Florida's hidden problem: the uninsured citizens.

• Author: Bell, William A.
• Position: Florida

Over the past 30 years, various health care "crises" have occurred. In each case, government has targeted public policy on solving the particular access, cost containment, or quality problem. As a result, the scope and practice of health care law today has expanded greatly and now affects a broad range of topics including advance directives; AIDS; antikickback; antitrust; bankruptcy; disability; emergency care; employment; fraud and abuse; home health care; individual rights; insurance; licensure; managed care; medical malpractice; medical records; medical staff; Medicare; mergers; product liability; professional rights; reproductive rights; and tax.

Another component of health law includes an issue that continues to trouble policymakers, experts, and practitioners as well. This unsolved problem is the uninsured. One public policy strategy has been to require that hospitals take care of the uninsured under the auspices of the Hill-Burton Act,[1] the Emergency Access laws,[2] and the Public Medical Assistance Trust Fund.[3] The effectiveness of this direction is limited for several reasons. It requires other insured hospital patients to share in the cost of care of the uninsured. It only assists uninsured patients who require hospital care because they have serious, acute symptoms. This lack of effectiveness of past strategies has been augmented by the absence of any public interest. Health care access and coverage solutions slipped from the governmental policy agenda with the demise of the national debate on health care reform in 1994. Although public attention may have diminished, the lack of health care coverage has only increased.

2.6 Million Floridians Without Health Insurance

A major problem facing Florida is the growing number of Floridians without health insurance coverage. Florida's uninsured population grew to 2.6 million in 1995, up from 2.2 million in 1989. Approximately 25 percent of these uninsured are children. This situation is only going to get worse. If Florida's growth in the uninsured parallels the national trend, 3.2 million or 25 percent of Floridians under 65 years of age will be uninsured by 2002.[4]

Coverage Decline

Health insurance coverage is declining in Florida for a number of reasons.

* Rising health care costs have reduced the affordability of health insurance.

* Some employers have discontinued offering health insurance to their employees. Other employer cost-saving strategies, such as greater sharing of...