• Navigating the System: When You’re Uninsured

    image In the US, millions of Americans have no health insurance. Being uninsured can be detrimental to your health. Many uninsured people delay getting needed medical care, live with serious medical conditions for too long, and do not receive preventative services. This can cause their health to deteriorate, leading to more serious—and more expensive— illnesses such as heart disease, cancer , and diabetes.
    But federal laws have made low-cost health insurance available to some people, especially children of low-income families. And emergency departments and clinics are required to provide a certain level of treatment to everyone, regardless of their insurance status. In addition, some “safety net” facilities offer free care to people who are unable to pay.

    Low-Cost Insurance for Children

    Uninsured children are less likely to receive “well-child” check-ups and other forms of preventative care, which can jeopardize their health. If your family does not have health insurance, you may be able to get insurance for your children at little or no cost, depending on your income level.
    Medicaid is a health insurance plan that supports the care of low-income families. However, the rules for counting your income and resources to determine eligibility vary from state to state and from group to group.
    While Medicaid covers many low-income children, coverage for adults is limited because parent eligibility income levels are set much lower than those of children. Unless they are disabled, even the poorest adults may be ineligible for Medicaid if they do not have children. Individual states set Medicaid limits and share the costs with the federal government.
    The Children's Health Insurance Program Reauthorization Act (CHIPRA), signed into law in February 2009 by President Obama, provides more children with health insurance under the Children's Health Insurance Program (CHIP). This program is meant for children and pregnant women in families that do not qualify for Medicaid, but also cannot afford to buy private health insurance.

    The Healthcare Safety Net

    America’s healthcare “safety net” is a system that provides healthcare to people who are underinsured or uninsured. Safety net providers undertake a mission to deliver healthcare to people who may not be able to pay for it. They may do so voluntary or out of a legal obligation. These providers may include emergency departments, community health centers, public hospitals, charitable clinics, and teaching and community hospitals. How these institutions are financed varies from state to state. In many cases, the owners of the facilities and the doctors that work there bear much of the financial burden.
    The only providers that are legally obligated to provide safety net care are emergency departments. The Emergency Medical Treatment and Labor Act (EMTALA) ensures that anyone who comes to an emergency department—whether they are insured or can pay for the services or not— must receive a medical exam and be stabilized before being transferred to public hospitals.
    This means that if you go to an emergency room with a medical problem, your treatment cannot be delayed because of a lack of insurance, and those with insurance cannot receive preferential treatment. There are signs posted in emergency departments that detail your rights according to the EMTALA provisions.
    But charitable providers and emergency rooms cannot fully substitute for health insurance. If you are uninsured or underinsured, do your best to make sure this is only a temporary situation. The risk is great: a major illness or injury can lead to financial ruin.

    Where to Get More Information

    Visit your state's website to find out about who is eligible for programs like Medicaid and CHIP, as well as what other types of assistance are available for uninsured people. with the new Health Care Reform bill, most Americans will need to get some sort of health insurance. If you are uninsured, you will be able to shop around for insurance in the new online "health exchanges," where companies will compete for your business. Depending on your income, you will be eligible for financial help to pay for coverage. To learn more about the Affordable Care Act, visit the government's website.


    Centers for Medicare and Medicaid Services http://www.cms.hhs.gov/

    Healthcare.gov http://www.healthcare.gov/


    Health Canada http://www.hc-sc.gc.ca

    Healthy Alberta http://www.healthyalberta.com/


    Children's health insurance program reauthorization act. Centers for Medicare and Medicaid Services website. Available at: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Childrens-Health-Insurance-Program-CHIP/Childrens-Health-Insurance-Program-CHIP.html . Accessed August 14, 2012.

    Emergency medical treatment & labor act (EMTALA). Centers for Medicare & Medicaid Services website. Available at: http://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/index.html. Updated March 26, 2012. Accessed August 14, 2012.

    Ross JS, Bradley EH, Busch SH. Use of health care services by lower-income and higher-income uninsured adults. JAMA . 2006;295:2027-2036.

    The uninsured and their access to health care. Kaiser Commission website. Available at: http://www.kff.org/uninsured/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=14185 . Published January 2003. Accessed August 14, 2012.

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