1999.02.11: (Fact Sheet) The Clinton Administration's Initiative to Improve Health Care Access for Uninsured Workers

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February 11, 1999

Contact: HHS Press Office
(202) 690-6343

THE CLINTON ADMINISTRATION'S INITIATIVE TO IMPROVE HEALTH CARE ACCESS FOR UNINSURED WORKERS

Overview: The Clinton Administration has taken a number of important steps since1993 to expand coverage and respond to rapid changes in the U.S. health care system. We have given states the flexibility to insure more low-income workers, allowed Americans to take their health care with them when they change jobs, expanded health coverage to the children of low-income families, and proposed both making Medicare available to Americans aged 55 to 65 and making Medicare and Medicaid available to disabled Americans who work.
This new initiative complements these strategies by addressing the need for health care delivery systems serving the 32 million adult Americans still without insurance. Many providers of free or low-cost health care services currently do not have the resources or technical capacity necessary to coordinate their efforts with other providers. This initiative, funded at $1 billion over 5 years, will help fill that gap. The bulk of the funding would provide federal grants to help community health clinics, health departments, public hospitals, academic health centers, and other providers of free or low cost health services to create networks that strengthen comprehensive care for the uninsured. This coordination of services will help uninsured workers receive more efficient and higher quality care and gain entry into a "seamless" system of care for low-income working families.

A key emphasis in the early years of the program will be assisting communities and providers in the development of the infrastructure necessary to participate in networks or other coordinated care arrangements. Funds will be available for the development of the financial, information, and telecommunications systems needed to appropriately monitor and manage patient needs. The initiative will also target substantial funding toward service gaps that can be identified within coordinated systems of care for the uninsured, reaching approximately 100 communities over five years. Although need will vary by community, the focus will be on expanding access to primary health care and ensuring that it is coordinated with other health care needs, including mental health and substance abuse services.

Millions of Americans still lack health insurance. In 1997, the number of Americans without health insurance stood at over 43 million. While the Children's Health Insurance Program and increased Medicaid outreach can potentially provide insurance coverage for about half of the approximately 11 million uninsured children, roughly 32 million adults between the ages of 19 and 64 remain uninsured. Among these uninsured adults, about 17 million have incomes below 200 percent of the poverty level. Many of them receive their care at community health clinics and local hospitals.

Many of these Americans suffer from multiple health problems and require access to a coordinated set of health care services. Yet data show that these needs are not being met. In 1997, 30% of uninsured adults did not receive needed medical care and 55% postponed needed medical care because they could not afford it. They were only about half as likely to receive a routine check-up as insured adults. Among those who did have a regular source of care, uninsured adults were about five times more likely than insured adults to use the emergency room as their regular source of care.

Health care providers that help uninsured Americans face many pressures. These providers consist of institutions, facilities, and individual health professionals that provide a significant volume of health care services, either without payment or on a reduced fee basis, to those who are uninsured. They face a number of challenges, such as increases in the number of uninsured workers, reduced Medicaid revenues due to the pressures of Medicaid managed care, and a growing need for mental health and substance abuse services.

The Clinton Administration proposes strengthening health services for uninsured workers. To respond to these needs, the President's fiscal year 2000 budget will propose a competitive grant program that would provide $1 billion over five years to strengthen public and private entities in 100 communities, increasing the availability of comprehensive, coordinated health care for uninsured workers. The President will request $25 million for the first year of this initiative in his fiscal year 2000 budget proposal, which will be sent to Congress on February 1, 1999. The intent of these grants is to establish patient-focused systems of care to serve low-income, uninsured workers with greater efficiency and improved quality of care.

Those who provide health care to the uninsured will get help to create the infrastructure they need to provide quality care. A key emphasis in the early years of the program will be assisting communities and providers to develop the infrastructure necessary to participate in networks or other coordinated care arrangements. Funds will be available for the development of the financial, information, and telecommunications systems needed to appropriately monitor and manage patient needs. This support will improve the ability of providers to track patient care needs and receipt of service over time; permit more clients to be served; and strengthen the financial standing of providers by enhancing their ability to compete for business from Medicaid and commercial managed care organizations. Once a coordinated system has been established within a community, uninsured workers will gain entry into a coordinated health care system that meets their individual needs.

Once health services are coordinated in a community, gaps in service can be identified and filled. The initiative will also target substantial funding toward service gaps that can be identified within coordinated systems of care for the uninsured. Although need will vary by community, the emphasis will be on expanding access to primary health care and insuring coordination with other health care needs, including mental health and substance abuse services.

There is a history of bipartisan support for coordinating health care for uninsured workers. In the 103rd Congress, Senator Dole introduced a bill that would have funded greater integration of services for the uninsured in a grant program similar to what we are now proposing. Support for coordinating community health services has been bipartisan, and the Administration looks forward to building that kind of consensus around this new initiative.

The Clinton Administration builds on a strong record of extending health care services to more Americans. Since 1993, HHS has approved Medicaid demonstration programs to extend health insurance coverage to 2.2 million Americans who would otherwise be uninsured. In 1996, the President signed the Kassebaum-Kennedy act, which ensured that Americans could take their health care with them when they changed jobs. In 1997, under the Balanced Budget Act, the Administration successfully supported the Children's Health Insurance Program (CHIP). Since then, 49 states and territories have had their CHIP plan approved by the U.S. Department of Health and Human Services.

Model Programs:

Urban - Sunset Park is a large community health center providing services to over 82,000 residents of Southwest Brooklyn, New York every year. Sunset Park is a multi-site system, operating as a managed care network, that offers primary care facilities, a school health program, and a mental health center which includes mental health and substance abuse treatment along with HIV/AIDS services and primary care. The network offers a full array of ancillary and diagnostic services, rehabilitation and early intervention programs, WIC nutrition programs, social services, comprehensive health promotion/disease prevention activities, and HIV counseling and testing.
Rural - Family Health Center of Marshfield, Inc. (FHC) serves eleven counties in rural north central Wisconsin. FHC offers an insurance-like package of benefits that encompass preventive, primary and secondary physician care, and prescription drugs. FHC also works with local rural hospitals to provide outpatient and emergency room services. FHC has a large grassroots referral network which includes existing and past members, clergy, providers, social service agencies, and may other private and public agencies. FHC has leveraged significant resources to assist Marshfield Clinic in the development of an immunization registry and is now seeking to link population-based registry outreach efforts with health benefits counseling in order to help identify children eligible but not enrolled in Medicaid.

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