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Uninsured Population in America

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Please help me with the following questions:

What has been happening with health insurance premium costs in relationship to workers earnings?

What are the average premium costs for covered workers and how much of those cost did high and low income workers have to pay?

What actions have the states been taking in attempting to balance their budgets?

Does the public generally support expanding coverage for the uninsured? What stategies have they supported and why hasn't there been any single strategy adopted?

What are the major challenges for the future regarding coverage for the uninsured and how likely is it that one will be adopted soon and why?

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Solution Summary

By responding to the healthcare and insurance questions, this solution addresses aspects of the uninsured population in America. Supplemented with information on health proposals for increase health insurance and access.

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1. What has been happening with health insurance premium costs in relationship to worker earnings?
Premiums for employer-sponsored health insurance in the United States are rising five times faster than workers' earnings, a recent survey released shows (September 9, 2004 08:40:31 PM PST, Karen Pallarito HealthDay Reporter). In fact, premiums increased 11.2 percent, on average, in 2004, according to the Kaiser Family Foundation and the Health Research and Educational Trust (HRET), sponsors of the annual employer health benefits survey. While not as high as last year's 13.9 percent increase, this year's increase is still five times the rate of inflation and five times the rate of growth in workers' earnings. It also marks the fourth year of double-digit premium inflation, according to the survey. (http://health.yahoo.com/news/_43329).
2. What are the average premium costs for covered workers and how much of those cost did high and low income workers have to pay?
As a result, health-care costs continue to affect hiring and remain a No. 1 issue in collective bargaining, according to Christine L. Owens, director of public policy with the AFL-CIO.
"There's no question that higher health-care costs and cost-shifting onto workers is a significant factor in the rising number of uninsured workers," Owens said during a press briefing in Washington, D.C., Thursday morning.
As health-care costs surge, workers are shouldering a mounting share of the financial burden, particularly for family coverage. The annual premium for a plan covering a family of four averaged $9,950, or $829 a month, in 2004, the survey found. Workers contributed $2,661 -- or 10 percent more than they spent the prior year. For single coverage, workers contributed an average of $558 toward the $3,695 annual premium this year. Employees' share was statistically unchanged from 2003. Over time, though, annual increases in worker cost-sharing add up. Since 2001, employees' share of health insurance costs has soared 57 percent for single coverage and 49 percent for family coverage, the survey reported. "Last year, the changes were statistically insignificant, but taken over four years you've got some real money," said Jon Gabel, vice president of health system studies at HRET, a nonprofit research group.
A total of 3,017 employers with at least three workers each participated in the survey, conducted between January and May. The findings appear in the September/October issue of the journal Health Affairs. The percentage of people getting health coverage from their employer remained relatively unchanged, at 61 percent in 2004 versus 62 percent in 2003. But those levels are off a recent high of 65 percent in 2001. As a result, roughly five million fewer workers are now getting health insurance through their jobs.
Employer-sponsored PPOs, the most popular type of health insurance coverage, also were the priciest in dollar terms, with annual premiums topping $10,000 for a family of four. Workers picked up $2,691 of the $10,217 total in 2004. Most workers, whether they have single or family coverage, encountered at least modest increases in out-of-pocket spending as well, the survey found. Twenty-seven percent of covered workers now pay out $20 for a physician office visit, up sharply from 16 percent in 2003. Prescription drug copayments, up slightly from last year, range from $10 for generics to $21 for preferred drugs and $33 for non-preferred drugs.
To keep a lid on costs, 56 percent of employers shopped for a new health plan this year. Of those, 31 percent made a change in insurance carriers and 34 percent changed the type of plan they offered, the survey found. As for the future, about half the large employers surveyed, those with at least 200 workers, said they were very likely to boost employee contributions in 2005. Only 15 percent of small firms, those with at least three but less than 200 workers, plan to shift more costs to employees next year. Still, smaller businesses are finding it increasingly difficult to extend health insurance coverage at all. Sixty-three percent of small firms offered health benefits to their workers in 2004, down from 68 percent in 2001.
"There just aren't that many options left for smaller businesses," said Kate Sullivan Hare, executive director of health care policy for the U.S. Chamber of Commerce. As costs mount, she added, "they are not going to be doing the family coverage subsidies; they can't afford to do it." (http://health.yahoo.com/news/_43329).
Some workers who choose firms where they get higher wages instead of health insurance are ignorant of the importance of health care insurance, myopic, or intend to "free ride" on the health care system if they get sick. If forcing some people to buy something is the only way to correct large-scale market failure (e.g. via adverse selection in the small firm market), then there might be justification for the "good of the many" outweighing the "bad for the few." (http://www.healthinsurance.info/HIUHI.HTM).

3. What actions have the states been taking in attempting to balance their budgets?
Lowering the cost of health care and insurance was named as a top priority for the President and Congress by 63% of the public, and by an equal share of Republicans (61%) and Democrats (61%). Asked about the causes of rising health care costs, 29% of Americans say that high profits made by drug and insurance companies are the most important factor, while 22% say the number of malpractice lawsuits and 15% say the amount of greed and waste that occurs in the health care system. In comparison, 7% cite the costs of medical technology and drugs, a factor many health care experts cite as a major driver of higher health care costs ( http://todaysseniorsnetwork.com/drugs_from_canada.htm).
The evolving relationship between public and private insurance Actions taken by public and private insurance programs increasingly have implications for each other. For example, changes in employer-sponsored insurance and expansions in the Medicaid program have interacted to produce some shifting of low-wage workers from private insurance to Medicaid (Holahan, 1997). The new State Children's Health Insurance Program, created under the Balanced Budget Act of 1997, will expand the interrelatedness of public and private insurance by further promoting the use of public funds to purchase private insurance for low-income children. Public and private purchasers also have engaged in productive partnerships to exert stronger value-based purchasing, share knowledge and resources, reduce duplication and overlap, and avoid cost shifting (Midwest Business Group on Health, 1997). (http://www.hcqualitycommission.gov/final/chap02.html).
Under the Employee Retirement Income Security Act of 1974 (ERISA), the Federal Government has oversight authority over self-funded and insured plans for employers, which are not subject to regulation by States (Mariner, 1996). The Employee Benefits Research Institute (Copeland and Pierron, 1998) estimates that in 1995, 123 million individuals were covered by ERISA-regulated plans, of whom more than 39 percent -- 48 million individuals -- were in self-insured (i.e., self-funded) plans. In 1995, 46 percent of insured workers were in self-funded plans, including 63 percent of all conventional plan enrollees, 60 percent of all PPO enrollees, and 53 percent of POS enrollees (Jensen et al., 1997). Self-insurance is less common for workers in HMOs; only 11 percent were self-insured in 1995. The share of workers from small- and medium-sized firms in self-funded plans increased from 15 percent in 1980 to 46 percent in 1993. Among small firms (under 100 employees), 31 percent were self- funded in 1992. The line between self-funding and insured arrangements is not entirely clear, with partly self-insured arrangements almost as likely as full self-insurance (Jensen, 1997). (http://www.hcqualitycommission.gov/final/chap02.html).

4. Does the public generally support expanding coverage for the uninsured? What strategies have they supported and why hasn't there been any single strategy adopted?

Expanding health coverage for the uninsured

The public places a relatively high priority on increasing the number of Americans with health insurance. More than half (57%) cite the issue as a top health care priority for the President and Congress - making it the third most-cited health-care priority behind lowering health-care costs and making Medicare more financially sound for the future. However, the public does not agree on a single best approach and is relatively evenly divided on a number of potential policy approaches. When asked to choose their most preferred option to increase the number of Americans with health insurance, 23% say offering businesses tax deductions or other financial assistance to help them provide health insurance to their employees, while 17% say offering tax deductions or other financial assistance to help individuals pay for private insurance and 17% say expanding state government programs such as Medicaid. Smaller shares ...

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