trends in health insurance coverage in the u.s. sherry glied, ph.d. assistant secretary for planning...
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33 Decreased Employer-Sponsored Coverage Is Closely Linked to Decreased Affordability SOURCE: T Gilmer and R Kronick. “Hard times and health insurance: how many Americans will be uninsured by 2010?” Health Affairs, May 18,2009. Reprinted with permission.TRANSCRIPT
Trends in Health Insurance Coverage in the U.S.
Sherry Glied, Ph.D.Assistant Secretary for Planning and Evaluation
Declining Coverage – What are the Sources of the Problems?
• Costs are rising relative to family incomes• Costs of obtaining coverage are very high for
small firms and for individuals• The small firm and individual insurance
markets are subject to risk selection (by insurers) and averse selection (by insureds)
• Limited capacity to smooth economic downturns
33
Decreased Employer-Sponsored Coverage Is Closely Linked to Decreased Affordability
SOURCE: T Gilmer and R Kronick. “Hard times and health insurance: how many Americans will be uninsured by 2010?” Health Affairs, May 18,2009. Reprinted with permission.
444
Decline in Private Firms Offering Coverage Is Concentrated Among Small Employers
47 47 46 45 43 42 43 43 43 41
95 95 95 95 94 94 94 94 95 94
99 99 99 99 99 99 99 98 99 99
0
20
40
60
80
100
1999 2000 2001 2002 2003 2004 2005 2006 2008 2009
Small Firms (<50) Medium Firms (100-999) Large Firms (1000+)
SOURCE: ASPE Analysis of MEPS-ICNote: Significant change from 1999-2009 at p<0.05 level for small firms
55
The Share of Americans Who Purchase in the Individual Market Is Declining
SOURCE: ASPE analysis of 1997 - 2007 MEPS-HC . Percentages reflect non-elderly persons with at least one-month of individual coverage during the year.
5.7%5.0%
4.6%5.0%
4.7% 4.8% 4.8% 4.6% 4.7%4.2% 4.1%
0%
1%
2%
3%
4%
5%
6%
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Perc
ent o
f the
non
-eld
erly
pop
ulati
on w
ith
indi
vidu
al c
over
age
Trends in the Purchase of Individual Coverage Vary by Age
Source: AHRQ analysis of MEPS-HC
77
Many People Hold Individual Insurance Coverage Only for Short Periods
38%29% 24%
45%64%
29%36%
33%
25%
22%32% 35%
43%30%
14%
0%
25%
50%
75%
100%
All Children Age 19-34 Age 35-54 Age 55-64
Perc
ent o
f Ind
ivid
uals
who
Pu
rcha
se In
divi
dual
Cov
erag
e
At least 2 years At Least 1 Year Less than a year
SOURCE: AHRQ analysis of MEPS-HC
88
Denial Rates in the Individual Market Are High for All Groups But Particularly for Those Over 55
13%
5%
11%
16%
26%
All Under Age 19 Age 19-34 Age 34-54 Age 55-64
Perc
ent o
f Und
erw
ritten
App
lican
ts
Deni
ed in
200
8
SOURCE: America’s Health Insurance Plans, Individual Health Insurance 2009: A Comprehensive Study of Premiums, Availability, and Benefits (October 2009)
Annual Unemployment Rate, 1997-2009
4.9 4.5 4.2 44.7
5.8 65.5 5.1
4.6 4.6
5.8
9.3
0123456789
10
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Annu
al U
nem
ploy
men
t Rat
e
Unemployment Rate, By AgeJanuary 2000 – October 2010
0
5
10
15
20
25
30
Jan
May Se
pJa
nM
ay Sep
Jan
May Se
pJa
nM
ay Sep
Jan
May Se
pJa
nM
ay Sep
Jan
May Se
pJa
nM
ay Sep
Jan
May Se
pJa
nM
ay Sep
Jan
May Se
p
Mon
thly
Une
mpl
oym
ent R
ate
Age 16-19Age 20-24Age 25-34Age 35-44Age 45-54Age 55 +
Share of Children, Parents and Other Adults Enrolled in Medicaid
Affordable Care Act Provisions Affecting Coverage
• Immediate– Coverage of adult children to 26– PCIPs– Small firm tax credits
• 2014– Exchanges– Premium tax credits and cost sharing reductions– Medicaid Expansions
Research Agenda
• Developing capacity to routinely track key indicators of Affordable Care Act outcomes
• Developing baseline data and structure for external and internal evaluation of Affordable Care Act and its components
Sherry Glied, Ph.D.Assistant Secretary for Planning and EvaluationU.S. Department of Health and Human Services
www.aspe.hhs.gov