Trends in Insurance Coverage 2000-2007 John Holahan September 23, 2008

Figure 1 Changes in the Nonelderly Uninsured, 2000-2007

Between 2000 and 2004, most of the net population growth was among low income people—a group less likely to have employer sponsored coverage and more likely to be uninsured. After 2004, most of the net population increase was among those above 400% FPL. 3

The number of uninsured continued to increase after 2004, despite the improving economy. While most of the newly uninsured are adults, the number of uninsured children grew sharply after 2004. 4

Figure 2 Percentage Point Changes in Health Insurance Coverage of Nonelderly 2000-2004 2004-2006 Uninsured Medicaid - SCHIP Employer Sponsored Change in Population Change in Uninsured 10.0 Million* 6.0 Million* 4.9 Million* 3.4 Million*

Figure 3 Percentage Point Changes in Health Insurance Coverage of Adults and Children by Income, 2000-2004 Adults Children Uninsured Medicaid - SCHIP Employer Sponsored Change in Population Change in Uninsured 8.5 Million* 6.3 Million* 1.5 Million* 0.4 Million

Figure 4 Percentage Point Changes in Health Insurance Coverage of Adults and Children by Income, 2004-2006 Uninsured Medicaid - SCHIP Employer Sponsored Adults Children Change in Population Change in Uninsured 4.5 Million* 2.4 Million* 0.4 Million* 1.0 Million*

Figure 5 Health care costs are growing faster than GDP and workers’ earnings Problems accessing and affording quality health care are serious issues for many Americans. The most recent Kaiser Famiily Foundation tracking poll finds that nearly one quarter of Americans struggles with paying for health care and health care ranks above paying for food , problems with debt and paying rent or mortgage as a "serious problem”. (http://www.kff.org/kaiserpolls/h08_posr081908pkg.cfm) As a result, health reform has become a key issue addressed by presidential candidates. As you can see from the figure on the slide, premiums are growing substantially faster than worker’s earnings and overall inflation. Thought the rate of growth in premiums has slowed in recent years, the trend of health care costs outpacing other indicators is expected to continue (is this correct?). Source: Kaiser/HRET Survey of Employer Sponsored Health Benefits, 1999-2007; Bureau of Labor Statistics, Consumer Price Index, U.S. City Average of Annual Inflation (April to April), 2000-2007; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, 2000-2007 (April-April).

There has been a much greater increase in work in low ESI industries (services, construction) than in high ESI industries (manufacturing). The former have also seen greater declines in ESI rates and increases in uninsurance rates. 9

Over half the growth in the number of uninsured workers has been among those in small firms. 10

Hispanics account for more than half the population growth in both periods; Hispanics have lower rates of ESI and higher uninsurance rates than White or Black Americans. Hispanics accounted for almost 40% of the increase in the uninsured over the entire period, despite being only 16% of the nonelderly population. 11

Non-citizens have much lower rates of ESI and higher uninsurance rates than do native citizens; they also had the largest increase in uninsurance rates. Non-citizens accounted for 20% of the increase in the number of uninsured despite being only 8% of the population. 12

Most of the population growth in the U. S Most of the population growth in the U.S. occurred in the South and West, regions with lower ESI rates and higher uninsurance rates than the rest of the nation. The South in particular had a large drop in the rate of ESI and increase in the uninsurance rate in both periods. Thus over half of the increase in the uninsured occurred in the South. 13

Figure 6 Percentage Point Changes in Health Insurance Coverage of the Nonelderly, 2006-2007 Adults Children Employer Sponsored Medicaid - SCHIP Medicare/Military Uninsured Change in Uninsured -1.5 Million* -0.9 Million* -0.6 Million*

Figure 7 Percentage Point Changes in Health Insurance Coverage of the Nonelderly in Massachusetts, 2006-2007 Adults Children Uninsured Medicaid - SCHIP Employer Sponsored Change in Uninsured -257 Thousand* -67 Thousand*

Additional Findings from 2006-2007 There was a reduction in the number of uninsured non-citizens, largely because of a decline in the number of non-citizens More than half (790,000) of the decline in the number of uninsured was among workers; about three quarters of this was among low-income workers About three quarters of the decline in uninsured workers was in low-ESI industries

Table 9 Projected 2007-2008 Health Insurance Coverage Changes