Employment-Based Health Coverage Continues Decline; Uninsured Rate Shrinks as Public Coverage Grows

The uninsured rate for working-age Americans ticked down in 2011, but only because public program coverage grew faster than employment-based health insurance coverage declined, according to a new report by EBRI.

While employment-based health coverage is still the dominant source of health insurance in the United States, it has been steadily shrinking since 2000. The latest data show that it continued to do so last year.

The EBRI analysis finds that the percentage of the nonelderly population (under age 65) with health insurance coverage increased to 82 percent in 2011 (up about half a percentage point from 2010), which is notable since increases in health insurance coverage have been recorded in only three years since 1994.

However, different trends are taking place behind that overall result: Among the nonelderly population, employment-based coverage is trending down (58.4 percent had employment-based benefits in 20011, down from the peak of 69.3 percent in 2000), while public-program coverage is trending up (accounting for 22.5 percent of the nonelderly population, up from the low of 14.1 percent in 1999).

Enrollment in Medicaid (the federal-state health care program for poor) and the State Children’s Health Insurance Program (S-CHIP) increased to a combined 46.9 million in 2011, covering 17.6 percent of the nonelderly population, significantly above the 10.2 percent level of 1999. Other sources of public health insurance include Medicare (which covers many disabled as well as the elderly), Tricare, CHAMPVA, and Veterans Administration (VA) health insurance.

Full details of the EBRI report, “Sources of Health Insurance and Characteristics of the Uninsured: Analysis of the March 2012 Current Population Survey,” are published in the September 2012 EBRI Issue Brief, no. 376, online at www.ebri.org  The report is based primarily on the March 2012 Current Population Survey (CPS) conducted by the U.S. Census Bureau, with some analysis based on other Census surveys.

The full report is online here. The press release is online here.

The Impact on the Uninsured of the Baby Boom Generation Reaching Age 65

By Paul Fronstin, EBRI

This week the Census Bureau released its annual report on income, poverty and the uninsured. The number of uninsured increases naturally because of population growth even when the percentage declines, but in 2011 both the percentage of the population and the number uninsured declined: Between 2010 and 2011, the percentage uninsured fell from 16.3 percent to 15.7 percent and the number fell from 50 million to 48.6 million. In fact, 2011 was only one of four years since 1994 that saw a decline in the percentage uninsured.

Click to enlarge

Why did both those measures fall in 2011?

Some segments of the population did see an increase in employment-based coverage, notably young adults taking advantage of the adult dependent mandate in the Affordable Care Act (ACA), but these gains were offset by other loses (such as the decline in coverage from one’s own job for workers of all ages), negating any impact on the aggregate decline in the uninsured. The percentage of the population with employment-based health benefits stood at 55.1 percent in 2011, compared with 55.3 percent the previous year, so it would not account for the decline in the uninsured.

There was growth in the number of people covered by Medicaid and SCHIP (the State Children’s Health Insurance Program). In 2011, 16.5 percent of the population had Medicaid or SCHIP, up from 15.8 percent in 2010. So this increase accounted for some of the decline in the uninsured.

Overall, the decline in uninsured was largely associated with a rise in the share of people covered by government-sponsored health plans, increasing to 32.2 percent in 2011 from 31.2 percent in 2010.

Coincident with this trend, it’s worth noting that the leading edge of the Baby Boom generation (the cohort of individuals born between 1946‒1964) turned 65 in 2011, meaning that this generation is finally reaching Medicare eligibility.

Statistically, 65-year-olds have now reached 1 percent of the total U.S. population. While not yet a large number, it is the largest in recent history, driving up Medicare enrollments, and perhaps marking the cusp of a significant demographic shift in insurance trends.

Click to enlarge

Health Care Access Remains an Issue

Americans continue to report difficulty getting access to health care services, regardless of their type of health plan, according to a new report by the nonpartisan Employee Benefit Research Institute (EBRI).

When comparing traditional health plans with “consumer-driven” health plans (CDHPs), which include high-deductible health plans that offer a health savings account or health reimbursement arrangement, the latest EBRI survey finds that between 30−40 percent of respondents (depending on the question) reported some type of health care access issue for either themselves or family members in 2011.

Individuals in high-deductible health plans were more likely than those with traditional coverage to report access issues. Differences between those with traditional coverage and CDHP enrollees have been seen in the past, but no statistically significant difference was found in 2011.

However, people who had health problems and those at lower income levels were consistently more likely to report problems with health care access, according to EBRI.

“We find that access to health care services is an issue across the board,” said Paul Fronstin, director of EBRI’s Health Research and Education Program, and author of the report. “Regardless of health plan type, individuals with health problems and those in households with less than $50,000 a year were more likely than their counterparts to report access issues.”

The press release is online here. The full report is online here.

May 2012 EBRI Notes: Employment-based Health Coverage Rates Continue to Fall

A new report by EBRI shows that the percentage of workers with employment-based health coverage continues to shrink.

The EBRI analysis, which looks at month-by-month health coverage rates before, during, and after the recession, finds that the brief uptick in employment-based coverage immediately after the recession has not endured.

Employment-based health benefits are the most common form of health insurance for nonpoor and nonelderly individuals in the United States, covering 69 percent of workers, 35 percent of nonworking adults, and 55 percent of children.

Between December 2007, when the most recent economic recession officially started, and June 2009, when the recession technically ended, the percentage of workers with coverage in their own name fell from 60.4 percent to 56.0 percent. While that ticked up almost 1 percentage point by the end of 2009, by April 2011, the coverage rate was down to 55.8 percent.

“While the link between health insurance coverage and employment has long been known, these data underscore the degree to which unemployment rates directly affect the levels of the uninsured in the United States,” said Paul Fronstin, director of EBRI’s Health Research and Education Program and author of the report.

The press release is online here. The full report is online here.

Fewer Have Employment-Based Health Coverage

Most Americans get their health coverage through their jobs, but new research published in the April 2012 EBRI Issue Brief  shows that fewer workers have access to this benefit.

“Since 2002, the percentage of American workers with health coverage has fallen, mostly because fewer workers have access to coverage through their jobs,” said Paul Fronstin, PhD, author of the report and director of EBRI’s Health and Education Program. “Fewer employers are offering the benefit, fewer workers are eligible for it, and fewer workers are taking advantage of the benefit when it is offered, largely due to cost.”

The EBRI report notes that the percentage of the population with employment-based health benefits is lower, most recently due to the 2007–2009 recession, but also as part of a longer-term trend that has seen fewer workers with access to health coverage.

The full report is online here. The press release is online here.