A current problem that Americans face each day is the affordability of health insurance. The number of individuals who are uninsured is continuously on the rise. The lack of health care coverage poses a threat to both the uninsured and the insured. The issue is having negative impacts on individuals and could soon cause problems within the government. The purpose of this essay is to examine the controversy of the uninsured and focus on the scholarship of the issue.

The number of uninsured is continuously growing in America. "A total of 82 million Americans…were uninsured at some point during 2002-2003" (Bodenheimer 556). However, not all of the 82 million were uninsured for an entire year. This statistic includes individuals who were uninsured for 6 months at a time or longer. Furthermore, individuals want the government to guarantee health care coverage but are not interested in increasing taxes to help put the plan into effect.

The idea for health insurance first started at the beginning of the twentieth century. Baylor University Hospital began this trend in 1929, causing other hospitals to soon catch on. This resulted in Blue Cross in 1932 "and forever changed the American health care system" (Wasley 12). However, throughout the years the costs have increased forcing the government to impose additional controls and regulations. Terree P. Wasley suggests that "the expansion of employer provided health care accentuated the medical needs of those without insurance" (13). Therefore, the uninsured pressured the government to create a health program that would be available to the unemployed. By 1965, the Medicaid program was created to ensure a health care program for additional individuals. Because of the various new procedures that were adopted the cost of health care is continuously on the rise. The government proposes more controls and regulations, which has not proven successful in the past.

As a result, one of the many groups that have been affected is small businesses. They are no longer able to afford health insurance for their employees. The reason for this increasing problem is the cost of health care coverage. According to the National Association for the Self-Employed, the cost of health care premiums is larger than ever, while the choices that insurance companies offer small businesses are limited. Small businesses are faced with fewer opportunities for health insurance that larger corporations are offered. Marc A. Cohen, Nanda Kumar, and Stanley S. Wallack argue that small businesses are not the only ones suffering. They respond that the elderly are also dealing with the affects of costly health care plans. The scholars state:

The elderly and their families pay about 50% of the costs of care, and the federal government and states through Medicaid programs pay about 42% of costs. Middle-income elderly, who do not qualify for Medicaid unless they impoverish themselves or transfer assets to establish Medicaid eligibility, face a potentially catastrophic expense when it comes to paying for LTC services (105).

Saundra H. Glover, Karl J. McCleary, Patrick A. Rivers, and Raymond A. Waller hold similar views to the NASE and Cohen et al. The scholars all concur that the issue is affecting numerous groups of people. Glover et al. explains that individuals from children to the elderly are placed in this category. The scholars state that the number of uninsured has increased by nearly nine million over the last four years. They point out that "83 percent" of the employed uninsured "make less than 200 percent of the federal poverty level for a family of three" (870). Marc Tunzi found his research to be very similar to Glover et al. He responds that 80 percent of the uninsured come from working families. These families often times do not make enough money to be able to afford health insurance but make too much to qualify for financial assistance.

Catherine Hoffman, Diane Rowland, and Alicia L. Carbaugh agree with NASE and Glover et al. arguing that one of the reasons for the large number of uninsured individuals is because employers are not able to provide health care benefits to their employees. Therefore, when individuals are unable to obtain insurance through employers they are forced to find insurance elsewhere. However, research shows that "…a $9,000 family policy in the individual market (if one were even available at the average employer group costs in 2003) would consume a third or more of their income" (Hoffman et al. 392). While Hoffman et al. holds a view that agrees with Bodenheimer their opinions differ concerning the exact number of uninsured. In the research performed by the group of scholars they find that nearly 44 million Americans are without health insurance. This number conflicts with the 82 million Americans that Bodenheimer found in his studies.

Likewise, the Institute of Medicine of the National Academies explains that there are various programs that have been made available for the uninsured; however, individuals do not take advantage of the opportunities because they are not aware that they are eligible. For example, Medicaid offers insurance without prior payment. "In 2001, an estimated 5.26 million children were eligible…but not enrolled" in the programs being offered (Institute of Medicine of the National Academies 45). There is an enormous amount of uncompensated care being used by the uninsured. The Institute of Medicine of the National Academies argues that, hospitals have approximately "$20.8 billion" that individuals owe them but are unable to pay (49). The government, taxpayers, and health care providers are responsible for the cost for individuals who can not afford health insurance.

According to the Institute of Medicine of the National Academies, in a book titled, "Insuring America's Health," one's life expectancy is shorter if the individual is not insured: "For example, uninsured women with breast cancer have a risk of dying that is between 30 and 50 percent higher than the risk for women with private health insurance…even when the cancer is diagnosed at similar stages" (46). This is a result of fewer doctor visits and not receiving continuous care from a doctor. Consistent with the Institute of Medicine of the National Academies' view on the life expectancy of the uninsured, Marc Tunzi suggests that individuals who do not carry health insurance are less likely to receive medical care resulting in severe illnesses. This is caused by a variety of factors including, a later diagnosis of the illness and the likelihood of being admitted (1357). Therefore, health insurance is something that not only the individual benefits from but the whole community benefits from because it allows the entire community to be healthier.

There are three types of health care coverage: Medicaid and Medicare, employer provided insurance, and private insurance. Thomas Bodenheimer agrees with Hoffman, et al. and the Institute of Medicine of the National Academies. He responds that Americans believe the government should endorse a plan that allows all individuals health care coverage; however, no one wants taxes increased to make sure of it. Janet D. Perloff points out that Congress has created Title XXI or the State Children's Health Insurance Program hoping to limit the number of children without health insurance. This program has given families another option for health care coverage. Perloff shares the same opinion as the Institute of Medicine of the National Academies. She explains "many children who are eligible for state Medicaid programs are not enrolled" (516). Therefore, the "lack of health insurance coverage limits children's access to health care services and compromises the health Status of children" (Perloff 517). This example by Perloff agrees with the book, "Insuring America's Health." Both scholars strongly believe that an individual's life expectancy is shorter when that individual does not have some type of health care coverage.

The number of individuals without health insurance has increased by 2.4 million people from 2001 to 2002. As earlier scholars pointed out there are numerous groups that are being affected by this problem. It is not only the unemployed and poor Americans who worry about being uninsured. According to Tunzi, the number of men without health insurance is 23 million while the number of women without health insurance is 20 million. Furthermore, the Caucasian population consists of more uninsured individuals than any other racial group. Tunzi suggests that "the group least likely to have health insurance comprises adults 18 to 24 years of age; approximately 8.1 million persons (30 percent) in this age group lack health insurance" (1357).

Furthermore, there are several programs that have been created in order to facilitate Americans in obtaining health care coverage. For example, Tunzi suggests that Medicaid was responsible for insuring 14 million individuals in the year 2002. He states, "10.5 million persons who were at or below 100 percent of the federal poverty level were not covered" (1357). Hoffman et al. shares Tunzi's view concerning the use of Medicaid and Medicare. According to Hoffman et al., "Medicare covers virtually all elderly individuals, 35 million aged 65-and-older, and another 6 million persons with disabilities" (390). Therefore, because programs like Medicaid and Medicare cannot cover every individual it results in the continued problem of health care coverage.

President Bush and John Kerry have both proposed strategies in order to help lower the cost of health care coverage. Both candidates also anticipate new plans that would provide an additional way for Americans to obtain health care coverage. A solution suggested by Wasley, "is to allow a system based on the market, one that offers citizens maximum freedom of choice and responsibility in purchasing their health care" (16). In order for John Kerry's plan to be a success the public must be better informed of the State Children's Health Insurance Program. Furthermore, educating the public would provide useful information concerning the plan explaining exactly which individuals qualify for the program.

The majority of scholars generally agree that health care coverage in America is not meeting the needs of American people. The scholars' views may differ concerning the better solution but their opinions are similar concerning the fact the issue of the uninsured is something that needs to be dealt with. The scholars are very eager to find solutions in order to help solve the problem.

"Affordable Health Care: Conditions Critical for Self-Employed, Study Shows." NASE. 18 June 2002. National Association for the Self-Employed. 10 Oct. 2004 <http:// news.nase.org/>.

Bodenheimer, Thomas. “Insuring the Uninsured: Will the 2004 Election Provide an Answer?” Annals of Internal Medicine 141.7 (2004): 556-61.

Cohen, Marc A., Nanda Kumar, and Stanley S. Wallack. “New Perspective on the Affordability of Long-term Care Insurance and Potential Market Size.” The Gerontologist 33.1 (1993): 105-13.

Glover, Saundra H., Karl J. McCleary, Patrick A. Rivers, and Raymond A. Waller “The Rising Number of Uninsured Americans: How Adequate is our Health System?” International Journal of Social Economics 30.8 (2003): 867-82.

Hoffman, Catherine, Diane Rowland, and Alicia L. Carbaugh. “Holes in the Health Insurance System-Who Lacks Coverage And Why.” The Journal of Law, Medicine & Ethics 32.3 (2004): 390-96.

Institute of Medicine of the National Academies. Hidden Costs, Value Lost. Washington: The National Academies P, 2003.

---, Insuring America’s Health. Washington: The National Academies P, 2003.

Perloff, Janet D. “Insuring the Children: Obstacles and Opportunities.” Families in Society 80.5 (1999): 516-25.

Tunzi, Marc. “The Uninsured.” American Family Physician 69.6 (2004): 1357-360.

Wasley, Terree P. “Health Care in the Twentieth Century: A History of Government Interference and Protection.” Business Economics 28.2 (1993): 11-16.

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