Health authority
alarmed at number
of poor, uninsured

A national expert says that
43 million Americans have
no health coverage

By Helen Altonn
Star-Bulletin

More than 43 million Americans have no health insurance and the number is increasing, says Dr. Alina Salganicoff, national authority on health care for low-income people.

Those associated with the Medicaid program also are alarmed about an erosion in Medicaid coverage, she said. "Those are not good trends."

Salganicoff, associate director of the Kaiser Commission on Medicaid and the Uninsured, was to speak today at the Hawaii State Primary Care Association's annual meeting in the State Capitol auditorium.

U.S. Surgeon General David Satcher also was to discuss priorities for improving the nation's health.

The 14-member nonpartisan Kaiser Commission was established by the Kaiser Family Foundation in 1991 as a research and policy institute to look at how health care is organized and financed for low-income populations.

Salganicoff, in an interview, cited welfare reforms as a big factor in the climbing rate of uninsured Americans because Medicaid benefits were separated from cash assistance.

In the past, she noted, people who received cash payments automatically were enrolled in Medicaid. Now they have to go through a separate enrollment process.

Participation in the Transitional Medicaid Program also has been low because people become ineligible when they go to work, she said.

About 10 million of the uninsured are children, Salganicoff said, including an estimated 4.5 million who are eligible for Medicaid and aren't enrolled.

An additional 3 million children are low-income but not poor enough to qualify for Medicaid, she said. Those children will be eligible for the nation's new state Children's Health Insurance Program, still being developed in Hawaii.

Salganicoff said an "incremental approach" is being taken to solve the dilemma of the uninsured.

The federal policy basically is aimed at increasing participation in Medicaid among children and older Americans on Medicare who are eligible for Medicaid assistance and aren't enrolled, she said.

There also have been discussions in Congress and the administration about allowing 55- to 65-year-olds to buy into Medicare, she said.