The lack of health insurance for every American is more complex an issue than most people realize. Sara Calabro finds that education is the first step toward solving it.Healthcare is a topical issue that seems to get a lot of people riled up. Be it on Capitol Hill, in an office, or at a cocktail party, words like "Medicare," "prescription-drug benefit," and "copayment" are bound to pop up and start a heated debate. But how many people actually know what the real issues are? And for those who don't, what is the healthcare communications sector doing to inform its audience? One thing many Americans might not know is that it is often the most disadvantaged people - the uninsured, and oftentimes, also unemployed - who are slapped with the biggest charges for healthcare. Because big managed-care companies and government agencies have the power to negotiate discounts with hospitals, it is the uninsured who get stuck paying in full. Last Monday, The Wall Street Journal displayed a chart that compared costs of a routine mammogram at five different hospitals. The official charge for the procedure at UCLA Medical Center, for example, is $460. But a patient covered under Medicaid would be charged $127. Under Medicare, the charge would be $90, and up to $242 under an HMO. A person with no insurance would be expected to pay the full $460. If they were aware of this, people who elect not to pay for health insurance might reconsider. According to the WSJ article, "America's 41 million people without health insurance tend to be young, working-class, and unaware that they are being billed more than everyone else for the same services." Ken Ferber, VP of corporate communications at WellPoint, told PRWeek last summer, "Dramatically changing science and the financial nuances of insurance are not concepts easily understood by the general public. There is a disconnect in communication because it is such an incredibly complicated area." He also admitted, "It took me an entire year to fully understand health insurance." The complicated nature of managed care is compounded by the often-negative portrayals of the industry in the media, particularly on TV and in the movies. Earlier this month, a campaign cosponsored by The Robert Wood Johnson Foundation (RWJF) integrated the issue of the uninsured into popular TV shows ER, Passions, and Law & Order: SVU. As part of "Cover the Uninsured Week," the effort was designed to draw attention to an issue that the foundation feels has been largely neglected for years. Overlapping the RWJF's campaign, the American Association of Health Plans (AAHP) launched a similar effort. Mohit Ghose, director of public affairs for the AAHP, explains, "We are a sponsoring organization for the RWJF effort, but what we're doing provides a solution to the issues that coalition raises." In other words, the RWJF is more focused on raising awareness. The AAHP's five-point proposal A solution for expanding access for the uninsured, according to the AAHP, requires a commitment on the part of policymakers. It calls for them to maximize the capacities of the current system, build on the strengths of the private sector, and avoid increasing healthcare costs. The actions being taken by the AAHP to garner such a response from policymakers are centered on a set of five principles, which were laid out in a statement from the organization's board of directors. First, all Americans should have access to a core set of safe and effective healthcare treatments and services. The second assertion is that a response that addresses the complexities of the uninsured population cannot be based on a one-size-fits-all mentality. For example, more than 80% of uninsured children and adults under the age of 65 live in working families, while others have no connection to the workforce. Some uninsured people have extensive healthcare needs, and some are young, healthy adults who choose to forego coverage. Additionally, while low-wage workers are less likely to have insurance, high-wage workers are also among the uninsured. Thirdly, the AAHP believes the capacities of the public and private healthcare systems should be maximized. According to the board's statement, despite several outreach initiatives in the two sectors to increase enrollment in health benefit programs, significant work still needs to be done. Sixty-seven percent of the 10.6 million uninsured children in the US qualify for the Centers for Medicare & Medicaid Services' State Children's Health Insurance Program (SCHIP), but many are not enrolled. Nine million people are eligible for employer-sponsored health insurance, but several do not take it. The fourth principle - the public sector should build on the strengths of the private - is an extension on the third. Health-plan participation in the private market has enabled 170 million Americans to obtain insurance through their employers or the individual market, while participation in public programs (i.e., Medicare, Medicaid, and SCHIP) has only provided 80 million with coverage. Finally, policymakers should not ignore the drivers of rising healthcare costs - according to the AAHP, the biggest contributor to the uninsured crisis. This fifth principle is based on the fact that millions of Americans are uninsured because they cannot afford it. Costs can be brought under control, according to the AAHP, by reforming the malpractice system, reviewing costly mandates that provide minimal value to consumers, and enforcing policies to promote a competitive healthcare market. The aforementioned WSJ article reported, "Before deregulation in 1997, hospital charges in New York state couldn't be more than 30% above costs. They now are an average of 87% above costs." Further, "In California, charges have ballooned to 178% above costs. By contrast, in Maryland, where hospital charges are still strictly regulated, charges average only 28% above costs." As part of the AAHP's campaign, it is rolling its five principles out to the press, medical societies, employer groups, Congress, and the Department of Health and Human Services. Additionally, "For the first time, we are actively getting our board members out there as spokespeople," reports Ghose. Op-ed pieces and radio and TV appearances are among the tactics being used by the members. Calculating the overall costs The AAHP is also directing people to the "Focus on the Uninsured" section of its website. There, visitors can access the group's cost calculator (www.aahpcostcalculator.org), where they can enter an increase in healthcare costs, and the tool calculates the impact such a rise would have on lost jobs, the number of uninsured Americans, and lost wages. "We designed the calculator as a method of humanizing the effects of rising healthcare costs," says Geoff Freeman, director of strategic planning. Based on the research numbers used to develop the calculator, the AAHP determined that every two hours, 465 Americans lose their health insurance. The organization developed an ad based on this figure that runs before trailers in movie theatres. The AAHP reaching audiences through the entertainment industry was expected since it teamed up with talent agency William Morris last summer. As part of its long-term effort to improve the image of managed-healthcare plans, the AAHP employed the agency to position the organization as a resource for writers and producers in Hollywood. At the time, the AAHP's then-SVP of strategic planning and public affairs Mark Merritt, said, "We need to get to all the places that healthcare news is coming from, and we can't do that if we neglect Hollywood." Whether via Hollywood, standard media outreach, or grassroots efforts, communicating the issues of healthcare coverage - much less solving them - is no easy feat. "Nothing we can do at this point is going to be a panacea," says Freeman, "but all these efforts can certainly make an immediate dent in expanding access to health insurance."