Fewer poor parents are offered health insurance
Fewer poor parents are offered health insurance
Survey data of families and individuals from 1996-97 and 1998-99 indicate that fewer low-income parents are being offered health insurance coverage through their employers and that fewer are accepting the coverage when it is offered. Analysts from the Center for Studying Health Change in Washington, DC, say the reason for the drop in employer-sponsored health coverage is unclear, but it is not that fewer low-income people are employed.
Left unanswered by the survey data is the key public policy question of whether the decrease in private insurance coverage resulted from expanded eligibility for public programs (substituting public for private coverage) or whether it occurred independently of the expansion of public programs.
"If the decrease in private insurance was largely due to substitution of public for private insurance, it would suggest that public coverage expansions have benefited primarily children who already had private insurance by providing them with a lower-cost alternative," the center’s report says. "This explanation would also imply that the public dollars required to reduce the number of uninsured children through these programs are considerably higher than expected."
If the decrease in public coverage occurred independently of public program expansion, it would imply that expansion of public coverage provides an important safety net to many low-income children whose parents no longer can afford private insurance coverage.
Center analysts say that some amount of substitution of public for private coverage is to be expected in any type of incremental health insurance expansion that targets the uninsured. Because Children’s Health Insurance Program implementation was still in its early stages during the survey, it’s too early for a substantial amount of substitution to have taken place, especially given the fact that the vast majority of new enrollees in Medicaid and other state coverage previously were uninsured, the analysts say.
The center says that financial pressures on low-income families steer them to dropping employer coverage independently of public coverage expansion. These financial pressures are likely to increase as the cost of living goes up along with health insurance premium costs.
"This will make it even more difficult to determine in the future whether the primary effect of public coverage expansion is to draw low-income persons away from private coverage, or whether these programs act as a safety net for families who no longer can afford private insurance," the report states.
The report’s authors expressed disappointment at the data indicating a reciprocal decline in private coverage along with an increase in public coverage, yielding no net change in the overall percentage who are uninsured.
"We were expecting to see some gains in public coverage for low-income children given recent expansions," says Peter J. Cunningham, senior researcher with the Center for Studying Health System Change and the study’s author. "Perhaps the most troubling trend is the increase in uninsurance for low-income parents who, unlike their children, do not have access to public programs."
[Contact Mr. Cunningham at (202) 554-7549.]
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