Health insurance more out of reach

Despite a booming national economy, private and public health insurance coverage continues to decline for Americans at all income levels, while American voters, who continue to view healthcare as an important topic, seem unmoved on the issue, according to two studies published in Health Affairs (vol. 19, no. 4).

According to the first study, conducted by The Urban Institute, Washington, the population of nonelderly uninsured grew from 17.3% to 18.4% between 1994 and 1998, a trend that has been in place since the late 1980s.

However, the reasons for declining coverage have changed. During the late 1980s and early 1990s, decreases in employer-based coverage for both adults and children were partially offset by increases in Medicaid coverage, but between 1994 and 1998, Medicaid coverage fell from 10.0% to 8.4%. Private nongroup coverage also dropped from 5.7% to 5.0%, possibly reflecting the higher cost of individual health insurance. Meanwhile, the number of adults covered through an employer rose by about 6.1 million, and the number of dependent children covered increased by 3.3 million. Thus, during this period, the increase in employer-sponsored coverage kept the number of uninsured from growing even larger.

But the study claims a closer look at the data reveals that those in middle and higher income brackets saw reductions in the rates of employer-sponsored coverage and increases in the likelihood of being uninsured. Changes in income distribution were responsible for gains in employer-sponsored coverage, as a robust economy helped boost many people into higher income brackets, where rates of employer-sponsored coverage are higher. Low-income populations received little benefit from the rise in employer-based coverage and were adversely affected by large reductions in Medicaid coverage.

"To some degree, the strong national economy is masking a problem that would otherwise be much worse," said John Holahan, director of the Urban Institute's Health Policy Center. "But if the economy falters or insurance premiums increase substantially, we can expect to see much higher numbers of uninsured."

Voter apathy

Voters will hear a lot about healthcare during the upcoming 2000 election campaign, but the message from politicians on healthcare will be segmented, without a single unifying theme, according to the second study. Voters' interest in healthcare issues is strong, but not as great as it was in 1992, the study found.

According to the study, the four major healthcare issues of concern to voters this year will be providing prescription drug coverage for the elderly under Medicare, making Medicare financially sound, protecting patients' rights and covering the uninsured. However, voters do not express strong support for comprehensive change in the healthcare arena. "Healthcare in this election is not about fundamentally changing the system," said lead study author Robert J. Blendon, "it is about solving specific issues that bother voters. What that means for the future is that while we're likely to see some efforts by elected officials in those areas, they will be modest in scope, when compared to the past 1992 election proposals." PR