Wednesday, October 05, 2005

US Census Press Release 09/30/2003

Numbers of Americans With and Without Health Insurance Rise, Census Bureau Reports...
The number of people with health insurance rose by 1.5 million between 2001 and 2002, to 242.4 million, and the number of uninsured rose by 2.4million, to 43.6 million, the U.S. Census Bureau reported today. An estimated 15.2 percent of the population had no health insurance coverage during all of 2002, up from 14.6 percent in 2001, according to the report, Health Insurance Coverage in the United States: 2002. The proportion of insured children did not change in 2002, remaining at 64.8 million, or 88.4 percent of all children. For the second year in a row, the overall decrease in coverage was attributed to a drop in the percentage (62.6 percent to 61.3 percent) of people covered by employment-based health insurance. The percentage of people covered by government health insurance programs rose in 2002, from 25.3 percent to 25.7 percent, largely as the result of an increase in Medicaid coverage. Other highlights: - Although Medicaid insured 14.0 million people in poverty, another 10.5 million people representing 30.4 percent of those in poverty had no health insurance in 2002; this percentage was unchanged from 2001. - The rate of uninsured Hispanics, who may be of any race, was 32.4 percent in 2002 higher than any other racial or ethnic group, but unchanged from 2001.- The proportion of the foreign-born population without health insurance (33.4 percent was more than double that of the native population (12.8 percent). - The health insurance coverage rates for non-Hispanic whites who reported a single race was 89.3 percent. For blacks and Asians who reported a single race, the rates were 79.8 percent and 81.6 percent, respectively. - Young adults (18-to-24 years old) were less likely than other age groups to have health insurance coverage 70.4 percent in 2002. This compares with 82.3 percent for those 25-to-64 years old and 99.2 percent for those 65 and over, reflecting widespread Medicare coverage. - While most children (67.5 percent) were covered by an employment-based or privately purchased health insurance plan in 2002, nearly 1-in-4 (23.9 percent) was covered by Medicaid. - The proportion of people who did not have health insurance ranged from about 8.0 percent in Minnesota, Rhode Island, Wisconsin and Iowa to 24.1 percent in Texas, based on three-year averages. New Mexico was the only state where the proportion of people without coverage fell, while the proportion rose in 18 states, based on comparisons of two-year averages. The estimates in the report come from the 2001, 2002 and 2003 annualsocial and economic supplements to the Current Population Survey. As in all surveys, the data are subject to sampling variability and other sources of error.

The National Academies Press Release 09/2002

Lack of Health Insurance Places Entire Families at Risk, Study SaysWASHINGTON -- If just one member of a family does not have health insurance, it adversely affects the health, emotional well-being, and financial stability of the entire household, says a new report from the National Academies' Institute of Medicine. Roughly 58 million people in the United States are either uninsured or live with a family member who is uninsured. One in five families have at least one member who is not covered."People without insurance generally have less positive experiences with the health system and are less likely to get regular care for themselves or their dependents, even if these dependents are insured," said Arthur Kellermann, professor and chair of emergency medicine at Emory University School of Medicine, Atlanta, and co-chair of the committee that wrote the report. "The stress of having even one uninsured family member can ripple through the household as other family members cope with their relative's illness, high medical bills, and financial distress. Moreover, even if every member of a family has insurance today, changes in the plan-holder's eligibility or employment status can mean sudden loss of coverage for some or all in the household tomorrow."Health insurance, the principal means by which Americans obtain health care, is frequently offered on an individual basis or with only partial regard to family circumstances. Coverage for dependents under employment-based health plans can be disrupted if plan-holders lose or change jobs, retire, divorce, or die. Public insurance programs are available to cover specific groups, such as children and low-income pregnant women who cannot get private insurance, but these programs typically do not extend coverage to all other family members. The mismatch between family needs and the conditions under which coverage is available is at the root of many of the negative consequences of being uninsured, the committee found.Children in particular are affected by lack of insurance because they rely on their parents or guardians to obtain both coverage and health care for them. The negative experiences of uninsured parents in obtaining care for themselves may affect their willingness to take their children for checkups or enroll them in public insurance plans. More than half of the nation's 8 million uninsured children are eligible for Medicaid or State Children's Health Insurance Program (SCHIP), but are not enrolled. When certain states expanded Medicaid coverage to include low-income parents as well as their children, enrollment of children increased more than in states without the parental coverage, the committee found. However, future expansions of Medicaid and SCHIP may be affected by the recent recession, the report cautions. There are likely to be more individuals eligible for public coverage as unemployment rises. Facing budget constraints, some states may either stop expanding public coverage or cut it back.Studies demonstrate that uninsured parents delay seeking care for themselves and their uninsured children until the symptoms are more severe. These delays may result in unnecessary hospitalizations for preventable or readily treatable conditions. Uninsured children are less likely to have a regular source of primary care than insured children, and they use medical and dental services less often. National data show that only 51 percent of uninsured children had a physician visit during the previous year, compared with 76 percent of insured children. Only 21 percent of uninsured children had a regular dental checkup, while half of insured children did. On average, sick newborns without health coverage receive two fewer days of hospital care than those with insurance.When parents experience poor physical or mental health, their children's emotional health and development may suffer as a result. Studies show that parental depression increases the chances that children will exhibit greater difficulty in learning to socialize, poorer academic performance and school behavior, and higher rates of mood disorders. Lack of insurance can seriously strain families' financial stability, the committee found. Families with no members insured for a year are more than twice as likely as families with full coverage to incur medical expenses that exceed 10 percent of their income. Most uninsured families cannot afford to buy coverage independently. The median income for two-parent families in which both parents have insurance is $67,000, compared to $30,000 for families in which neither parent has coverage and $14,280 for single parents who lack insurance. "Given the high premium costs of independently purchased insurance, coverage might require a quarter or more of the family's income," said Mary Sue Coleman, president of the University of Michigan, Ann Arbor, and co-chair of the IOM committee. "For lower-income families, there is not much left in the budget after paying for necessities such as food and rent." Nonetheless, uninsured families pay more than 40 percent of their medical expenses out of pocket on average. The remainder is absorbed by health care providers, hospitals, charities, and the larger community. Families without full coverage also are disproportionately headed by single parents and are more likely to be immigrants or racial and ethnic minorities. In addition to lack of financial means, they often face multiple barriers to care, including cultural differences, less education, and language barriers. Private, employment-based health plans increase the likelihood that all family members will be covered, but these plans also have limitations. Changes in the plan-holder's eligibility or status often disrupt coverage for the entire family. Families with members in late middle age and approaching retirement are most susceptible to the negative consequences of losing coverage, since they tend to have greater health care needs and higher medical costs than younger families. Although the Consolidated Omnibus Budget Reconciliation Act, or COBRA, offers protection during transitional periods to some of those with workplace coverage, many families cannot afford to pay for it. Also, the cost of health care is once again rising fast, resulting in higher premiums, co-payments, and deductibles. This may lead more employees to decide they cannot afford coverage for themselves or their families, and more employers to reduce their coverage offerings. This report is the third of six that will provide an extensive review of research intended to paint an accurate portrait of who lacks health insurance and why, along with the personal, social, and economic consequences. These reports are designed to lay the groundwork for a more informed and productive public debate about health care coverage. The committee's final report will identify promising strategies for addressing the problems of uninsurance in the United States.

Kaiser Family Foundation Press Release 09/2005

Premiums Rise 9.2% In 2005, Less Than In 2004 But Three Times The Increase In Workers’ Wages
One in Five Firms Offer High-Deductible Health Plan Option; 2.4 Million Workers with Insurance Enrolled In Consumer-Driven Plans
Washington, D.C. – The percentage of businesses offering health insurance to their workers has declined steadily over the last five years as the cost of providing coverage continues to outpace inflation and wage growth, according to the 2005 Annual Employer Health Benefits Survey released by the Kaiser Family Foundation and Health Research and Educational Trust.
The survey found that three in five firms (60%) offered coverage to workers in 2005, down significantly from 69% in 2000 and 66% in 2003. The drop stems almost entirely from fewer small businesses offering health benefits, as nearly all businesses (98%) with 200 or more workers offer such benefits.
“It is low-wage workers who are being hurt the most by the steady drip, drip, drip of coverage draining out of the employer based health insurance system,” Kaiser Family Foundation President and CEO Drew E. Altman, Ph.D., said.
Premiums increased an average of 9.2% in 2005, down from the 11.2% average found in 2004. The 2005 increase ended four consecutive years of double-digit increases, but the rate of growth is still more than three times the growth in workers’ earnings (2.7%) and two-and-a-half times the rate of inflation (3.5%). Since 2000, premiums have gone up 73%.
The annual premiums for family coverage reached $10,880 in 2005, eclipsing the gross earnings for a full-time minimum-wage worker ($10,712). The average worker paid $2,713 toward premiums for family coverage in 2005 or 26% of the total health premium. While workers’ share of their premium has been relatively stable over the past few years, they are now paying on average $1,094 more in premiums for family coverage than they did in 2000.
“While premium increases slowed this year, they continue to rise much faster than inflation and other economic indicators. As a result, workers and businesses alike are finding it harder to afford health coverage,” said Health Research and Educational Trust President Mary A. Pittman, Dr. P.H.
High-deductible health plans
The survey found that 20% of employers who offer health insurance now provide a high-deductible health plan option. Jumbo firms – those with 5,000 or more workers – are significantly more likely than smaller firms to offer a high-deductible plan option, with 33% offering one in 2005. The survey defines high-deductible health plans as those with at least a $1,000 deductible for single coverage or at least a $2,000 deductible for family coverage.
Among employers who offer a high-deductible plan, relatively few (19.5%, or 3.9% of all offering employers) also make a contribution to a health reimbursement arrangement (HRA), offer a plan that would permit an enrollee to establish a health savings account (HSA), or do both. HRAs and HSAs are tax-favored accounts that employees can use to pay for medical expenses. Such arrangements are often described as consumer-driven because patients pay for a greater share of their health care directly, rather than through insurers, and therefore may have a financial incentive to reduce their health-care spending.
Despite the growing availability of high-deductible plans, relatively few workers are enrolled in consumer-driven arrangements. The survey estimates that this year about 2.3% of non-federal covered workers, or 1.6 million people, are enrolled in high-deductible health plans with an HRA, and about 1.2%, or 810,000 people, are enrolled in plans that are eligible for use with an HSA.
“Consumer-driven plans are proving attractive to some, but with just a couple million people now enrolled, it's too early to know whether they'll have a meaningful effect on the health system,” said Gary Claxton, a Kaiser Family Foundation vice president and co-author of the study. “The jury is still out on whether employees feel that these arrangements work for them, particularly when they get sick, and on whether employers feel that they have a real impact on costs.”
The survey also provides a detailed look at the features of high-deductible health plans, including premiums, deductibles, use of spending accounts, and employer and worker contributions. Such plans can cost less than other forms of employer-sponsored health coverage, but also leave workers exposed to greater potential out-of-pocket costs.
“Premium increases have slowed somewhat, but there's little confidence out there that we have an answer to health care cost growth,” said Jon Gabel, co-author of the study. “In the mid-1990s, premium hikes dropped to less than 1%, and we're still far away from that right now.”
Other highlights from the 2005 survey include:
Reasons for not offering coverage. Firms that do not offer health benefits to their workers – the overwhelming majority of whom are small firms – were most likely to cite cost as a key factor, with nearly three in four (73%) saying high premiums were “very important” to their decision. In comparison, just over half (52%) said their firm’s small size and one in three (33%) said the fact that their workers had access to other coverage were very important to their decision.
Type of insurance. In 2005, PPO plans were more common than ever, with 61% of all employees with health coverage enrolling in a PPO (up from 55% in 2004). Enrollment in HMOs, which generally cost less than PPOs, fell to 21% in 2005 from 25% in 2004. Conventional, or indemnity, benefit plans have all but disappeared, covering just 3% of covered workers.
Future plans. Looking toward the future, more than 40% of large firms (200 or more workers) offering health benefits say they are “very likely” to ask employees to pay more in premiums next year, while just 15% of smaller firms say they plan to do so. Across all firms offering coverage, relatively few say that they are “very likely” in the next year to raise deductibles (8%), raise office visit cost-sharing (7%) or raise prescription drug copayments (7%). About 1% of firms say they are “very likely” to drop health coverage entirely in the near future.
Utilization and disease management. About eight in 10 covered workers (81%) are in a health plan that uses case management for high-cost claims. Most covered workers also must get prior certification for inpatient services (75%) and outpatient surgery (55%). More than half (56%) of covered workers are enrolled in a plan with at least one disease management program. Among workers in these plans, virtually all (99%) are in a plan that provides management for diabetes. Large majorities are also in plans that provide management for asthma (86%), hypertension (82%), and high cholesterol (66%).
Confidence in cost-containment strategies. Few employers have a lot of confidence in strategies to contain rising health-care costs. For example, 16% of employers say consumer-driven health plans are “very” effective at controlling costs, while another 45% say they are “somewhat” effective. Nearly as many view higher employer cost-sharing as very (12%) or somewhat (46%) effective, and view disease management as very (14%) or somewhat (38%) effective. Fewer see tighter managed-care networks as very (7%) or somewhat (37%) effective.
The 2005 Employer Health Benefits Survey was conducted between January and May of 2005 and included 2,995 randomly selected, non-federal public and private firms with three or more employees (2,013 of which responded to the full survey and 982 of which responded to an additional question about offering coverage).