The Looming Shadow of the Uninsured

March 21st, 2006 by

The National Coalition on Health Care reports that the percentage of Americans with insurance is declining and is now at the lowest level in more than a decade. The lack of insurance has powerful implications for adults and children alike, but given The Insider’s focus on the workplace, we’ll limit our discussion to the workers who lack insurance.
In 2003, 27 million workers were uninsured. This is a vast understatement, of course, because it does not take into account the millions of undocumented workers who not only lack health insurance, but all other benefits that accrue to normal employees. The 27 million is probably closer to 35 or even 40 million. In any event, there a number of reasons why working people don’t have insurance: it might not be offered by the employer (increasingly prevalent among small employers and certain large employers with whom Insider readers are quite familiar); they cannot afford the coverage that is offered by the employer (high premiums, high co-pays, high deductibles); they don’t qualify for coverage (part-timers); or they have moved from job to job and are outside the vesting period for coverage.
Whatever the reason, there are millions of workers without health insurance. We can safely assume that these people ignore most preventative health measures: annual check ups, regular medication for ongoing conditions, etc. They postpone treatment as long as possible, and straggle into emergency rooms when they can no longer stand the pain or discomfort. So what? Why would an employer care about these “non-work related” conditions?
The Workers Comp Intersection
It’s pretty easy to imagine the circumstances where these uninsured employees may find themselves on workers comp: first, poor health can make concentration difficult; people suffering from untreated conditions are at risk for making mistakes on the job. To cite an extreme example, an employee with an untreated seizure disorder is at very high risk for injury. Equally important, these people may lack health insurance, but most have a generous indemnity plan, one which comes with no co-pays, deductibles or premiums for the employee. In other words, while health care coverage is declining, workers comp is virtually universal. If you work for someone, you’re covered.
I am not suggesting that employees lacking health insurance will go out of their way to find ways of filing comp claims. After all, the health condition would have to be work-related to qualify under comp. Few conditions would meet that standard. No, I’m not concerned about fraud, but about safety. I spent a few days last week at a pipe manufacturing plant, where molten scrap metal was poured into molds to make water and sewer pipe. As I watched the ironworkers tend the molds and machines, I wondered how well they could concentrate if, for example, they suffered from an untreated ulcer, or a cataract, a bum knee or the onset of diabetes. With most physically demanding jobs, one moment of inattention, one distraction, is enough to cause serious and occasionally catastrophic injury. The margin of error for many workers is very small indeed.
All of which leads me to a fundamental question: how can a company establish a credible safety program if their employees lack basic health insurance? No safety protocol can anticipate the impact of undetected personal health problems on the employee’s ability to perform the work safely.
There are many dimensions to the health care debate, most of which are far beyond the scope of this blog. But I am struck by this conundrum: safe workplace programs assume that workers are healthy enough to perform the work. If there is no health insurance, for whatever reason, how can you be sure that your employees can perform the work safely? Under OSHA’s General Duty Clause (Section 5(a)(1) of the Occupational Safety and Health Act), employers must furnish employment and a place of employment “which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees . . .” As the number of uninsured workers grows each year, the risk of serious injury grows with them. Eventually, this country will probably find the will and the resources to solve this problem. In the meantime, let this be warning to the myriad employers who cannot or will not provide health insurance to their employees.
Thanks to our vigilant colleague, Joe Paduda, for his heads up on this data.