Health care is an issue with life-or-death consequences that affects every person in America. It’s foundational to a productive, satisfying life. But so far, it has been neglected this election cycle. Immigration, inflation, abortion restrictions and wars in Gaza and Ukraine have drowned out discussions of expanding Medicare and shoring up public health in the wake of the COVID-19 pandemic.

Millions of Americans — nearly 1 in 12 by recent estimates — lack health coverage. In some states the numbers are much higher, like my home state of Texas, where about 1 in 6 people are uninsured.

Now, with the end of COVID-era policies that provided coverage for many low-income families, the ranks of the uninsured are growing. According to new data from the Centers for Disease Control and Prevention, the percentage of Americans without health insurance jumped from a historic low of 7.2% last summer to 8.2% — over 27 million people — in the first quarter of 2024.

Without policy changes, these numbers will only grow larger.

Studies suggest that those without insurance are more likely to die prematurely compared to those with health coverage. A lack of preventive care — including cancer screening, vaccines and tests for chronic conditions like high cholesterol — is part of the reason. Uncontrolled diabetes, kidney failure after years of untreated hypertension and a delayed breast cancer diagnosis are some of the consequences I’ve seen in my uninsured patients as a family physician, after years of inadequate or nonexistent health care.

But obtaining preventive care is only one of the challenges facing those without coverage. For this population, getting appointments with specialists, diagnostic testing and treatments may be even more difficult.

Physician Ricardo Nuila, an associate professor of medicine at Baylor College of Medicine in Houston and author of “The People’s Hospital,” sees the consequences of delayed and inadequate care among his low-income and often uninsured patients on a regular basis.

Nuila told me about one patient with stage 1 cancer — likely curable — who lost insurance during the pandemic just as he was about to receive treatment.

“Without insurance, he was given the runaround for months by his doctors,” he said. By the time the patient made it to Houston’s largest public hospital, where he could be seen without insurance, the cancer had spread.

Limited access to care and a fear of medical bills can lead those without insurance to skip checkups and put off treatment. An unexpected illness or accident can cause financial devastation.

But even for those with health coverage, the cost of care often creates economic hardship. High co-pays and deductibles, insurance denials for needed services, out-of-network providers, and expensive prescriptions threaten the physical and financial well-being of too many Americans.

In a Commonwealth Fund survey of insured, working-age adults released in August, 45% of respondents reported facing an unexpected medical bill or co-pay in the past year. Seventeen percent said their health plan had declined to cover “a medical screening, procedure or treatment recommended by a doctor.”

At my current clinic for people with multiple sclerosis, even our insured patients often struggle to get critical medications covered. Delays in treatment can lead to MS progression.

Recent legislation to lower prescription drug costs, touted as a major accomplishment of the Biden administration, will have a modest effect at best and doesn’t apply to the non-Medicare population.

While spending far more on health care than any other nation, the United States is the only industrialized country that doesn’t provide universal health coverage.

Although the Affordable Care Act led to a significant decrease in the number of people without insurance, it didn’t go far enough. It’s no wonder that a national survey conducted by the Pew Research Center earlier this year showed that reducing health care costs ranked among the public’s top policy priorities.

As we approach the presidential election, let’s demand that our leaders address cost concerns and make coverage more accessible.

Implementing a “public option,” where the government offers a health insurance plan alongside private insurers, should again be considered to increase competition and lower costs. We also should invest more in preventive care programs, community health centers and initiatives that focus on social determinants of health, especially housing affordability.

“This is not a solution that the market will provide,” Nuila said. “We will have to do this deliberately and democratically.”

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Lisa Doggett is a columnist for Public Health Watch. She is a family and lifestyle medicine physician at the Multiple Sclerosis and Neuroimmunology Center of UT Health Austin. She is also the author of the memoir, Up the Down Escalator: Medicine, Motherhood, and Multiple Sclerosis. This column was produced for Progressive Perspectives, a project of The Progressive magazine, and distributed by Tribune News Service.

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