Senate Democrats

Why We Must Act: Senate Democrats Make the Case for Health Reform

While Senate Republicans debate arcane parliamentary procedure, Senate Democrats have are focused on improving health care for all Americans.  Democrats, like most Americans, want to ensure that those who like their current coverage can keep it, while ensuring that all American families have access to quality, affordable health care.  Democrats know that for our economy to truly recover and prosper, we must help middle-class families and businesses cope with skyrocketing health care costs.  Rather than becoming distracted by process, Senate Democrats are focused on the case for health reform, and they, like millions of Americans, know we must act.

Why We Must Act: Eight Years of Inaction Contributed to High Costs and a Rising Number of Uninsured

Skyrocketing health care costs are contributing to the current economic crisis, weighing heavily on family, business and government budgets.  As highlighted in a report recently released at HealthReform.gov, “The Costs of Inaction,” inherited flaws in our health care system have led to higher health care costs, reduced access to care, and inconsistent quality of care throughout the country.[1] 

High health care costs.  In 2007, the United States spent approximately $2.2 trillion on health care, about $7,421 per person or 16.2 percent of the Gross Domestic Product (GDP), with federal spending on Medicare and Medicaid accounting for 4 percent of GDP.[2][3]

Rising health care costs are not only affecting federal health expenditures, they are also squeezing family budgets.  Health insurance premiums have doubled in the past eight years and, when combined with increasing out-of-pocket costs like co-payments and deductibles, more Americans than ever struggle to afford the health care they need.[4]  Increasing medical costs contribute to bankruptcies, foreclosures, and burden American businesses trying to remain competitive in the global economy. [5][6][7]  In addition, a recent Kaiser Family Foundation tracking poll found that, within the past year, high health care costs have led six in ten Americans to delay or skip medical care.[8]

Cost is the major barrier to American small businesses offering health benefits to their employees.  One survey found that three-quarters of small businesses that did not offer benefits cited high costs as the reason, with high administrative costs for servicing a very small group of insured individuals greatly contributing to those high costs.[9][10]

Reduced access to care.  In the past eight years, an additional 6.9 million Americans have lost their health insurance coverage, and 45.7 million Americans are now uninsured.[11]  During the past two years, approximately 87 million people were uninsured at some point.[12] 

Furthermore, nearly 160 million Americans with employer-based health insurance are only a pink slip away from losing their coverage.  Every one percentage point increase in the unemployment rate is associated with an increase of more than one million uninsured.[13] 

Having a job, however, does not guarantee access to health insurance, as more than 80 percent of the uninsured are in working families, and nearly one-third of the uninsured, about 13 million Americans, work for small businesses with less than 100 employees.[14][15] 

While having health insurance does not necessarily guarantee access to health care, research shows that health insurance status is associated with regular access to health care.  According to the Centers for Disease Control and Prevention, in 2006, 3.2 percent of insured children did not have a usual source of health care, compared to 33.3 percent of uninsured children who lacked this access to care.[16]  More than 50 percent of uninsured adults did not have a usual source of health care, while just less than 10 percent of insured adults lacked a usual source of care.  And, according to a report by the Urban Institute, 22,000 uninsured adults die prematurely each year as a direct result of their lack of insurance.[17]   

Inconsistent quality of care.  Even for those Americans fortunate to have health insurance, our health care system does not provide the consistent, quality care they need and deserve, nor does it accurately reflect the $2.2 trillion annual investment we make.  In 2004, the last year for which complete data are available, the United States ranked 29th in the world in infant mortality.[18]  And, the U.S. infant mortality rate remained essentially unchanged between 2000 – 2005, at approximately 6.86 infant deaths per 1,000 live births.[19]  

As reported in a 2003 RAND Corporation study, and highlighted by Senator Baucus’ “Call to Action,” adults receive just 55 percent of recommended care.[20]  This same study found that adults with diabetes received just 45 percent of the care they require.  This finding supports the belief that our health care system must do a better job in coordinating care for patients with chronic diseases.  For example, a recent report found that if every state achieved the diabetes control levels of the top four best performing states, at least 39,000 fewer patients would have been admitted to the hospital for uncontrolled diabetes, savings as much as $126.7 million annually.[21]

Democrats Make the Case for Health Reform

As the health reform debate progresses, Democrats will continue to focus on ensuring quality, affordable health care for every American.  Democrats are committed to achieving health reform because:

  • Being uninsured is hazardous to your health.  In 2006, 22,000 people died because they did not have health insurance.[22]
  • Allowing your neighbors to be uninsured is hazardous to your economic health – In America today, having health insurance does not mean our health care system is working for you.  The fact is, when the uninsured cannot pay for the health care they desperately need, health care providers shift those costs to those who can pay.  A recent study estimates that in 2009, premiums for family coverage were 8 percent higher – a national average of $1,100 – due to the cost shift from the uninsured.[23] 
  • Americans do not receive the health care they need – In July 2007, former President George W. Bush restated one of the myths about the American health care system: “I mean, people have access to health care in America.  After all, you just go to an emergency room.”[24] 

As a recent report by the New America Foundation highlights, physicians are required by law to stabilize patients in an emergency, but they are not required (nor do many have the time or resources) to treat a patient’s condition in a comprehensive manner.[25]  And, with one in six Americans postponing or skipping medical care due to high costs, these Americans are not receiving the care they need, and are more likely to require emergency medical care.

  • As a nation, we cannot afford our current system.  In 2007, the United States spent a total of $2.2 trillion on health care, just over 16 percent of GDP, and the Congressional Budget Office (CBO) estimates that federal spending on Medicare and Medicaid was approximately four percent of GDP.[26]

If Congress does not act, total health care spending will consume 25 percent of total GDP in 2025, just 16 years from now, while federal spending on Medicare and Medicaid will balloon to seven percent of GDP during that time period.[27]

  • As individuals, we cannot afford our current system.  In 2007, one-third of Americans spent 10 percent of their annual income on health expenses, a marked increase from 2001, when just 21 percent of adults were forced to dedicate such a high proportion of their income to health care bills.[28]  One study estimates that, unless Congress acts, by 2016, at least half of American families will have to spend more than 45 percent of their annual income to purchase health insurance.[29]

As noted above, medical costs contribute to bankruptcies and foreclosures.  Half of all Americans filing for bankruptcy in 2001 – 2 million people – pointed to medical costs as a reason for their filing.[30]

  • Health reform is critical to economic recovery.  The U.S. economy lost as much as $207 billion in 2007 due to the poor health and shorter lifespan of the uninsured.[31]  Using this estimate, our economy lost $4,541 per uninsured American, which most analyses place well below the cost of providing the uninsured with health insurance.
  • The American public supports reform.  A recent, nationwide poll found that, despite our troubling economic times, 59 percent of Americans believe health reform is now more important than ever.[32]

Senate Democrats recognize that Americans are suffering, physically and financially, as a result of our current health care system, and that we cannot waste time on meaningless procedural debates.  Democrats will continue to make the case for health reform, advance the debate on options for reform, and remain focused on the health care needs of American families and businesses.



[1]      HealthReform.gov, “The Costs of Inaction: the Urgent Need for Health Reform,” (March 2009), available at http://www.healthreform.gov/reports/inaction/inactionreportprintmarch2009.pdf.

[2]      Office of the Actuary, Centers for Medicare and Medicaid Service, U.S. Department of Health and Human Services, “National Health Expenditures 2007 Highlights,” available at http://www.cms.hhs.gov/NationalHealthExpendData/downloads/highlights.pdf.

[3]      P.R. Orzag, “Growth in Health Care Costs: Statement before the Committee on the Budget,” (January 31, 2008), available at http://www.cbo.gov/doc.cfm?index=8948.

[4]      The average annual premium cost for family health coverage in 2008 was $12,608, compared with $6,438 in 200. Kaiser Family Foundation and Health Research and Educational Trust, “Employer Health Benefits 2008,” (2008), available at http://ehbs.kff.org/pdf/7790.pdf.

[5]      C.T. Robertson, R. Egelhof, and M. Hoke, “Get Sick, Get Out: The Medical Causes of Home Foreclosures,” Health Matrix, 18 (2008): 65-105, available at http://works.bepress.com/christopher_robertson/2.

[6]      E. Warren, “Sick and Broke,” Washington Post, February 9, 2005.

[7]      L. M. Nichols and S. Axeen for the New American Foundation, “Employer Health Costs in a Global Economy: A Competitive Disadvantage for U.S. Firms,” (May 2008).

[8]     Kaiser Family Foundation, “Kaiser Health Tracking Poll – - April 2009,” (April 2009), available at http://www.kff.org/kaiserpolls/posr042309pkg.cfm

[9]      Holve E, Brodie M, Levitt L, “Small business executives and health insurance: Findings from a national survey of very small firms,”  Managed Care Interface, 2003;16(9):19-24.

[10]   Congressional Budget Office, “CBO’s Health Insurance Simulation Model: A Technical Description,”  (October 2007), available at http://www.cbo.gov/ftpdocs/87xx/doc8712/10-21-HealthInsurModel.pdf.

[11]    U.S. Census Bureau, “Health Insurance Coverage: 2007,” available at http://www.census.gov/hhes/www/hlthins/hlthin07/hlth07asc.html.

[12]    Families USA, “Americans at Risk: One in Three Uninsured,” (March 2009), available at http://www.familiesusa.org/assets/pdfs/americans-at-risk.pdf).

[13]    S. Dorn et al for Kaiser Commission on Medicaid and the Uninsured, “Medicaid, SCHIP, and Economic Downturn: Policy Challenges and Policy Responses,” (April 2008), available at http://www.kff.org/medicaid/upload/7770.pdf.

[14]    Kaiser Family Foundation, “The Uninsured:  A Primer, Key Facts About Americans Without Health Insurance,” (October 2008), available at http://www.kff.org/uninsured/upload/7451-04.pdf

[15]    Current Population Survey March 2008.

[16]    National Center for Health Statistics, “Health, United States, 2008 With Chartbook,” (2009), available at http://www.cdc.gov/nchs/data/hus/hus08.pdf#079.

[17]    S. Dorn, “Uninsured and Dying Because of It: Updating the Institute of Medicine Analysis on the Impact of Uninsured on Mortality,” (January 2008), available at http://www.urban.org/UploadedPDF/411588_uninsured_dying.pdf.

[18]   M. F. MacDorman and T.J. Mathews, “Recent Trends in Infant Mortality in the United States,” (October 2008), available at http://www.cdc.gov/nchs/data/databriefs/db09.htm#ref5.

[19]    Ibid.

[20]   E. McGlynn, et al, “The Quality of Health Care Delivered to Adults in the United States,”  New England Journal of Medicine 2003;348:2635-45, available at http://content.nejm.org/cgi/reprint/348/26/2635.pdf.

[21]    Agency for Healthcare Research and Quality, “2007 National Healthcare Quality Report” (February 2008), available at http://www.ahrq.gov/qual/nhqr07/nhqr07.pdf.  

[22]   S. Dorn, “Uninsured and Dying Because of It: Updating the Institute of Medicine Analysis on the Impact of Uninsured on Mortality,” (January 2008), available at http://www.urban.org/UploadedPDF/411588_uninsured_dying.pdf.

[23]   B. Furnas and P. Harbage for the Center for American Progress, “The Cost Shift from the Uninsured,” (March 2009), available at: http://www.americanprogressaction.org/issues/2009/03/pdf/cost_shift.pdf.

[24]   D. Froomkim, “Mock the Press,” Washington Post (July 11, 2007), available at http://www.washingtonpost.com/wp-dyn/content/blog/2007/07/11/BL2007071101146_pf.html.

[25]   New America Foundation, “The Case for Health Reform: The Moral, Economic, and Quality Motives for Action,” (February 2009), available at

[26]   P.R. Orzag, “Growth in Health Care Costs: Statement before the Committee on the Budget,” (January 31, 2008), available at http://www.cbo.gov/doc.cfm?index=8948.

[27]   Ibid.

[28]   S. R. Collins, J. L. Kriss, M. M. Doty, and S. D. Rustgi for The Commonwealth Fund, “Losing Ground: How the Loss of Adequate Health Insurance Is Burdening Working Families: Findings from the Commonwealth Fund Biennial Health Insurance Surveys, 2001-2007,” (August 2008), available at http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2008/Aug/Losing-Ground–How-the-Loss-of-Adequate-Health-Insurance-Is-Burdening-Working-Families–8212-Finding.aspx

[29]   S. Axeen and E. Carpenter for the New America Foundation, “The Cost of Doing Nothing: Why the Cost of Failing to Fix Our Health System is Greater than the Cost of Reform,” (November 2008), available at http://www.newamerica.net/publications/policy/cost_doing_nothing.

[30]   D. U. Himmelstein, E. Warren, D. Thorne, and S. Woolhandler, “MarketWatch: Illness and Injury as Contributors to Bankruptcy,”  Health Affairs, (February 2, 2005).

[31]    S. Axeen and E. Carpenter for the New America Foundation, “The Cost of Doing Nothing: Why the Cost of Failing to Fix Our Health System is Greater than the Cost of Reform,” (November 2008), available at http://www.newamerica.net/publications/policy/cost_doing_nothing.

[32]   Kaiser Family Foundation, “Kaiser Health Tracking Poll – - April 2009,” (April 2009), available at http://www.kff.org/kaiserpolls/posr042309pkg.cfm.

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