Private health insurance coverage declines
Private health insurance coverage declines
Children, early retirees, and near-poor hurt most
If a recent General Accounting Office (GAO) report holds true, some private duty provi ders may notice a slight but steady decrease in the number of clients covered under private insurance.
The July 1997 GAO report, Private Health Insurance: Continued Erosion of Coverage Linked to Cost Pressures, says fewer Americans are able to afford private insurance premiums.1 These Americans either remain uninsured some paying for health care services out of pocket or rely on government assistance.
"Declining private health coverage has been accompanied by growth in the uninsured population and Medicaid enrollment, which in turn has increased government health expenditures," the report says.
The decline in private health coverage will definitely affect private duty providers’ ability to get paid for their services, says Donna L. Franks, RN, MS, CCM, a home care consultant with Homecare Resource Associates in Des Plaines, IL. "That’s going to limit them quite a bit as far as any private insurance goes. Many providers are not that interested in switching over to Medicaid as a payer source unless their states have a waiver program."
The report cites the rising cost of health insurance, shifts in employment patterns, low growth in family income, and indirect effects of expanded Medicaid coverage as reasons for the declining private health coverage. "If private health coverage continues to erode," the report concludes, "federal and state policy decision-makers will be called upon to tackle issues of access, affordability, and quality of health insurance, particularly for children, early retirees, and near-poor families."
Between 1980 and 1995, the population under age 65 covered by private health insurance decreased from 79.5% to 70.5%. (In 1995, about 164 million people under age 65 were covered by private health insurance.) The proportions of the population under age 65 that are uninsured or are Medicaid recipients increased by 5.5 and 4.3 percentage points, respectively, between 1980 and 1995, according to the report. (For more information about how to decrease denial of private insurance claims, see p. 117.)
Coverage for children, early retirees, and near-poor families has declined faster than coverage for the overall population. For example, between 1989 and 1995 the level of private health coverage for children declined by 7 percentage points, compared to a decline of 4.5 percentage points in the overall population under 65. Similarly, private health coverage rates for retirees under age 65 dropped from nearly 76% in 1989 to 69% in 1995.
Even if people have employer-based health insurance, the report finds that many are paying a growing share of their premiums and are more likely to have some limitation in their choice of health plan or health provider.
Reference
1. General Accounting Office. Private Health Insurance: Continued Erosion of Coverage Linked to Cost Pressures. GAO/HEHS-97-122. Washington, DC; July 1997.
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