FOOTNOTES
[1] Figures are 1997 data from "Highlights National Health Expenditures, 1997," December 9, 1998. http://www.hcfa.gov/stats/nhe-oact/hilites.htm
[2] The 1997 federal poverty threshold is $8,350 annually for a single adult under 65 years old, $10,748 for two people under 65, and $11,063 for a couple with one child. U.S. Census Bureau, Current Population Survey, http://www.census.gov.
[3] Single adults over age 21 and adults in two-parent families are eligible only if they receive cash benefits.
[4] Kathryn Haslanger et al., Taking Steps, Losing Ground: The Challenge of New Yorkers Without Health Insurance (NY: United Hospital Fund, 1998), p.22.
[5] Data are from the New York State Department of Health, http://www.health.state.ny.us/nysdoh/mancare/medicaid/main.htm, January 1999.
[6] Haslanger et al., op. cit., p. 1.
[7] Ibid., p. 45.
[8] These and other data on national health care expenditures are from http://www.hcfa.gov/stats/nhe-oact/tables/tll.htm, December 9, 1998.
[9] Total personal health care expenditures are less than total national health care expenditures because they exclude certain public health, research and other activities. Personal health care expenditures in 1997 totaled $969 billion.
[10] The total may fall short of this amount. As of July 31,1998, collections were 87 percent of the projected annual total. See Daniel Sisto, President, Healthcare Association of New York State, "HCRA Pool Shortfalls Confirmed; Compliance Actions Initiated," memorandum, November 18, 1998.
[11] Deborah Bachrach and Anthony Tassi, "Funding Available to Support Safety Net Providers, Subsidized Insurance Programs, and Other Public Goods, In New York State," an analysis prepared for the Citizens Budget Commission, September 1998.
[12] The figure is for 1996 and is compiled in Bachrach and Tassi, op. cit.
[13] Data are from audited financial reports submitted to the New York State Health Department. See State of New York, Department of Health, "New York State Hospitals Post Record Profits," news release, January 25, 1999.
[14] Bachrach and Tassi, op. cit.
[15] Ibid.
[16] Data from latest available audited financial statements of the medical centers.
[17] The subsidy from the City to HHC in fiscal year 1998 includes payments for jail inmates and for emergency services to members of uniformed services as well as a general operating subsidy.
[18] Bachrach and Tassi, op.cit.
[19] Ibid. The total includes $791 million from Medicaid and $58 million from workers compensation and other State programs.
[20] Data from Institutional Cost Reports filed by hospitals with the New York State Department of Health and summarized in Bachrach and Tassi, op. cit.
[21] The estimate also is conservative because it excludes any part of the estimated $544 million raised annually for graduate medical education from private insurance. This paper focuses only on the public payments for the uninsured.
[22] The figures in Table 5 identify only visits for which no payment was made. As discussed in the text, some visits financed by Medicaid may be for services to individuals counted in surveys as uninsured but subsequently qualifying for Medicaid under "spend-down" provisions.
[23] "Serving the Uninsured in a Managed Care Environment," Currents (NY: United Hospital Fund, winter 1998).
[24] The figures are for a Board-certified internist in Manhattan as of late 1998.
[25] Louis Harris and Associates, The Commonwealth Fund Survey of Health Care in New York City (The Commonwealth Fund, February, 1998), p.31.
[26] Ayanian, J.Z., B.A. Kohler, T. Abe and A. M. Epstein, "The Relationship between Health Insurance Coverage and Clinical Outcomes among Women with Breast Cancer," New England Journal of Medicine, 329 (5): 326-31.
[27] Nina Bernstein, "New York Faults Hospital for Denying Checkup to Baby Who Starved," The New York Times, October 24, 1998.
[28] J.S. Weisman, C. Gastonis and A.M. Epstein, "Rates of Avoidable Hospitalization by Insurance Status in Massachusetts and Maryland," Journal of the American Medical Association, 268 (17) 2388-94.
[29] J. Hadley, E.P. Steinberg, and J. Feder, "Comparison of Uninsured and Privately Insured Hospital Patients: Condition on Admission, Resource Use and Outcomes," Journal of the American Medical Association, 265 (3): 374-79.
[30] Robert E. Hurley, Deborah Freund, and John Paul, Managed Care in Medicaid (Ann Arbor: Health Administration Press, 1993).
[31] U.S. General Accounting Office, Arizona Medicaid: Competition Among Managed Care Plans Lowers Program Costs, Report #HEHS-96-2, October 1995, pp. 2-3.
[32] State employee premium from "1998 Survey of State Employee Health Benefits" (The Segal Company, 1998); individual policy premium from Haslanger et al., op. cit., p. 31.
[33] Ibid., p. 23. The United Hospital Fund estimates that about 10 percent of those currently privately insured would switch to a fully subsidized plan if given the option.
[34] Per person Medicaid costs from Haslanger et al., op.cit., p.52. Calculations based on number of uninsured children and adults in this income group. See Haslanger et al., p.47.
[35] These maximum incomes are the points at which 5 percent and 2 percent, respectively, of income equals the premium amount of $1,860.
[36] The cost calculation for near-poor adults uses the state employee rate ($1,860) rather than the average Medicaid expense ($2,285) that was used earlier for adults below the poverty level. The health care costs of the lower income uninsured are probably closer to costs for the Medicaid population; the costs for the near-poor are probably closer to those for a working population.