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47 Million Stories

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By now, we all know the number. Forty-seven million without health insurance, with that number likely to grow.

And with the presidential election campaign gearing up, anyone interested in the issue will be able to pick and choose from a selection of disturbing statistics that all point to one troubling fact: The number of uninsured has been increasing since around 2000.

No one can doubt the scope and immediacy of the problem. They become evident in any enlightened conversation on the issue, such as the recent public hearing on state health care concepts that took place during the spring meeting of the National Association of Insurance Commissioners.

Sitting through that hearing, I wondered how we will ever sift through such a complex morass of issues. But on reflection, I think the answer starts with thinking simple.

Listening to the discussion, I found myself getting caught up in the numbers and the details of various proposals. The thread of the dialogue made sense. Intellectually, I understood the need to do something. But I still wasn’t getting that gut feeling of urgency.

So I tried to think of 3 people I know who lack health insurance coverage. It took about 2 seconds: the lady I used to get my coffee from; a waiter acquaintance who put off needed dental work until he could stash away enough to get the job done; and a dance instructor who found out what it meant to be without coverage when a New York cabbie took a corner too tightly and squashed the poor guy’s toes.

In the case of these 3, things happen to have turned out well enough: The coffee lady remains fit, jogging regularly; the waiter is getting his teeth done; and the dance instructor’s toe crunching was just a brush relegating him temporarily to wallflower status.

But the threat of going bare on coverage still looms for them and the others in that 47 million count. I wondered how many in the room of about 200 people could also count off 3 people they know who don’t have coverage. I bet most could come up with 3 without too much effort or had crossed paths with at least 3 who lack health insurance.

If feeling the urgency is the first, simplest step in facing the problem, communicating consumer options is a second step.

That need was discussed by Michael Wroblewski, a representative with Consumers Union, Yonkers, N.Y. He described the disconnect between the health care options consumers are asked to choose from and their basic understanding of coverage limits, and questions to ask.

Consumers are “most engaged” when they are getting a premium quote that is easy to understand, he said.

After feeling the urgency and getting consumers to feel engaged, a third simple step is to break the problem down into smaller pieces.

I think this is where states can, and often do, shine. If ever there was a case to be made for state authority, this is it. State authorities understand the particular needs of their own citizens.

In a handout offered by Cathy Schoen, a representative with the Commonwealth Fund, New York, innovation in the states surfaced throughout.

Among those initiatives were the Massachusetts and California health plan proposals and Vermont’s new plan targeting individuals without access to work-based coverage. The Vermont plan is the result of enactment of the Health Care Affordability Act last May. Illinois just started an All-Kids program available to any child uninsured for 12 months or more.

Whether these proposals and plans ultimately provide the solution or whether they lead to another, more permanent solution or solutions is still unclear. But what is more certain is that they are a good start to ensuring that more of the 47 million stories out there have favorable endings.

Jim Connolly

Senior Editor