if have cancer, asthma, diabetes, or any other long-term illness, there’s no obligation by the hospital.
* Even in an emergency situation, there’s no prohibition on what the hospital can charge. And in fact, the uninsured is often charged 2-4 times what insurance companies and public programs pay for the exact same service. That’s the bill they get.
So even our EMTALA law does not ensure access to care, and certainly not *coverage* for care. People need care, and they need coverage to pay the bills. And the Census figures show a staggering number of people who have neither.
The irony is that the Census figures do have a “voila” moment. It shows that policy matters: states like Hawaii, Massachusetts, and Minnesota–that have set standards for employer based coverage, or have expanded public programs–have significantly lower uninsured rates in comparison to other states.
We know what we need to do to say “Problem solved!” But it’s not by sweeping it under the rug.