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Providing Insights that Contribute to Better Health Policy Uninsured Decliners of Employer Sponsored Insurance: How They Changed from 1997-2003 Len M.

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Presentation on theme: "Providing Insights that Contribute to Better Health Policy Uninsured Decliners of Employer Sponsored Insurance: How They Changed from 1997-2003 Len M."— Presentation transcript:

1 Providing Insights that Contribute to Better Health Policy Uninsured Decliners of Employer Sponsored Insurance: How They Changed from 1997-2003 Len M. Nichols and Peter J. Cunningham Academy Health ARM June 6, 2004 San Diego, CA

2 Overview Why study decliners Data source Measurement of ESI take-up Coverage, access, and take-up trends Who declines and is uninsured? Multivariate take-up models Conclusions

3 Why Study Decliners Uninsured are heterogeneous Incremental and/or targeted policies are the order of the day 20% of uninsured have access to ESI Decision to decline perplexing

4 Specific Research Questions Have there been changes in declining activity, and if so, by whom? Do more or different types of people need subsidies to purchase insurance than was the case in 1997 or 2001?

5 Data Rounds 1,3 and 4 CTS Household Survey 1996-97, 2000-01, Calendar 2003 Roughly 30,000 households, 50,000 persons Complex sample design, national and site estimates for 12 communities Details at www.hschange.org

6 Concepts of ESI Take-up Worker Family

7 Overall Trends, 2001 to 2003 Decline in ESI coverage offset by increase in public coverage Decline in ESI due to job loss, fewer jobs with ESI attached, and lower take-up (for low income) Declines in ESI hit low income hardest, by far Family take-up rate did not drop on average More decliners have public coverage than in 1997

8 Who Declines and is Uninsured? Majority are low income, increasing fraction are high income 20% are children 28% are Hispanic 1/3 Single no kids, 47% married with kids 83% report good, VG, or excellent health 23% report unmet need or delayed care

9 Multivariate Take-Up Models Worker and person level take-up Logit on take-up|access; 2003 vs. 2001 and vs. 1997 Controls = age, gender, race/ethnicity, family status, income, health status, firm size, site dummies NO significant change in family take-up over time Significant decline in take-up for workers, esp. low income workers, vs.1997and vs. 2001

10 Conclusions Low income workers and families hit hard by recession + premium cost increases Declines in access larger than declines in take-up Public insurance = safety net for workers as well Decrease in take-up among low income workers but not among low income persons => ? Likelihood of two offers rising over time? Portents for many low income workers and families not good in any event

11 Coverage199720002003 Percent ESI coverage65.167.063.4*# Percent other private6.96.05.5# Percent Medicaid/SCHIP coverage7.79.012.0*# Percent other coverage4.93.94.1# Percent uninsured15.414.115.0 Percent in families with at least 1 working adult84.083.981.0*# ESI access rate – persons in working families79.680.778.5* Percent declined ESI coverage (all persons in families with ESI access) 7.46.77.6 Percent with private coverage17.612.212.2# Percent with public33.740.244.1# Percent uninsured48.647.643.7 Among all uninsured persons, percent with access to ESI coverage in family 22.121.620.0 *Difference between 2001 and 2003 is statistically significant at.05 level. #Difference between 1997 and 2003 is statistically significant at.05 level. Source: Community Tracking Study household surveys, 1997, 2001, and 2003. Table 1. Coverage, ESI access and take-up rates, all persons less than age 65.

12 Coverage rates for workers 199720002003 Percent with ESI coverage74.176.373.8* Percent with other private coverage6.05.25.2# Percent with Medicaid/SCHIP coverage1.72.02.9*# Percent with other coverage2.82.32.5 Percent uninsured15.314.215.7* Percent with ESI offer at own job70.772.569.9* Percent declined ESI coverage offered through their own job19.620.720.5 Percent with private coverage64.769.565.3* Percent with public12.311.013.2 Percent uninsured23.119.521.6 Percent of workers with spouses offered ESI coverage33.534.432.7* Percent of workers offered ESI through their own job and a spouses job 24.225.723.4* *Difference between 2001 and 2003 is statistically significant at.05 level. #Difference between 1997 and 2003 is statistically significant at.05 level. Source: Community Tracking Study household surveys, 1997, 2001, and 2003 Table 2. Coverage, ESI offer and take-up rates for workers.

13 199720002003 Family income: % LT 200% of poverty59.756.553.0 % 200-399% of poverty30.127.928.0 % 400% and higher10.215.619.0# Age: % 0-1722.021.319.4 % 18-4468.267.165.7 % 45-649.811.714.9 Race/ethnicity: % white57.949.655.4 % Hispanic22.933.428.0 % black17.214.610.8# % other2.02.45.8# Family status: % single person, no kids32.333.633.3 % single person, with kids16.315.48.8*# % married person, no kids9.58.311.0 % married person, with kids41.942.846.9 Health status: % excellent, good health85.882.882.6 % fair or poor health14.217.217.4 % with unmet need or delayed care due to cost29.126.923.1 *Difference between 2001 and 2003 is statistically significant at.05 level. #Difference between 1997 and 2003 is statistically significant at.05 level. Source: Community Tracking Study household surveys, 1997, 2001, and 2003 Table 3. Characteristics of uninsured persons in families where ESI was offered and declined.

14 199720002003 Family income: % LT 200% of poverty59.756.553.0 % 200-399% of poverty30.127.928.0 % 400% and higher10.215.619.0# Age: % 18-4422.021.319.4 % 45-6468.267.165.7 Race/ethnicity: % white57.949.655.4 % Hispanic22.933.428.0 % black17.214.610.8# % other2.02.45.8# Family status: % single person, no kids32.333.633.3 % single person, with kids16.315.48.8*# % married person, no kids9.58.311.0 % married person, with kids41.942.846.9 Firm size: % Fewer than 100 workers39.544.941.6 % 100+ workers60.555.158.4 Health status: % excellent, good health85.882.882.6 % fair or poor health14.217.217.4 % with unmet need or delayed care due to cost29.126.923.1 *Difference between 2001 and 2003 is statistically significant at.05 level. #Difference between 1997 and 2003 is statistically significant at.05 level. Source: Community Tracking Study household surveys, 1997, 2001, and 2003 Table 4. Characteristics of uninsured workers offered ESI coverage.

15 199720002003 Percent with ESI coverage All persons LT age 6565.167.063.4*# % LT 200% of poverty39.037.432.5*# % 200-399% of poverty75.574.472.2*# % 400% and higher84.083.684.0 Percent with access to ESI All persons LT age 6566.867.763.7*# % LT 200% of poverty45.043.636.8*# % 200-399% of poverty75.673.970.8*# % 400% and higher82.681.082.0 Percent decline ESI coverage All persons LT age 657.46.77.6 % LT 200% of poverty16.118.319.6 % 200-399% of poverty5.84.96.4 % 400% and higher3.53.23.6 *Difference between 2001 and 2003 is statistically significant at.05 level. #Difference between 1997 and 2003 is statistically significant at.05 level. Source: Community Tracking Study household surveys, 1997, 2001, and 2003 Table 5a. ESI coverage, family offer and take-up rates by family income, for persons.

16 199720002003 Percent decline ESI coverage and uninsured All persons LT age 653.63.23.3 % LT 200% of poverty9.09.59.2 % 200-399% of poverty2.82.52.8 % 400% and higher1.01.11.3 Percent decline ESI coverage and covered by public All persons LT age 652.52.73.4# % LT 200% of poverty5.17.79.2# % 200-399% of poverty2.01.52.3 % 400% and higher1.41.51.7 *Difference between 2001 and 2003 is statistically significant at.05 level. #Difference between 1997 and 2003 is statistically significant at.05 level. Source: Community Tracking Study household surveys, 1997, 2001, and 2003 Table 5b. ESI coverage, family offer and take-up rates by family income, for persons.

17 199720002003 Percent with ESI coverage All workers LT age 6574.176.373.8* % LT 200% of poverty50.649.141.3*# % 200-399% of poverty78.078.177.7 % 400% and higher85.986.4 Percent offered and eligible for ESI All workers LT age 6570.772.569.9* % LT 200% of poverty54.454.847.9*# % 200-399% of poverty73.373.772.2 % 400% and higher78.879.178.7 Percent decline ESI coverage Workers offered and eligible for ESI19.620.720.5 % LT 200% of poverty25.027.529.2# % 200-399% of poverty18.619.417.6 % 400% and higher17.919.519.7# *Difference between 2001 and 2003 is statistically significant at.05 level. #Difference between 1997 and 2003 is statistically significant at.05 level. Source: Community Tracking Study household surveys, 1997, 2001, and 2003 Table 6a. ESI coverage, offer and take-up rates by family income, for workers.

18 199720002003 Percent decline ESI coverage and uninsured Workers offered and eligible for ESI 4.54.04.4 % LT 200% of poverty 12.513.815.3# % 200-399% of poverty 3.93.73.9 % 400% and higher 1.4 1.7 Percent decline ESI coverage and covered by public Workers offered and eligible for ESI 2.42.32.7 % LT 200% of poverty 4.44.96.7# % 200-399% of poverty 2.41.82.1 % 400% and higher 1.61.81.9 *Difference between 2001 and 2003 is statistically significant at.05 level. #Difference between 1997 and 2003 is statistically significant at.05 level. Source: Community Tracking Study household surveys, 1997, 2001, and 2003 Table 6b. ESI coverage, offer and take-up rates by family income, for workers.

19 2003 Binary0.16* (.09) 0.12 (.09) 0.07 (.10) 0.21** (.10) Large firm*LOW INCOME -0.01 (.18) -0.12 (.15) 0.09 (.13) 0.13 (.12) 2003*LOW INCOME 0.07 (.14) 0.15 (.12) 0.19** (.09) 0.26*** (.10) 2003*CHILD (0-17) 0.01 (.09) 0.19** (.08) 2003*FAMIL Y with dependents -0.11 (.10) -0.18* (.10) Binaries for each PSU in sample Not shown N= 59,497N = 60,168N=34,673N=35,016 Chi Sq. = 7349 70 d.f. Chi Sq. = 6648 70 d.f. Chi Sq. = 3793 68 d.f. Chi Sq. = 3817 68 d.f. Table 7, part, multivariate logit Persons, 01-03, 97-03, workers, …


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