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PubMed2001

Low-wage workers and health insurance coverage: can policymakers target them through their employers?

Many policy initiatives to increase health insurance coverage would subsidize employers to offer coverage or subsidize employees to participate in their employers' health plans. Using data from the 1997 Robert Wood Johnson Foundation Employer Health Insurance Survey, we contrast "low-wage employers" with all other employers. Employees in low-wage businesses have significantly worse access to employment-based insurance than other employees do; they are less likely to work for an employer that offers insurance, less likely to be eligible if working in a business that offers insurance, and less likely to be enrolled if eligible. Low-wage employers contribute lower shares of premiums and offer less generous benefits than other employers do. Policies that would target subsidies to selected employers to increase insurance offers to low-wage workers are difficult to design, however, because several commonly mentioned employer characteristics (including firm size) are found to be poor indicators of low-wage worker concentration. Programs that would set minimum standards for employer plans to be eligible for "buy-ins" need to base these standards on the less generous terms offered by low-wage employers in order to effectively reach low-wage workers and their dependents.

Eligibility Determination↗
PubMed1987

Health insurance coverage of the working poor.

This study examines the working poor, and their pattern of health insurance coverage. The data indicate that in 1977 almost 22% of the working poor lack health insurance throughout the year. Moreover, children of the working poor were almost twice as likely as children of the poor nonemployed to be without coverage. The implications of the Omnibus Budget Reconciliation Act of 1981 (OBRA) which restricted the working poor's eligibility for Medicaid are discussed. It is argued that being employed, in itself, does not guarantee poor people access to medical care and may, in fact, serve to restrict it.

Health Benefit Plans, Employee↗
PubMed1991

Employer-sponsored insurance coverage for alcohol and drug abuse treatment, 1988.

This paper uses 1988 Bureau of Labor Statistics data to analyze the content of insurance coverage for alcohol and drug abuse treatment offered by medium and large private sector firms. Ninety percent of workers had medical insurance. Of these, 81% had coverage for alcohol abuse treatment and 75.5% had coverage for drug abuse treatment. The coverages were almost always offered together, and the benefits were generally identical for both. Coverage for inpatient detoxification was most common, followed by outpatient care and inpatient rehabilitation. Self-insured plans, although exempt from state-mandated benefits, were as likely to include alcohol and drug abuse coverage as Blue Cross and Blue Shield and commercial plans, and their specific benefits were no less generous. Coverage limitations tended to be more restrictive for these illnesses than for others. The nature of the limitations varied greatly, although day and dollar limits were most common for inpatient treatment, and visit limits and higher copayments were most common for outpatient treatment.

Alcoholism↗
PubMed1985

The elderly's private insurance coverage of nursing home care.

About 40 per cent of Medicare beneficiaries had private insurance coverage of skilled nursing facilities (SNF) in 1977. Data from the 1977 National Medical Care Expenditure Survey show that among such persons, about 85 per cent had full coverage of Medicare's Part A copayments for days 21-100 but only 15.7 per cent had maximum coverage of at least 365 days of care or a benefit of $100,000 or more. The most comprehensive benefits are found among persons with middle or high incomes; more generous first-dollar coverage is found in the North Central and South regions, and more generous maximums in the West.

Aged↗
PubMed1995

Reduction mammaplasty: criteria for insurance coverage.

The guidelines by which insurers determine eligibility for coverage of reduction mammaplasty must rely largely on only subjective materials, yet they often apply strict criteria ranging from minimum resection weights to outright refusal to compensate. I have reviewed the data from 100 consecutive reduction mammaplasties performed by me over the last 2 years. Body weight, combined specimen weight, and height relationships were studied. Patient-identifiable questionnaires regarding the presence or absence of preoperative regional discomforts were sent to the same group. It was not possible to construct a useful formula that would verify either subject complaints of discomfort or the prospect for their relief based on body dimension or specimen weight. This study suggests that a graded, three-level minimum specimen weight standard for body weights less than 70 kg, 70 to 79 kg, and over 80 kg would be more equitable.

Body Height↗
PubMed1988

Insurance coverage and the demand for dental care. Results for non-aged white adults.

The fraction of the U.S. population with private dental insurance coverage increased considerably during the past two decades. Experimental data from the Rand Health Insurance Study have revealed that dental insurance is an important determinant of demand. In this analysis, detailed health insurance data from the National Medical Care Expenditure Survey are used to study the effects of insurance on demand by a standard population of white adults aged 16 to 64. Results from this national probability sample are generally comparable to those from the Rand experimental data. Estimates indicate that the primary effects of dental insurance are to facilitate access to care and to increase dental expenditures. Results are consistent with the notion that first-dollar coverage exerts a greater effect on demand than insurance which requires payment of a deductible. Findings also suggest that insurance affects the mix of dental services received. Loss of dental benefits because of cost containment efforts will result in significant reductions in demand for dental services.

Adolescent↗
PubMed1982

Duplicate health insurance coverage: determinants of variation across states.

Although it is recognized that many people have duplicate private health insurance coverage, either through separate purchase or as health benefits in multi-earner families, there has been little analysis of the factors determining duplicate coverage rates. A new data source, the Survey of Income and Education, offers a comparison with the only previous source of state level data, the estimates from the Health Insurance Association of America. The R2 between the two sets is only .3 and certain problems can be traced to the methodology underlying the HIAA figures. Using figures for gross and net coverage, the ratio of total policies to people with private coverage ranges from .94 in Utah to 1.53 in Illinois. Measures of industry distribution, per capita income and employment explain a large portion of the variance, but it appears that these factors operate in opposite directions for group and non-group policies. Similar sociodemographic variables also explain net coverage. These findings have substantial implications for research and the structuring of employee health benefits.

Analysis of Variance↗
PubMed2003

Workers' decisions to take-up offered health insurance coverage: assessing the importance of out-of-pocket premium costs.

BACKGROUND: Many proposed policy initiatives involve subsidies directed toward encouraging employers to offer coverage and toward workers to encourage enrollment in offered plans. Given that insurance coverage reflects employers' decisions to offer coverage, eligibility requirements for such coverage, and employees' take-up decisions, all three elements are important when considering mechanisms to decrease the number of uninsured individuals. RESEARCH DESIGN: In this study, we examine the relationship between workers' decisions to take-up offers of health insurance and annual out-of-pocket contributions, total premiums, and employer and workforce characteristics. We model the take-up decision using cross-sectional data from approximately 18,000 establishments per year from the 1997 to 1999 Medical Expenditure Panel Survey - Insurance Component. RESULTS: We find that workers are less likely to enroll in coverage as single employee contributions increase. Our results for family contributions are much smaller than for single contributions and are not statistically significant in all years. Our simulation results suggest that reducing employee contribution levels for single coverage from existing levels in 1999 to zero would yield an increase in take-up rates of roughly 6% points in establishments that had required a positive level of contributions. Our results also indicate that of the 13.8 million private sector workers who decline coverage from their employers, 2.5 million would potentially enroll in employer-sponsored coverage if the cost of single coverage were to fall to zero. CONCLUSION: Reducing employee contributions will increase take-up rates; however, even when employees pay nothing for their coverage, some employees elect not to enroll.

Computer Simulation↗
PubMedDate not supplied

Medical expenditures and insurance coverage for people with diabetes: estimates from the National Medical Care Expenditure Survey.

Access to health insurance and protection against expenditures for medical care are of special concern to diabetic patients in the United States. This study examines some information on the extent and breadth of public and private health insurance for individuals with diabetes, as well as some estimates of their use of health-care services and their mean expenses for this care. About 12% of all diabetic patients less than 65 yr old (approximately 311,000 individuals) were uninsured throughout 1977, a rate not much different from that for the rest of the United States population. Those with diabetes who are uninsured tend to be younger, Black or Hispanic, in excellent or good health, and live outside of metropolitan areas and in the South or West. As expected, diabetic patients use more medical care than others of their age and sex, and their medical expenses are also much higher, particularly in younger age groups. In 1977, average total medical-care expenses for people with diabetes were $1514 compared with $548 for the rest of the population. They and their families paid approximately 20% out of pocket (approximately $355). Their health insurance premiums were not much different from those without diabetes, averaging approximately $1000 in 1977 for those under age 65. The private insurance coverage for diabetic patients was similar to that for others, although slightly fewer had major medical coverage than the general population.

Adult↗
PubMed2002

Patterns of health insurance coverage among rural and urban children.

Despite the potential for the State Children's Health Insurance Program to improve the health care coverage of rural children, the expansion of public health insurance to children in rural areas may be hampered by a lack of understanding about the patterns of insurance coverage they experience. This study uses the Census Bureau's 1993-1996 panel of the Survey of Income and Program Participation to evaluate differences in the duration of, and in their entry into and exit from, uninsured spells. While the average duration of new spells was shorter for rural children and most regained coverage quickly, rural children were also more likely than urban children to experience protracted spells of uninsurance. Moreover, rural children were more likely than urban children to move between public and private coverage. These findings have important implications for designing insurance expansion programs and outreach strategies to effectively enroll and retain rural children.

Adolescent↗
PubMed1994

Private insurance coverage for the treatment of mental illness versus general medical care: a policy of inequity.

Private insurance coverage has historically been and continues to be discriminatory toward patients requiring treatment for mental illness and substance abuse disorders in comparison with those in need of general medical care. Factors contributing to this disparity include stigma, relatively low overt consumer demand for psychiatric care, lack of knowledge about psychiatric illness and treatment on the part of insurers, a historical reliance on public sector psychiatry, and the assumption that more liberal psychiatric benefits result in unnecessary and excessive use. Strategies aimed at eliminating discriminatory insurance practices against those in need of mental health care must be implemented. Recommended approaches include further research on the cost effectiveness of mental health care, public education regarding the nature of mental illness and its treatment, patient/family advocacy, and the marketing of services by mental health professionals.

Cost-Benefit Analysis↗
PubMed1994

Health insurance coverage among persons with AIDS: results from a multistate surveillance project.

To determine factors associated with health insurance coverage among persons with acquired immunodeficiency syndrome (AIDS), we interviewed 1958 persons 18 years of age or older who were reported to have AIDS in 11 states and cities. Overall, 25% had no insurance, 55% had public insurance, and 20% had private insurance. Factors associated with lack of insurance varied by current employment status. Employed persons with an annual household income of less than $10,000 were 3.6 times more likely to lack insurance than employed persons with a higher income. Unemployed persons diagnosed with AIDS for less than 1 year were two times more likely to lack health insurance than unemployed persons diagnosed for a longer time. Making insurance available to persons identified as most likely to lack insurance should improve access to care for persons with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1992

A descriptive analysis of health insurance coverage among farm families in Minnesota.

This paper reports the findings of a study of health insurance coverage and access to health services among farm families in Minnesota. The study included 1,482 families actively engaged in farming during 1989. While less than 10 percent of the population were uninsured during this period, the majority had limited coverage with high deductible and coinsurance provisions. Moreover, they were paying an estimated 15 to 20 percent more for their plans than a similar plan would have cost in the Minneapolis-St. Paul, MN, area. With the exception of cost, satisfaction with health services was found to be very high, and there were few indications of access problems.

Agriculture↗
PubMed1996

Trends in health insurance coverage in California, 1989-1993.

California's uninsurance rate of 22.7 percent is higher than the national average. The state's rate of employment-based insurance coverage--below the national average--is declining because of rising health insurance premiums, falling family incomes, and the changing structure of the economy and the labor market. Growing Medicaid coverage, fostered by expanded eligibility and falling incomes, has prevented rapid growth in the state's uninsured population. Anticipated cutbacks in federal Medicaid funding, however, would increase California's uninsurance rate. Continuing cutbacks in health services for the uninsured would reduce their access to health care and increase stress on many private health services.

Adolescent↗