The current healthcare crisis in New York City cannot be overstated. As many as one in four New Yorkers, some two million people, do not have health insurance (1). Additionally, more than 800,000 New Yorkers did not receive needed medical care in the past year alone (2), seventy-five percent of whom were uninsured (3). While one in three New York City households has an annual income of less than $25,000 (4), healthcare costs in the city are among the highest in the country.
Nevertheless, New York does offer successful public insurance programs. For instance, in addition to Medicare and Medicaid, New York offers Child Health Plus, which covers nearly all New York children under age 18, and Family Health Plus, which is meant to cover those ineligible for Medicaid. While a significant improvement, Family Health Plus still holds such strict income requirements that a one-parent one-child family earning just $19,500 annually does not qualify for coverage (5). As housing and living costs soar in the city and many new jobs are part-time or temporary, it is becoming increasingly difficult for thousands of low-income New York families ineligible for public insurance to afford vital healthcare.
Therefore it is actually the working uninsured that comprises three-quarters of all uninsured New Yorkers (6). In fact, several reports have suggested that working actually increases the risk of being uninsured for adults in low-wage families (7-9). With the standard doctor's visit costing at least $100 before tests or treatment, and the least expensive insurance premiums approaching $400 per month, millions in our communities are left with the most vital and basic healthcare needs unmet.
There is also significant public cost stemming from the large number of New Yorkers without health insurance. Uninsured New Yorkers are three times more likely than the insured to report inability to access medical care (3,10). As seeking and receiving care are then often delayed, the uninsured may have more acute needs and require increasingly more expensive treatment. Moreover, they most often turn to publicly supported hospitals and clinics, and in particular emergency rooms after being turned away from hospitals and clinics that require the uninsured to pay out-of-pocket for skyrocketing healthcare costs.
Thus the growing ranks of the uninsured are finding disparate access to care despite facing highly acute health needs. Because one in every twenty uninsured Americans lives in New York City (1,11), it is essential that other resources providing care to the uninsured be developed, supported, and expanded to reach out to communities across the five boroughs.
References:
(1) Brown ER, Wyn R, Teleki S. 2000. Disparities in health insurance and access to care for residents across U.S. Cities. The Commonwealth Fund. New York, NY.
(2) Karpati A, Lu X, Mostashari F, Thorpe L, Frieden TR. 2003. New York City community health profiles 2003. New York City Department of Health and Mental Hygiene. New York, NY.
(3) Karpati A, Kerker B, Mostashari F, Singh T, Hajat A, Thorpe L, Bassett M, Henning K, Frieden T. 2004. Health disparities in New York City. New York City Department of Health and Mental Hygiene. New York, NY.
(4) U.S. Census Bureau. Census 2000.
(5) New York State Department of Health. http://www.health.state.ny.us/nysdoh/fhplus/. Maximum gross annual income $19,245 for family size two, one parent plus one child, effective January 1, 2005.
(6) Holahan D, Haslanger K, Finneran K. 2001. Coverage trends among New Yorkers 1995-1999. United Hospital Fund. New York, NY.
(7) Kaiser Commission on Medicaid and the Uninsured. 2004. Health insurance coverage in America – 2003 data update. Kaiser Family Foundation. Washington, DC.
(8) Kaestner R, Neeraj K. 2003. Welfare reform and health insurance coverage of low-income families. National Bureau of Economic Research. Cambridge, MA.
(9) Weil A, Holahan J. 2001. Health insurance, welfare, and work. Brookings Institution. Washington, DC.
(10) Survey of healthcare in New York City 1997. Commonwealth Fund.
(11) Schoenborn CA, Adams PF, Schiller JS. 2003. Summary health statistics for the U.S. population: National Health Interview Survey, 2000. National Center for Health Statistics - U.S. Centers for Disease Control & Prevention. Vital Health Statistics, 10(214).
