State Health Lawmakers' Digest: New Uninsured (Vol. 1, No. 3), In the Abstract

IN THE ABSTRACT

Health Insurance, Access and Health Status of Children: Findings from the National Survey of America's Families

STUDY AND RESULTS: In the Urban Institute's newest installment of "Assessing the New Federalism," Genevieve Kenney, Lisa Dubay and Jennifer Haley examined insurance coverage for children age 18 and younger in 13 states--Alabama, California, Colorado, Florida, Massachusetts, Michigan, Minnesota, Mississippi, New Jersey, New York, Texas, Washington and Wisconsin. The report uses data from the National Survey of America's Families (NSAF) to study recent trends in access and coverage by comparing type of coverage, income group and age.

WHAT'S IMPORTANT: Overall, the proportion of uninsured children has not declined between 1997 and 1999. Higher-income children are slightly less likely to be insured than they were two years ago, due to declines in employer-sponsored coverage and the insurance rates of low-income children have remained virtually unchanged, despite widespread implementation of the State Children's Health Insurance Program (SCHIP). Low-income children also are four times as likely as higher-income children to be uninsured. These findings suggest that gains from SCHIP/Medicaid programs may not yet be readily apparent and that efforts to enroll eligible children may need to be strengthened.

FIND THIS STUDY: "Health Insurance, Access and Health Status of Children: Findings from the National Survey of America's Families" was published by the Urban Institute in October 2000 as part of its series, Snapshots of America's Families. It can be ordered by calling (202) 261-5079 or can be downloaded from http://newfederalism.urban.org/nsaf/index.htm.

RELATED STUDIES: Look for a forthcoming Urban Institute report entitled "Eligibility for Public Programs: National and State Estimates" and written by Lisa Dubay and Jennifer Haley examining SCHIP eligibility among higher-income children. The Children's Defense Fund's "Children in the States 2000" also provides current insurance information for children at the state level (http://www.childrensdefense.org/states/data.html).

ACCESS TO COVERAGE

EMPLOYER HEALTH BENEFITS: 2000 ANNUAL SURVEY

STUDY AND RESULTS: This report presents findings from a survey of more than 3,000 public and private employers. Through graphs and charts, the report illustrates various trends, including cost, employee coverage, health plan enrollment and choice, and prescription drug and mental health benefits.

FINDINGS: Health insurance premiums are increasing (up 8.3 percent between 1999 and 2000), due in part to higher spending for prescription drugs. In addition, more small businesses are offering health insurance, with a 65 percent rate of enrollment among those offered insurance across all business sizes. According to employers, the most common reason for employees not choosing coverage is because workers are covered elsewhere (72 percent) not because they can't afford the premiums (11 percent).

FIND THIS STUDY: Employer Health Benefits: 2000 Annual Survey by the Kaiser Family Foundation and Health Research and Educational Trust can be found at http://www.kff.org. For individual copies, contact the Kaiser Family Foundation at (800) 656-4533.

GROUPS AT RISK

WORKING WITHOUT BENEFITS: THE HEALTH INSURANCE CRISIS CONFRONTING HISPANIC AMERICANS

STUDY AND RESULTS: Using data from the March 1999 Current Population Survey and the Commonwealth Fund 1999 National Survey of Workers' Health Insurance, this report examines reasons behind the coverage crisis and the effect that lack of health insurance has on the Hispanic community. Hispanic Americans are twice as likely to be uninsured as the general population. Nearly 40 percent of Hispanics under age 65 do not have insurance, and 9 million of the 11 million uninsured Hispanics are in working families. Lack of coverage limits Hispanics' timely access to health care and leads many individuals to forego care altogether.

WHAT'S IMPORTANT: Several factors contribute to the high uninsured rate of Hispanic Americans, including concentration in low-wage and small firm jobs that do not offer insurance. Buying coverage in an individual (non-employer) market is almost always too expensive.

FIND THIS STUDY: Working Without Benefits: The Health Insurance Crisis Confronting Hispanic Americans (publication #370), published in March 2000 by the Commonwealth Fund, can be ordered by calling (888) 777-2744, or it can be downloaded from http://www.cmwf.org.

RELATED STUDIES: Can't Afford to Get Sick: A Reality for Millions of Working Americans (publication #347), published by GAO in September 1999.

IMMIGRANTS' HEALTH CARE: COVERAGE AND ACCESS

STUDY AND RESULTS: This chart pack highlights recent work on health coverage and access for immigrant populations. Section one highlights the demographics of immigrants and public policies that affect access to public benefits. Section two provides information about policies that affect health coverage and the role of citizenship status on health coverage. The last section focuses on access to health services for immigrants and highlights potential barriers to service. Low-income immigrants are more likely to be uninsured and less likely to receive Medicaid than are non-immigrants. Immigrants constitute about 20 percent of the 44 million uninsured in the United States. In 1998, of the 8.3 million low-income non-citizens, more than 58 percent had no health insurance and only 15 percent received Medicaid.

WHAT'S IMPORTANT: Many access and coverage disparities stem from recent policy changes that treat new legal immigrants different than both existing immigrants and citizens.

FIND THIS STUDY: Immigrants' Health Care: Coverage and Access (publication #2203), published in August 2000 by the Kaiser Commission on Medicaid and the Uninsured, can be ordered by calling (800) 656-4533, or it can be downloaded from http://www.kff.org.

RELATED STUDIES: Racial and Ethnic Differences in Health, 1996 (publication #99-0001), published in 1999 MEPS Chartbook No. 2.

A Synthesis of the Literature Racial & Ethnic Differences in Access to Medical Care, published in October 1999 by The Henry J. Kaiser Family Foundation.

HEALTH CARE AFTER WELFARE: AN UPDATE OF FINDINGS FROM STATE-LEVEL LEAVER STUDIES

STUDY AND RESULTS: This Center on Budget and Policy Priorities document analyzes 25 studies- conducted by states or counties- of children and families leaving welfare between January 1997 and summer 1999. Studies were conducted from three to 18 months after the subjects left welfare. The authors looked at the percentages of children and adults in these surveys who retained Medicaid, obtained private or employer-sponsored insurance, or lapsed into uninsurance.

FINDINGS: Virtually all children leaving welfare remain eligible for Medicaid or SCHIP, as do a smaller number- but still a majority- of their parents. Nevertheless, about half of parents and a third of children lost coverage. In most studies, fewer than half the parents who left welfare for work were offered employer-sponsored coverage, and not all of them purchased it when it was offered. In nearly all states, at least one parent in four was uninsured after leaving welfare. In many states, one child in five was uninsured after his or her parent left welfare. As a whole, these studies suggest that many states have not de-linked Medicaid and welfare sufficiently and that many families lost Medicaid inappropriately.

CAVEAT: The author stresses that the investigators who conducted these studies used different methods, took very different study samples, and interviewed subjects at different time intervals after they left welfare. As a result, although comparisons among studies may reveal broad trends, they are statistically imprecise.

FIND THIS STUDY: Health Care After Welfare: An Update of Findings from State-Level Leaver Studies, by Jocelyn Guyer. August 2000, Center on Budget and Policy Priorities. The publication can be ordered free of charge by calling (202) 408-1080. It also is available in PDF format online at www.cbpp.org.

OTHER STUDIES: See also Bowen Garrett and John Holahan, "Health Insurance Coverage after Welfare", Health Affairs, 19, no. 1 (Jan./Feb. 2000); and Leighton Ku and Brian Bruen, The Continuing Decline in Medicaid Coverage, Urban Institute, December 1999.

HEALTH INSURANCE FOR THE NEAR ELDERLY

STUDY AND RESULTS: This report examines private health insurance coverage for the near elderly-those between the ages of 55 and 64. It specifically looks at their health, employment, income and health insurance status; their ability to obtain employer-based health insurance if they retire before becoming eligible for Medicare; and use of and costs associated with buying individual market or employer-based continuation policies.

FINDINGS: Roughly 86 percent of the near elderly have access to some type of health insurance. However, health coverage is a concern for many in this age group who retire early or who lose access to employer-based policies. Private health coverage may be too expensive for some of them because often both their health and income decline at the same time they leave the work force. Their health care expenditures are about 45 percent higher than those of the younger group, while their median family incomes are about 25 percent lower. Fewer than 40 percent of large employers offer retiree health coverage, and that number continues to decline.

WHAT'S IMPORTANT: In most states, some of the near elderly who try to buy policies in the individual insurance market may be denied, may have certain conditions or body parts excluded from coverage, or may pay significantly higher premiums than the standard rate. Although many states have tried to increase access to health insurance coverage, obtaining policies still may be expensive, especially for less healthy individuals who may have high expected costs.

FIND THIS STUDY: Private Health Insurance: Declining Employer Coverage May Affect Access for 55- to 64-Year-Olds by the U.S. General Accounting Office (GAO/HEHS-98-133, June 1998).

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