NINE SUMMARIES OF
COMMONWEALTH REPORTS
DEC 2000 - JUN 2001
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Additionally, see summaries of 12 reports from the December 2000 conference
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Or see titles of 22 reports from the June 2000 and earlier
hosted by the Commonwealth Fund
INDIVIDUAL HEALTH INSURANCE MARKET IS FAILING OLDER ADULTS, RAISING QUESTIONS ABOUT TAX CREDITS
Losing Employer-Based Coverage Leaves Adults in Midlife Years Vulnerable to High Expenses and Access Problems
Early retirement because of poor health or loss of a job may be risky business if you lose your employer or group health insurance coverage. A new study shows that adults ages 50 to 64 who buy individual coverage are likely to pay much more out-of-pocket for a limited package of benefits than their counterparts who are covered via their employers.
The study, which appears in the July/August issue of the policy journal Health Affairs, makes clear that older working-age adults could face financial and access problems if they lose their employer-based health plan. The authors conclude that today's individual health insurance market "does not work well" for adults in the age 50-to-64 range who lack access to group premium rates.
The findings, based on an analysis by researchers at The Commonwealth Fund's Task Force on the Future of Health Insurance, illuminate the potential problems of implementing a tax credit system for the purchase of health insurance among certain populations. A number of legislative proposals, including one put forward by President Bush, would provide tax credits in the $500 to $1,200 range for individuals. Based on their analysis, the researchers say these would be insufficient to help older adults buy coverage. An analysis of premium costs in 15 cities showed a median cost of nearly $6,000 for a 60-year-old. "Even in states with community rating [which limits what insurers can charge], credits in the $1,000 range would pick up at most one-third of premium costs," the study finds. At a minimum, "tax credits would need to be adjusted by age and region to reflect market realities," the authors say.
EMPLOYER POLICIES CREATE BARRIERS TO HEALTH INSURANCE COVERAGE
Waiting Times, Restrictions for Part-Timers, and High Premiums Affect Enrollment Rates
A surprising number of working Americans can't get health insurance-even though they work for companies that offer health coverage-because their employers have policies such as waiting periods for new employees and exclusions for part-time employees. In addition, high employee contributions for health insurance often deter low-income workers from signing up for coverage even when they are eligible. The research, published in the July/August issue of Health Affairs provides new information about the effect of workplace eligibility policies on employees' health insurance coverage.
In "Embraceable You: How Employers Influence Health Plan Enrollment," Jon Gabel, Jeremy Pickreign, and Heidi Whitmore of the Health Research and Educational Trust (HRET), and Cathy Schoen of The Commonwealth Fund conclude that the most important ways for employers to improve coverage rates would be to eliminate or shorten waiting periods, include part-time workers or lower hours worked thresholds for eligibility, and reduce the cost to employees of participating in the plan.
"Looking beyond offer rates, employer eligibility policies play an important role in coverage," said Jon Gabel, vice president for health systems studies at HRET. "Nearly one of four employees working for firms that offer benefits is ineligible. Removing barriers to participation could significantly increase coverage rates for working families." Most new employees face a waiting time before they become eligible for their workplace health plan: only one of three (31%) has coverage that starts immediately. Among employers offering health plans, eleven percent of all employees face waiting times of four months or more. Those working for small or midsize and low-wage firms are most likely to experience such long waiting times.
Restrictions on part-time worker eligibility also restrict participation. Only two of five (41%) part-time workers are eligible to join a health plan that is available to their full-time co-workers. Firms with fewer than 1,000 workers are the least likely to cover part-time workers: about one of four part-timers in small (27%) and medium-size (25%) firms is eligible for health benefits, compared with over half (58%) of part-time workers in large firms.
Running in Place: How Job Characteristics, Immigrant Status, and Family Structure
Keep Hispanics Uninsured, June 2001
Despite making up an increasing portion of the U.S. population and workforce, a new report by The Commonwealth Fund reveals that Hispanics lag far behind non-Hispanics in health insurance coverage. In Running in Place: How Job Characteristics, Immigrant Status, and Family Structure Keep Hispanics Uninsured, Claudia Schur and Jacob
Feldman of the Project HOPE Center for Health Affairs analyze the dynamics of the types of jobs and industries in which Hispanics work, their status as immigrants, and factors related to family structure-all of which add up to limited opportunities for Hispanics to obtain health insurance.
"This report sheds light on the multiple burdens faced by Hispanics, especially immigrants with low incomes, who contribute to our nation's economic success but face barriers to sharing in the results on an equal basis with other workers," said Karen Davis, president of The Commonwealth Fund. "Recent rulings have pointed to the inequity of the 1996 restrictions on immigrants' access to Medicaid. Similarly, inadequacies in the private employer health insurance system negatively affect Hispanics' and other immigrants' ability to obtain coverage."
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How the New Labor Market Is Squeezing Workforce Health
Benefits, June 2001
Employer-sponsored health insurance benefits for private-sector workers through their own jobs have declined since the late 1970's within most industries, and low-wage workers are affected the most, according to a new report from The Commonwealth Fund. In examining trends over a 19-year period, the report, How the New Labor Market Is Squeezing Workforce Health Benefits, by James L. Medoff and colleagues at the Center for National Policy, finds that two-thirds of private-sector workers had health insurance coverage through their own employers in 1979, but just over half did by 1998. The decline was sharpest for those earning the least, with rates of own-employer coverage falling from 42 to 26 percent for workers in the bottom fifth of the hourly wage scale.
"Those who can least afford to be without health insurance are most likely to be without job-based benefits," said Cathy Schoen, vice president for health policy, research, and evaluation for The Commonwealth Fund. "This is a disturbing trend that deserves priority attention from policymakers as well as private business leaders. Low-wage workers are at risk of being shut out of the health care system."
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Health Insurance: A Family Affair. Jeanne Lambrew,
May 2001
The Commonwealth Fund suggests that extending insurance to parents may not only decrease the number of uninsured Americans but may be the best way to cover more uninsured children. The report, Health Insurance: A Family Affair, by Jeanne M. Lambrew of George Washington University, reveals that in states that have expanded Medicaid and State Children's Health Insurance Program (CHIP) coverage to parents as well as children, uninsured rates for eligible children are far lower than in states that have not expanded coverage to parents.
"The failure of states to insure parents-and entire families-at least partly explains the slow growth of insurance coverage for children in some states and the persistence of high uninsured rates," said Cathy Schoen, executive director of The Commonwealth Fund Task Force on the Future of Health Insurance. "This report suggests that proposals to encourage states to expand health insurance to low-income parents could benefit not only these parents but their children, too."
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State and Local Initiatives to Enhance Health Coverage for the Working Uninsured.
Sharon Silow-Carroll, Stephanie E. Anthony, and Jack A. Meyer,
November 2000.
States and local communities can employ a number of strategies to expand
health insurance for uninsured working people and their families, according
to a new report by The Commonwealth Fund Task Force on the Future of
Health Insurance.
State and Local Initiatives to Enhance Health Coverage for the Working Uninsured, by Sharon Silow-Carroll, Stephanie E. Anthony, and Jack A. Meyer of the Economic and Social Research Institute, describes the various ways states and local communities are making coverage more affordable and accessible. Although the authors focus primarily on programs that target employers and employees directly, they also examine a sample of programs targeting a broader population. A few initiatives deal with state efforts to make private insurance plans more accessible to individuals and very small firms, but without subsidizing premiums. Under other programs, states reinsure private health plans to help them reduce the premiums charged to employers and employees. There are also a few examples of managed care and Medicaid expansion programs that make publicly sponsored coverage available to low- and moderate-income people-a group that includes many uninsured workers and their families.
As the study notes, most of the 42.6 million uninsured people in the United States are workers and their family members. A majority of the working uninsured have incomes that place them in the poor or near-poor category, putting them at risk of financial ruin from any type of serious disease, illness, or accident. At the same time, many small firms that operate on a narrow profit margin cannot afford to purchase coverage for their workers or are reluctant to offer coverage to workers who may only be there for a short time.
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Enhancing Health Coverage for the Working Uninsured: Lessons from Six State and Local Programs.
Sharon Silow-Carroll, February 2001
Historically, government's response to the lack of affordable health insurance has been limited to programs targeting society's most vulnerable groups-the elderly, poor children, pregnant women, and the disabled. More recently, many states and communities have begun to focus on a vast, frequently overlooked subset of uninsured Americans: low-income workers.
About 24 million workers and their family members lack health insurance. Many work for small companies that do not offer coverage. Others simply cannot afford the required premiums and coinsurance.
A number of state and local governments are now tackling the problem by helping employers and workers afford private health coverage. In Expanding Employment-Based Health Coverage: Lessons from Six State and Local Programs, a new study conducted for The Commonwealth Fund's Task Force on the Future of Health Insurance, analysts at the Economic and Social Research Institute (ESRI) have uncovered a number of creative, promising strategies.
Most of the programs focus on small employers and their workers. Some, like Massachusetts' Family Assistance Program, subsidize premiums so that employers and employees, or both, can afford to purchase coverage. Instead of directly subsidizing premiums, other initiatives make private group coverage available to very small groups and the self-employed, including high-risk individuals. Among these programs are the Healthcare Group of Arizona and the New Mexico Health Insurance Alliance, both of which also arrange reinsurance for health plans.
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Patterns of Insurance Coverage Within Families with Children.
Karla L. Hanson,
Health Affairs, January 2001.
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In "Patterns of Insurance Coverage Within Families with Children" (Health Affairs,
Jan/Feb 2001), Karla Hanson of the New School University analyzes data on 32 million
U.S. families with children. In more than three-quarters of families all members have
health coverage, but in a surprisingly high proportion of families-one of seven-only some
members are insured. Hanson finds that:
In 1.6 million families, the parent (or parents, if a two-parent family) is covered while the children are uninsured. These are most likely families in which a parent has coverage through his or her job but cannot afford higher premiums to cover the entire family.
In 1.3 million families, the children are insured but the parent or parents are uninsured. The majority of these are low-income families in which the children are covered by Medicaid but the parents are ineligible.
In 1.6 million families, either one parent is uninsured and the other parent and children are insured, or some children are insured and some are not. In the latter case, families are more likely to have a sick or disabled child.
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Role of Insurance in Providing Access to Care . Cathy Schoen and
Catherine DesRoches, HSR: Health Services Research, April 2000.
For many Americans, health insurance coverage is not a constant. Individuals and families often gain, lose, and then regain health coverage over time as they undergo change in their lives, such as a change in jobs or loss of employment. As a result, the number of those who are insured but have experienced a period without coverage during the year is considerably greater at any given point than the number of uninsured.
For their study "Uninsured and Unstably Insured: The Importance of Continuous Insurance Coverage" (Health Services Research, April 2000, Part II), Cathy Schoen of The Commonwealth Fund and Catherine DesRoches of the Harvard School of Public Health analyzed three different survey databases to examine continuity of health coverage within the U.S. population. The authors find that compared with those who have been continuously insured, insured adults (ages 18 to 64) who have had a recent time without coverage are at high risk for going without needed care and having difficulty paying medical bills. This group is up to three times as likely as the continuously insured to report problems obtaining access to health care services. In fact, rates of access and affordability problems are virtually the same for the recently uninsured as they are for the currently uninsured.
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