FYI -  from /Health Affairs/ press release of study done by Holahan and 
Cook, of the Urban Institute
(see below for citation and link to article). 

Trends towards growing social and economic inequality in the United 
States continue.
Note particularly disproportional and escalating losses for those at the 
bottom of the economic ladder
 - low wage workers, low income households and children in those 
households.
I would expect continuing slow-downs and reversals in meeting Healthy 
2010 public health and prevention goals,
especially in sensitive health indicators like vaccine-preventable 
childhood & adult diseases,
STD & TB infection and control, and maternal/neo-natal mortality. -- 
Alice Furumoto-Dawson

*
Coverage Losses Continued Even as The Economy Improved
from 2004 through 2006

Continuing Declines In Employer-Sponsored Coverage Plus Slower Growth
in Medicaid and SCHIP Reversed Coverage Gains For Children*

Bethesda, MD -- The number of uninsured people in the United States grew 
by 3.4 million from 2004 to 2006, even as a resurgent economy raised 
incomes and lowered poverty rates, Urban Institute researchers say in a 
/Health Affairs/ Web Exclusive study published today. 
http://content.healthaffairs.org/cgi/content/abstract/hlthaff.27.2.w135 
<http://www.healthaffairs.org/alert_link.php?url=http://content.healthaffairs.org/cgi/content/abstract/hlthaff.27.2.w135&t=h&id=666>

The economy's emergence from recession did not interrupt the rise in 
uninsurance dating back to 2000. In fact, on an annual basis, the ranks 
of the uninsured grew faster in 2005 and 2006 than they did during the 
four years from 2000 through 2004, when a total of 6 million people 
became uninsured. The study is based on data from the 2000, 2005, and 
2007 March supplements to the Current Population Survey conducted by the 
U.S. Census Bureau.

"In good economic times and bad, the dominant factor behind the growing 
number of uninsured was the decline in employer-sponsored health 
coverage," said lead author John Holahan, the director of the Health 
Policy Center at the non-partisan Urban Institute. From 2000 to 2004, 
the rate of employer coverage fell dramatically: In 2000, 67.8 percent 
of the nonelderly were covered by employer-sponsored insurance (ESI), 
but by 2004, only 63.3 percent had ESI.

From 2004 to 2006, the rate of ESI dropped another percentage point, 
from 64.0 percent to 63.0 percent. (The 2000-04 and 2004-06 coverage 
statistics are not strictly comparable because the 2004 and 2006 data 
reflect revisions the Census Bureau made to the assignment of dependent 
coverage.)

"The decline in the rate of employer coverage was much greater during 
the first part of the decade, but it is disturbing that ESI rates 
continued to decline even as the economy improved. What's more, from 
2000 to 2004, Medicaid and the State Children's Health Insurance Program 
were able to compensate for ESI losses among children, but in the 
2004-06 period the deteriorating budget picture caught up with states 
and Medicaid and SCHIP growth slowed," said Holahan. As a result, the 
number of uninsured children rose 1.0 million from 2004 to 2006, after 
having fallen by 400,000 from 2000 to 2004. Over the two periods, the 
number of adults without coverage increased by 8.7 million.

*Declines In Employer-Sponsored Coverage *
*Were Largest For Those At Lower Incomes*

Declines in ESI rates occurred at all income levels but were most 
pronounced for the low-income, note Holahan and coauthor Allison Cook, a 
research associate at the Urban Institute. ESI rates for low-income 
adults -- those with family incomes below 200 percent of the federal 
poverty level (FPL) -- dropped 4.2 percentage points in 2000-04 and 1.6 
points in 2004-06. By contrast, the decreases in ESI rates for 
higher-income adults -- those with family incomes above 400 percent of 
the FPL -- were only 2.0 points in 2000-04 and 0.5 points in 2004-06.

For children, the pattern was similar. The percentage of low-income 
children with ESI dropped 5.5 percentage points in 2000-04 and 2.5 
points in 2004-06, while the corresponding decreases for higher-income 
children were only 2.2 points in 2000-04 and 0.5 points in 2004-06. For 
both adults and children, the decline in ESI rates for middle-income 
people -- those with family incomes between 200 percent and 400 percent 
of the FPL -- fell between the declines for low-income people and those 
for higher-income people.

To the extent that firms cannot shift rising insurance premiums "back to 
workers in the form of lower wages, they become less likely to offer 
coverage. At the low end of the income scale, premiums add much more to 
compensation and often cannot be shifted back to workers. Nor are the 
tax benefits at the low end of the income distribution particularly 
great, which weakens the incentive to give up wages for health 
insurance," Holahan and Cook write.

The authors warn that the erosion of ESI is likely to continue, 
particularly for low-income people, "because the basic factors 
underlying it seem unlikely to change." In addition to rising health 
care costs, those factors include the shift in employment to industries 
such as services and construction, where ESI rates have traditionally 
been relatively low, and away from industries such as manufacturing, 
where ESI rates have been relatively high; and the movement of the 
population to the South and West, again away from the large 
manufacturing centers of the North and Midwest.

Holahan and Cook say that the increase in the number of noncitizens has 
also contributed to the decline in ESI, but "in a relatively minor way," 
accounting for about 20 percent of the growth in the number of uninsured 
people from 2000 to 2006.

After the embargo lifts, you can read the article by Holahan and Cook at
http://content.healthaffairs.org/cgi/content/abstract/hlthaff.27.2.w135
<http://www.healthaffairs.org/alert_link.php?url=http://content.healthaffairs.org/cgi/content/abstract/hlthaff.27.2.w135&t=h&id=666>

*ABOUT */*HEALTH AFFAIRS*/*:*

/Health Affairs/, published by Project HOPE, is the leading journal of 
health policy. The peer-reviewed journal appears bimonthly in print with 
additional online-only papers published weekly as /Health Affairs/ Web 
Exclusives at www.healthaffairs.org 
<http://www.healthaffairs.org/alert_link.php?url=http://www.healthaffairs.org/alert_link.php?url=http://www.healthaffairs.org&t=h&id=456>. 
The full text of each /Health Affairs/ Web Exclusive is available free 
of charge to all Web site visitors for a two-week period following 
posting, after which it will switch to pay-per-view for nonsubscribers. 
Web Exclusives are supported in part by a grant from the Commonwealth Fund.

-- 
Alice Furumoto-Dawson, Ph.D.
Sr. Research Associate
Center for Interdisciplinary Health Disparities Research
Institute for Mind & Biology
University of Chicago
Chicago, IL - USA

Email:  [log in to unmask]
http://cihdr.uchicago.edu/


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