Trends in today's health care marketplace are putting care for the uninsured at risk. The numbers of insured are growing,1 and safety net providers such as public hospitals and community health centers are feeling the financial strain of the growth of Medicaid managed care. The uninsured have experienced difficulty obtaining needed care in the past,2-7 and their ability to obtain such care in the future is in even greater jeopardy.
In the absence of attention to the aggregate problem of the uninsured, special focus on vulnerable subpopulations—Children, low-income women, the unemployed, and older uninsured adults—should receive greatest priority. Incremental changes that would expand health insurance coverage to groups most likely to benefit from access to care would reduce the immediate burdens created by shrinking availability of free care.
Incremental Options for Expanding Health Insurance Coverage
Building on existing programs and administrative structures offers a foundation for incremental expansions.