For decades the dividing line in the health care debate has been whether health care should be delivered through the government or through the private sector. This issue has been debated and bandied about from the times of Goldwater and Kennedy and the debate lives on today. Two key questions today: Should government-based health care programs serve as a safety net for the nearly 46 million individuals in America who do not have health insurance? And should government-based health care be available for purchase by the working population not covered by employer-based care?

This article focuses on the naive idea that government-provided health care reduces costs. It would appear that President Obama’s push for comprehensive health care reform will actually result in an expansion of Medicaid, Medicare and State Children’s Insurance Programs to a varying degree, thus resulting in increased costs. Meanwhile, it does not appear that Americans want or believe they can afford universal coverage for each individual residing in America.

Interestingly, the number of Americans getting health insurance from Medicaid increased from 38.3 million in 2006 to 39.6 million in 2007 according to Steven Reinberg in a recent article in U.S. News and World Report. The article points out that over the same period, the number of uninsured dropped by about the same number, the first decline in the number of uninsured in 7 years.

The recent stimulus package passed overwhelmingly by the U.S. Congress and signed into law by President Obama appropriated 87 billion dollars for Medicaid programs in all 50 states for a two year and three month period of time ranging from October 2008 through December 2010 according to Vernon Smith, the former Michigan Medicaid Director and a principal at Health Management Associates in Lansing Michigan.

Catherine Hoffman, ScD, a Henry J. Kaiser Family Foundation researcher, states that private health insurance is the primary source of health insurance for approximately 65% of Americans under 65 years of age. She notes the percentage of individuals with private health insurance coverage is dwindling. Also, the states with the highest uninsured rates are those states with the lowest rates of private health insurance coverage. Hoffman states, “Data from the current survey does show the percentage of the nonelderly population that is uninsured is increasing largely because of the decline in employer-sponsored insurance.”

When I served Governor John Engler of Michigan as a Health Care Advisor in the early 1990s, we learned that a large number of the uninsured work full time or part time or are a spouse or child of a person working full time or part time at a business with less than 50 employees. We learned that the working status of the uninsured does not comply with the perception generally held by the public. At that time, data from the population survey showed 62% of the uninsured worked 30 or more hours, 27.4% were unemployed, 9.2% worked 10 to 29 hours per week, and 1.3% worked 1 to 9 hours per week in the state of Michigan.

Nearly two decades later, in a recent Families USA report, “Americans at Risk”, data from the March 2009 Current Population Survey and Medical Expenditure Panel Survey documents that about 79% of those without health insurance in 2007-2008 were from working families, nearly 70% of those defined as uninsured were from families with a worker who was employed full time and 9.5% from families with a worker employed part time.

Another piece of the health care puzzle is that an estimated 12 million illegal immigrants reside in the United States—that is at least 2 times the number of people living in the state of Indiana. While illegal immigrants are not eligible for coverage through Medicaid or public benefits, immigrants can access health care through federally qualified community health centers. Studies show that 15% to 22% of the uninsured in America are illegal immigrants.

California is spending over 1 billion dollars for coverage for illegal immigrants who have no health insurance. A Florida Hospital Association survey of 28 hospitals found health care for illegal aliens exceeded $40 million. In states like Arizona and Texas, the costs are high. The Texas comptroller estimates the cost of health care for illegal immigrants was $1.3 billion in 2006. The stakes of the health care reform are steep.

Did you know that a large share of uninsured Americans are age 18-24, feel healthy and do not want to spend money on health care insurance? These younger Americans roll the dice and go without health insurance. When they do get sick or have an accident, we all pay for it through higher costs at the hospital and higher premiums on our insurance. It’s what California Governor Schwarzenegger calls “the hidden tax.” Do we mandate that these elements of the population have to get health care insurance? Who pays for it?

Persistently rising health care costs are why many employers are dropping coverage, lessening coverage or simply not offering workers health insurance coverage. Rising health care costs heighten the plight of the uninsured. Health care costs will be addressed in my next article.

Mark Hurt is an attorney in north central Indiana who served as Health Care Advisor to Congressman Fred Grandy (R-IA), U.S. Senator Dan Coats (R-IN) and Governor John Engler (R-MI). Mark Hurt can be reached at .

Matthew Tetrault