The recession and health care politics

A CNN poll released today shows 75 percent of Americans think the economy is the most important issue facing the country. Healthcare came in second -- at a very distant 7 percent.

Many health policy specialists and political strategists, though, say the two issues are inseparable in people's minds -- views of the economy are closely aligned with people's personal economic situations, which are in turn strongly influenced by the cost of healthcare premiums, deductibles and out-of-pocket costs.

A new study by the Kaiser Commission on Medicaid and the Uninsured uses focus groups in five American cities to break down how the recession is affecting demand for a safety net. As the jobless rate increases, the unemployed and their families often find themselves on the outside of the employer-based system.

Many, the study says, can't afford to keep the insurance they had at their previous jobs through COBRA, which requires ex-employees to pay for their entire premiums themselves (and an average family plan costs more than $1,000 per month). They can't afford to buy their own insurance.

Medicaid and the state Children's Health Insurance Program help, the study says. But some parents don't realize their kids may be eligible for State Children's Health Insurance Program or don't know how to enroll them. And many jobless parents earn too much through their unemployment benefits or part-time work to qualify for Medicaid.

Without insurance coverage, the study says, the unemployed are skipping crucial follow-up care, delaying care until it's an emergency or not taking drugs they need to stay healthy. When they go to the doctor, they get into debt, making their economic situation even worse.

As the jobless rate inches up, it's worth considering how these dynamics will affect the political demand for a major health insurance overhaul in Congress this year.