STOP Obamacare in Pennsylvania and the Uninsured

I came across this page on Facebook which seems at first glance to the novice to be diametrically opposite to the PUSH Facebook page.  Obamacare is not really single payer.  It does require everyone to purchase private health insurance but those who cannot have to pay a $20 fine.  It does not really guarantee universal coverage.  Also it is the for profit nature of the US health care system that drives up costs, not what is detailed in this group's page such as law suits and the unfettered free market. 

STOP Obamacare in Pennsylvania

The link to the group's webpage on the group's Facebook page has an analysis of the issue by a Dr. Nicholas Pandelidis in York, PA.  He begins by acknowledging the uninsured but only cites 2007 Census Bureau estimates of 47 million (it was really estimated to be 44 million in 2007) or 16% (it was estimated to be 14.7% in 2007) of the population before the recession instead of the estimated 49.9 million or 16.3% from 2010.  

Pandelidis also cites a 2008 study from the CDC which found that change in employment as the main factor in being uninsured for 24% of them.  This seems plausible although this data was also collected before the recession and the problem of unemployment is definitely worse now.  He cites another study from AHRQ (Agency for Healthcare Research and Quality) which was also conducted before the recession and estimated that 55% of 18-24 year olds were uninsured for at least one month while "only" 18.2% were for four years.  This study reports that 11.1% in this age group were for four years.  Not mentioned by Pandelidis was that there were higher percentages in the other age groups of long term uninsured of 2 years or more.


Dr. Pandelidis then cites a 2009 paper from Baruch College at CUNY.  This paper also erroneously states that 2006 Census Bureau estimates of the uninsured were 47 million or 16% of the population (rather than 45.2 million and 15.3% according to their site).  The authors of this study also define those who are uninsured and have incomes above the poverty line as "voluntarily uninsured."  I believe it would be better to ask the uninsured directly if they choose to not have insurance.  They can have other expenses which may prevent them from purchasing insurance such as mortgages and student loans.


One study that is not mentioned by Dr. Pandelidis is from Harvard (It is a cheap trick in hiding behind the name of an institution to give a study legitimacy.) which estimated that there are an estimated annual 45,000 deaths in the US each year from a lack of insurance after adjusting for things like obesity, smoking, and poverty.  

Pandelidis talks about the usual conservative talking  points on health care such as tort reform and competition which will be discussed later. 


**Related Posts**

Teapartiers sandbagged by health insurers | MollyRush's Blog and a calculation mortality rates for lack of insurance.

 

Questioning Effectiveness

Questioning Effectiveness

To save both lives and money, most countries with single payer health care systems support, or at least monitor, research on the cost-effectiveness of drugs and medical procedures. One of the less well known provisions of the Affordable Care Act is a plan to support comparative effectiveness research. The bill creates a Patient-Centered Outcomes Research Institute, a nonprofit organization charged with conducting research on the comparative cost-effectiveness of various medical treatments and making recommendations to health care providers.

An Associated Press article reports that, beginning in 2012, the government will collect a fee of $1 per person from health insurance companies to cover the cost of the new agency. The fee goes up to $2 in 2013, and rises with the inflation rate in subsequent years.

I can remember a time when virtually everyone agreed that program evaluation—now called comparative effectiveness research—was an important scientific endeavor. Why should anyone suffer through and pay for a drug or medical treatment that doesn't work? If two treatments are equal in effectiveness, shouldn't only the cheaper one be covered by insurance? By coincidence, today's newspaper has two articles implying that current evaluation research is inadequate. All-metal hip replacement implants are breaking down after a few years, causing endless suffering to those who have received them. And Chantix, a quit-smoking drug that is only slightly better than a placebo, apparently has adverse side effects that include violence, depression and suicide. (“The good news, Mrs. Obama, is that your husband has quit smoking . . .”)

But the consensus over evaluation research began to break down when American corporations and their friends in the Elephant Party declared “war on science.” Although its origins can be traced to the 1960s “debate” over the health effects of cigarette smoking, the war began in earnest about a decade ago. As a result, many Americans believe that scientific research is inevitably biased, that scientists discover non-existent problems just to supplement their incomes, and that the consensus conclusions of experts are just another opinion, no better or no worse than, say, Rush Limbaugh's opinion.

Combine this with a distrust of government and you get claims like that of the Elephant beauty queen Sarah Palin that the Jackass Party is trying to set up “death panels” to ration medical care. (Yes, Gov. Palin, health care is being rationed, but not by the government.) In the current political environment, there is a very real possibility that this new agency's research will be wasted because every conclusion it draws will be endlessly disputed.

A second problem is evident in the Elephant-friendly way the AP article presents the fee—as a tax. Obviously, the research institute has to be funded. But couldn't the Obama administration have found a way to pay for it out of general revenue, without making the source of funding so explicit and obvious? You can bet the insurance companies will publicize this fee for all it's worth, hoping to get consumers to blame their next $1000/year rate increase on the government's $1/year “tax increase.”

Gail Wilensky, a former Medicare administrator who supports the agency, is paraphrased in the article as saying that it “should focus on high cost procedures and drugs on which the medical community has not developed a consensus.” I disagree. The most important thing to do is to support research with maximum potential for saving lives. By emphasizing the cost-cutting implication of their research, Ms. Wilensky probably hopes to keep the agency from being trampled by a bewildered herd of Elephants. But you can't pacify this species. If you try to save money, you will almost certainly be accused of rationing care.

One of my resolutions for 2012 is to do an occasional series of posts on the values and pitfalls of health care evaluation research.   

It Ain't Over 'Til It's Over

UPMC and Highmark have agreed to extend their contract until June 30, 2013. Until then, people who have Highmark health insurance will not have to pay out-of-network fees. Certainly, this is good news. Credit goes to Jay Costa, Dan Frankel, Randy Vulakovich, Don White and all those state legislators who put pressure on UPMC to negotiate, and to Governor Corbett, whose unnamed mediator is said to have brokered the deal.

However, Highmark customers may want to hold their applause. News reports don't say whether there have been any changes in the financial terms of the contract for the period between June 2012 and June 2013. It's still possible that Highmark policy holders face an unpleasant surprise the next time new rates are announced. More importantly, this is not a permanent solution to the problem. A UPMC spokesperson pissed on everyone's parade by stating, “This date provides 18 months for UPMC patients to review the multiple competitive health insurance options now available to assure that their care will continue uninterrupted with UPMC physicians and hospitals.” In other words, UPMC's refusal to negotiate with Highmark will continue. Highmark customers with pre-existing conditions have been given a stay of execution rather than a pardon.

On November 29, Ed Grystar, Chuck Pennaccio and Tony Buba published an op-ed in the Pittsburgh Post-Gazette pointing out how the ongoing conflict between these two corporate psychopaths shows how much we need a health care system administered by people who are accountable to the public—a single payer or Medicare-for-all system. (You can read their article by clicking on “op-eds” at the top of this page.) This new agreement gives single payer advocates another 18 months to keep repeating this argument to anyone who will listen.

Obama, the States' Rights President

Last week, we posted an op-ed by Wendell Potter about the Obama administration's pending decision on the minimum health benefits insurance companies will be required to cover under the Affordable Care Act (ACA). The ACA says that ten categories of benefits must be covered: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance abuse services; prescription drugs; rehabilitative and habilitative services; laboratory services; preventive medicine; and pediatric services. However, the bill left it up to the administration to specify exactly what services must be included within each category. Consumer groups were hoping for a specific and comprehensive list of benefits. Insurance companies and employers who pay for part of their employees' health insurance argued that “affordability” should be the primary consideration. They lobbied to make the list as narrow as possible. Guess which group had the most money to spend on lobbying? Do I need to tell you the outcome?

The decision was announced by Kathleen Sibelius, Secretary of Health and Human Services, in a 15-page “guidance” released on December 16. In a sense, the President decided not to decide. The list of essential benefits will be left up to the individual states. Each state is supposed to choose an existing health insurance plan as a benchmark. All insurers are required to either provide the same benefits as the benchmark plan, or coverage of equal or greater value.

States have wide latitude in selecting a benchmark plan. It could be any one of the following:

• One of the three largest health plans for state employees.
• One of the three largest small group plans operating in the state.
• The largest commercial health maintence organization in the state.
• One of the three largest health plans for federal employees.

Complicating the states' decisions is the fact that some of the eligible benchmark plans do not provide coverage in all ten required categories. It's not clear how that problem will be resolved.

The decision was accompanied by a flurry of states' rights rhetoric straight out of the Elephant playbook. Sibelius said, “We want to give the states the flexibility to choose an essential health benefits package right for them.”

Although the outcome of these state-level deliberations is uncertain, I think we can make some predictions with confidence. First, the decision ensures that basic health insurance will vary a great deal from one state to another, with resulting inequality of health outcomes. Secondly, since most of the possible benchmarks are from within the state, states whose residents already have comprehensive coverage are likely to continue to have it, while states whose citizens are underinsured will continue to underinsure them. Finally, the result of this decision will probably be poorer health care for U. S. citizens generally than had the federal government made the decision. I say this for several reasons:

• The states will have to pay part of the expenses of any expanded health care coverage. Even blue states like New York, California and Illinois are strapped for cash right now.
• The Elephant Party controls most of the state governorships (29, compared to 20 Jackasses and one Independent). Some Elephant Attorneys General are participating in lawsuits to have the ACA declared unconstitutional. Among the states where we can expect hostility to the ACA is Pennsylvania, where the Elephants control all three branches of government and typically refuse to even consult with the Jackasses on pending legislation.
• This decision will lead to a predictable stampede. Health insurance and Chamber of Commerce lobbyists will descend on our state capitols wheeling barrows of cash into the waiting arms of our public servants. In fact, this may be the greatest fundraising bonanza for state legislators in the history of the country. Public interest groups will be even less able to compete than they were at the federal level.

For the Obama administration, this decision represents yet another concession to corporate interests that opposed health care reform. It comes in the wake of their decision in October to ditch those provisions of the ACA that promised long term care insurance. It is yet another in the seemingly endless series of broken promises by the President who promised hope and change.

David Steil, the President of Health Care for All—PA, our parent organization, has suggested that, because states' geographies and cultures are different, states should determine the health care coverage their citizens receive. I disagree. States have less leverage than the federal government to bargain effectively with hospitals, insurance and drug companies. More importantly, the likely outcome of state variability is that those Americans who have the greatest need for expanded health care coverage are least likely to get it. If you live in a progressive state, you might be fairly well insured against most health emergencies, but if you live in Texas, now may be a good time to look into that cemetery plot you've been putting off buying.  (A new Harvard study has estimated that 45,000 Americans die each year from lack of adequate health insurance.)

Anyone who favors the policy of having states define essential health care benefits must answer this question: What exactly is it about the “cultures” of states like Alabama, Mississippi and Texas that makes them want less adequate health care coverage, especially for their poorest citizens, than states like Minnesota, Oregon and Vermont? Are these cultural differences that deserve our respect?

Correlating PA's Uninsured with Sen Pat Toomey's 2010 Vote

The 2010 election was a referendum on the Affordable Care Act as the coming election and Supreme Court Session will be.  The 2010 Pennsylvania the Senate race between Joe Sestak and Pat Toomey was a contrast on economic issues.  It was won by Toomey with 51% of the vote.  In the CNN exit poll health care was the 2nd most important issue for PA voters behind the economy.  The table below shows how the voters went for the issues and candidates in the exit poll.

Important Issue	Sestak	Toomey
War in Afghanistan (7%)	N/A	N/A
Health Care (22%)	56%	44%
Economy (63%)	43%	57%
Illegal Immigration (5%)	N/A	N/A

When the voters were asked specifically about the health care law (but not Single Payer) the voters broke down this way.  Note even in this election those who liked the law plus those who wanted it expanded out number those who wanted it repealed.  It wasn't asked how many voters were uninsured.

What Should Congress Do With New Health Care Law?	Sestak	Toomey
Expand It (35%)	88%	12%
Leave It As Is (17%)	70%	30%
Repeal It (45%)	10%	90%

There is no county level exit poll data for Pennsylvania but I can correlate the percentage of the vote for Toomey in each county and the corresponding % uninsured.  The relationship shown above while statistically significant is not as strong as the ones discussed in my previous post, accounting for 6.9% of the variability.  Philadelphia is a strong outlier where Toomey had 16% of the vote and the county had 16.3% uninsured. 

One should not assume that the uninsured were likely to vote for Toomey outside of Philadelphia.  I am unaware of voter turnout rates in the uninsured.  The graph above suggests that a higher percentage of Toomey voters are more likely to be found in counties with higher percentages of uninsured (outside of Philadelphia).  Other variables are more strongly correlated with the % uninsured, such as % rural and % illiterate and explain this relationship better.  There was no relationship between the % illiterate and the % of vote for Toomey in PA counties.

I would've made a great exit poll question to see how many Toomey voters were uninsured.

**Related Posts**

Making Sense of the Pat Toomey-Joe Sestak Senate Race 

 

POLL: Dislike of healthcare law crosses party lines, 1 in 4 Dems want repeal - TheHill.com (But Doesn't Ask Why)

 

Correlating PA County % Uninsured Rates with Other County Level Measures

 

Dan Onorato's Happy New Year

When Dan Onorato leaves office at the end of the year, he won't be cashing unemployment checks. On January 3, the retiring Allegheny County Executive and former Jackass Party candidate for governor will start working for health insurance giant Highmark as an executive vice president. He will be "head of the government relations team"--in other words, their chief lobbyist.

Jim McTiernan of Triad USA, the consulting firm that appears to have brokered the deal, said, "Having someone who can help [Highmark] navigate the political process is key." Onorato, he said, "has statewide connections--the knowledge base to get to the right levels and the right parties." Onorato, for his part, was sharing the love:  "I am thrilled to be joining Highmark, a great Pittsburgh-based organization that has a history of helping families and companies with their health and wellness needs." Since Highmark is a "corporate person," she is apparently best described as a philanthropist.

Onorato's salary was not made public, but the man he replaces makes over $1 million a year. His yearly salary as County Executive was $90,000. Rep. Jim Cooper of Tennessee famously quipped that "Capitol Hill is a farm league for K Street." A few years in Congress at a relatively modest salary can serve as a stepping stone to a lucrative career as a Washington lobbyist. Newt Gingrich is a prime example. You'll be happy to know that a similar career path is available to Pennsylvania politicians.

Happy New Year, Dan-O! Welcome to the revolving door between corporations and government. Can a revolving charge account at Tiffany's be in your future?

Moving Backward

If you are a supporter of single payer who believes that change in the U. S. health care system will be gradual and incremental, you probably support the Affordable Care Act, and you probably think any policy changes that move us in the direction of single payer are progress, while you oppose any changes that move us toward privatization. Medicare is the largest single payer system we have in this country. The members of the Elephant Party are nearly unanimous in their support of Rep. Paul Ryan of Wisconsin's plan to privatize Medicare. Up until now, they have been unsuccessful in getting any Jackasses to sign onto the Ryan plan. That has all changed. Sen. Ron Wyden of Oregon, a member of the Jackass Party, has joined with Ryan to propose a “compromise” plan to “save” Medicare. While it stops short of privatizing Medicare, it is a major step in that direction.

When the Affordable Care Act was being debated, supporters of single payer favored a public option to compete with private health insurance plans. Our thinking was that if the public option proved more attractive to subscribers, it would move the country in the direction of single payer. The Ryan/Wyden plan offers seniors a “private option” as an alternative to the single-payer Medicare, possibly in the hope that competition from the private sector will eliminate Medicare from the U. S. health care system (although they deny that intention).

The Ryan/Wyden plan is a premium support program, similar to school vouchers. Seniors will be given a certain amount of money to spend on health care. They will choose among several alternatives, including traditional Medicare and various private health care plans, most of which will cost more than the amount they have been given.

Here is a simplified version of Austin Frakt's summary of the plan:

• Private medicare plans will compete with traditional Medicare in an exchange. Private plans must offer the “actuarial equivalent” of what is available from Medicare. In other words, the private plans don't have to offer the same coverage as Medicare, but the coverage they offer must be of equal value.
• The premium support citizens receive is equal to the cost of either the second cheapest private plan in the exchange or Medicare, whichever is lower. If you choose a more expensive plan, you pay the difference. If you choose the cheapest plan, you get a rebate.
• Private plans may not reject an applicant for any reason; that is, discrimination on the basis of pre-existing conditions is not permitted.
• If this price competition doesn't work to contain the cost of Medicare, the cost will be capped at a growth rate equal to the growth rate of the GDP, plus 1%. This will be done by reducing support for the sector or sectors (hospitals, drug companies, etc.) most responsible for the cost increase.
• Anyone now over 55 will not participate in the new plan, which will not be implemented before 2022.

There are several potentially serious problems with the Ryan/Wyden plan. Again, I am indebted to Frakt for his thoughtful posts about premium support programs (which he favors, by the way).

• Although private insurance companies will be forbidden to turn away people with pre-existing conditions, they will find all kinds of ways to enroll only the healthiest people, i.e., by directing their advertising at affluent citizens. Traditional Medicare will be left with the sickest people, who will pay the highest fees. A process called “risk adjustment” is supposed to deal with this problem by increasing the rebate to plans that cover less healthy people, but this is after-the-fact and it's not clear how it will work.
• Private insurance companies often treat their customers badly. The deny necessary care and provide poor customer service. This can also be used to drive away the least healthy people.
• When it comes time to design the plan, Medicare will have no money to spend on lobbying and campaign contributions, while the insurance companies will be stuffing Congress-critters' pockets with cash. This virtually guarantees that the playing field will be tilted in favor of the private plans.
• Since private plans don't have to offer the same coverage as Medicare, but only the actuarial equivalent, it will be hard for seniors to compare the plans. The insurance companies have almost unlimited advertising budgets with which to confuse and mislead consumers. Most seniors citizens do not have a friend with a Ph.D. to help them pick the best plan, so many of them will make bad choices.

The combined effect of these problems will be to leave Medicare with fewer and less healthy customers. This will increase Medicare's costs, while weakening its bargaining power when negotiating with hospitals or drug companies over the prices of goods and services. This could eventually lead to the demise of Medicare.

When Walmart goes into a new community, they offer consumers heavily advertised “sales” for the first couple of years. (Since they have thousands of outlets, they can afford to run some of them at a loss for a short time.) The purpose is to drive other local retail stores out of business. Once they have eliminated the competition, they quietly raise their prices. It's possible that the insurance companies will begin by setting their prices unrealistically low, in the hope of sending Medicare into a death spiral.

It's going to be difficult to oppose a premium support plan. Critics will ask: "What can be wrong with offering people more choices? If you are really confident that single payer is more cost effective, why do you worry that people will switch to private health insurance?"  Some of our objections will sound as if we oppose giving people more choices because we are afraid they will choose unwisely. This seems paternalistic, and conflicts with most Americans' mistaken view that they are too smart to be influenced by advertising.

I apologize for the length of this post, but I believe that premium support programs are a serious threat to move our health care system in the wrong direction. The New York Times has come out in favor of premium support. The insurance companies have almost unlimited funds with which to bribe Congress and the President to pass such a program. In fact, I'm afraid that dismantling Medicare is almost inevitable. If that happens, it will be nearly impossible to pass single-payer health care in this country. How can you demand Medicare for all when there is no Medicare?

Early news reports have suggested that Senator Wyden is seen by his fellow Jackasses as a traitor for breaking ranks and suggesting major changes to Medicare. (Paul Krugman refers to him as a "useful idiot.") My guess is that the reality is quite different. They are probably grateful to him for offering them cover while they quietly line up to follow his lead. The insurance companies have millions of dollars to pass out. Right now, the Elephant Party is getting most of that money. But the Jackasses want it, and if they signal a willingness to pass premium support, they are likely to get a lot more of it. The results will be disastrous for single payer, and possibly for the country.

Correlating PA County % Uninsured Rates with Other County Level Measures

Now that the PUSH website is officially launched I've looked into the updated Census county level data to see how the estimates correlate with other county level data to see what information they could provide about the state's uninsured.  I downloaded data from the Robert Wood Johnson foundation and the census bureau on the state's 67 counties and computed correlation coefficients to determine if there is an association.  For those who are unfamilliar with correlation it is a number that tells you if there is an association between two variables.  The demographic variables I correlated the % uninsured with were % illiterate, diabetes, rural, female, no English, Hispanic, Native American, and African American.  Of these % illiterate, rural, female, Asian, and Native American had statistically significant correlations (which means that we can be confident that as one county level of these variables changes, the % uninsured in that county is likely to change).  Of all of these associations, the one with % illiterate was the strongest accounting for 68.2% of the variability in the data.  The data for this relationship are presented in the graph below. 

If the correlation were perfect, all of the counties would form a perfect straight line and it would account for 100% of the variability in the data.  Philadelphia County had by far the highest illiteracy rate at 22% and the third highest uninsured rate at 16.3%.

The second strongest association was between the % rural and % uninsured accounting for 26.4% of the variability.  The graph below shows why this relationship is not as strong as the one between illiteracy and the uninsured with a lot more scatter than the one above.  Philadelphia County with a high rate has a 0% rural population while four counties, Forest, Fulton, Potter and Sullivan, have 100% rural populations and high uninsured rates.

The other variables that are also correlated with % uninsured are also highly correlated with these other two variables and when they are accounted for they disappear.  One should always be careful in concluding that a cause and effect relationship exists between two correlated variables.  There are always possible third variables that can explain the relationship.

Medicare For All is the Only Solution

The Highmark-UPMC battle shows how private insurers serve no useful purpose

Tuesday, November 29, 2011

By Ed Grystar, Chuck Pennacchio and Tony Buba

The current contract disagreement between Highmark and UPMC provides a clear example of why the free-market health care system has failed. When profit is the primary motive, patient needs get short shrift.

Health care is not a commodity, but a human right. These two "nonprofits" operate with the needs of the public clearly secondary to fulfilling their first objective, which is maximizing profit. The public be damned.

While these two health care businesses fight for market share in our region, the number of uninsured in the country and in Pennsylvania has reached all-time highs, health insurance profits are breaking records for the third year in a row and ever-rising health care insurance premiums are unsustainable for business and the public. Nationwide, they  now average $15,000 per year for family coverage while the median family income is approximately $49,000 per year.

What citizens want and need is the ability to choose physicians and providers for their health care needs, not the threat of losing their insurance or a forced choice (unavailable to many) to purchase another insurance plan.

Simply put, patients need and want heath care, not health insurance.

These insurance giants do not bring anything positive to the health care delivery system. They do not care for the sick or treat injuries. They are not necessary to patients, employers or the community.

While some are grateful for Highmark's takeover of the ailing West Penn Allegheny Health System, there is an inherent and dangerous conflict of interest in joining medical services with private insurance companies -- be it UPMC or Highmark -- given that insurance companies earn profits by denying care, raising premiums and increasing patient out-of-pocket costs.

Only by replacing the insurance-dominated health care system with an improved Medicare-for-all system can we resolve the myriad problems with the current system.

Now in Congress and in the Pennsylvania Legislature is legislation that would move all citizens to a single-payer, not-for-profit Medicare-for-all system -- H.R. 676 in the U.S. House of Representatives and S.B. 400 in the Pennsylvania Senate.

Patients would choose their physicians and hospitals, and decisions on care would be based not on which insurance product you have or network you are in, but on consultation between patient and doctor. Physicians and hospitals would not have to deal with time-consuming and wasteful insurance forms and processing.

In the federal bill, the government would negotiate lower prices for medications from pharmaceutical companies. Insurance company profits, executive salaries and marketing costs would no longer be passed on to the patient in the form of ever-increasing premiums and out-of-pocket costs. In fact, the overhead for the government to administer  traditional Medicare is 3 percent, compared to 15 percent to 30 percent for private insurance companies.

Insurance premiums would be replaced with a single-payer fund that would reimburse providers a fair amount. There would be no premiums, deductibles or co-pays. This funding would be based on a tax that would amount to less than current insurance premiums.

Everyone, from cradle to grave, would be covered for all health care needs, including preventive, dental, vision and long term care. Such systems exist in other industrialized countries that spend far less money per capita and achieve better health care outcomes than the United States.

Because everyone would be covered, hospitals in economically distressed communities like Braddock and Aliquippa would stay open because they would be uniformly and fairly reimbursed for the care they deliver and their patients' medical needs. In our current system, such communities have a larger proportion of people who are uninsured and on Medical Assistance, where reimbursement is lower and hospitals lose money.

Meanwhile, the advertising onslaught by UPMC and Highmark would no longer be necessary.

Opinion polls over the past decade show strong public support for a Medicare-for-all solution. Nevertheless, it has been consciously shut out of the debate by the media and political leaders.

The disconnect between strong public support and the lack of political support in the Congress and state legislatures can only be changed by building a grassroots movement that challenges the power of the big money that dominates our political process. It will take action by the 99 percent to make this happen.

Ed Grystar is co-chair of the Western Pennsylvania Coalition for Single Payer Healthcare (www.wpasinglepayer.org). Also submitting this article were Chuck Pennacchio, executive director of HEALTHCARE4ALLPA (www.healthcare4allpa.org), and Tony Buba, steering committee chair of Save Our Community Hospitals, whose original mission was to keep the UPMC hospital in Braddock.

Racial and Gender Differences in Pennsylvania's Uninsured

The Pittsburgh chapter of Healthcare 4 all PA has set up a website and blog to advocate for Single Payer healthcare in the area.  We have a diverse group of activists with diverse talents who are eager to spread the word on the need for universal non profit medical care.  For example Julie Sokolow is an excellent documentary filmmaker who also has a site called Healthy Artists, MaryPat Donegan is a long time activist, statewide board member, and Psychologist, Molly Rush is also a long time activist and Thomas Merton Center Board Member, Natalie Bencivenga is the editor of Two Day Mag and a social work student.   Lloyd Stires is a social psychologist who specializes in mass media and behavior.  We have many other capable volunteers which are too numerous to name.

My specialty is as a statistician.  The Census Bureau has come out with county and state level estimates of the uninsured for the whole US.  Recently they came out with estimates for the years 2008 and 2009 to give an impression of the impact of the recession on the uninsured before the new health care law was passed in 2010.  The table below shows the rates for both years for Pennsylvania by gender shows a greater impact for men in the last two years than for women.  The overall rate for the state was 10.6% in 2008 and 11.7% in 2009 (Margin of Error or MOE +/- 0.2% in both cases).  Below is a graph with all 67 counties with male and female rates plotted against each other and a state map to show where each is located for 2009.    The reasons for this difference could be due to gender differences in income.  Women are a majoity of Medicaid recipients in the US and in PA.

	% 2008	MOE	% 2009	MOE
Male	11.7	0.3	13.3	0.3
Female	9.5	0.2	10.0	0.2

The Census Bureau also showed how the uninsured broke down at the state level across racial lines but unfortunately not at the county level.  This could be due to there being a lack of racial diversity in many rural counties.  The rates increased uniformly across the three groups in 2009.  While the rates were highest among Hispanics followed by blacks and then whites, their respective margins of error likewise increased due to smaller numbers.  These rates are outside the margins of error so we can be confident that they are different.  According to the Kaiser Foundation, whites are 63% of Medicaid recipients in Pennsylvania blacks are 19% and Hispanics are 14%.  These numbers contradict what right wing pundits often say about Hispanic/Latino's coming here to use up our services.  The Daily Show clip below has a good take on this. 

year	% uninsured white	MOE +/- %	% uninsured black	MOE +/- %	% uninsured hispanic	MOE +/- %
2008	9.10	.20	15.10	.70	21.50	1.00
2009	10.10	.20	16.20	.70	22.60	1.00

The Daily Show With Jon Stewart	Mon - Thurs 11p / 10c
American Refugees Seek Health Care in Mexico
www.thedailyshow.com
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**Related Posts**

Gender Differences in Pennsylvania's Uninsured 

News Health Care for All Pennsylvania