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The numbers of the uninsured in America had stopped growing and was actually declining, according to a recently released study completed with census figures from March 2000.
But the researchers caution that, one year later, a sag in the economy and the reemergence of health care cost inflation could cause the ranks of the uninsured to start growing again.
The study, from the Employee Benefit Research Institute (EBRI) in Washington, DC, casts a spotlight on a moment in time when the economy was surging and the past year’s steady drop in corporate profits and key economic indicators was only a month away from rearing its head.
Conclusions from the study include:
• For the first time since 1987, the percentage of Americans with health insurance increased in 1999.
• The overall drop in the number of Americans without health insurance is credited to low employment and a strong economy.
• While states added thousands more children to the Children’s Health Insurance Program (CHIP), public health insurance coverage did not increase between 1998 and 1999.
"The percentage of children in families just above the poverty level without health insurance coverage declined dramatically, from 27.2% uninsured in 1998 to 19.7% uninsured in 1999," the study notes.
"Some of the decline can be attributed to expansions in Medicaid and CHIP, but it appears that expansion in employment based health insurance and individually purchased coverage had an even larger effect than expansion of CHIP," according to the study.
• More than 42 Americans, in 1999, were without health insurance.
"Should a severe downturn in the economy occur, causing the uninsured to represent 25% of the nonelderly population, 63 million Americans would be uninsured," the study concludes.
This is also the first time that the numbers of Americans without health insurance has dropped.
Between 1987 and 1993, the rise in the number of those without health insurance rose because of the an erosion of employment-based benefits, the study notes.
Employers started picking up the pace between 1993 and 1998, the study continues, and more people were covered, but a "decline in public sources of health insurance would mostly explain the increase in the uninsured population," the study points out.
Employment-based health insurance coverage grew between 1997 and 1998, according to the study, producing some expected and unexpected results.
"It is not surprising because the strong economy and low unemployment rates have caused more employers to provide health benefits in order to attract and retain workers," the study notes, "and also may have resulted in more workers being able to afford health insurance. It is surprising because 1998 saw the return of health care cost inflation, and this inflationary trend accelerated in 1999."
More competitive health care markets and alternative forms of third-party reimbursement arrangements (capitation, fee scheduling, and discounting, for instance), make it tougher for providers to shift the costs to other health care payers, the study notes.
"As a result, the nature of cost shifting may be changing," according to the study.
Figures used in the study were taken from the March 2000 Current Population Survey, which is conducted every year by the U.S. Census Bureau. The numbers and the conclusions from EBRI are collated and presented to inform health care policy and policy-makers, Ms. Christensen explains.