HEALTH INSURANCE: Elusive in U.S. Despite Economic Boom

      Even though the U.S. economy has surged recently, private and public health insurance coverage continues to decline for Americans at all income levels, according to a new Urban Institute study appearing in the July/August issue of Health Affairs. "To some degree, the strong national economy is masking a problem that would otherwise be much worse," lead author John Holahan, director of the Urban Institute, said, adding, "But if the economy falters or insurance premiums increase substantially, we can expect to see much higher numbers of uninsured." According to the report, the number of non-elderly uninsured ballooned from 17.3% to 18.4%, or by 4.2 million between 1994 and 1998. Medicaid coverage fell from 10% to 8.4% during that time, affecting about 1.9 children and 1.2 million adults. Private non-group coverage also dropped from 5.7% to 5%, possibly reflecting the higher cost of health insurance. Meanwhile, although the number of adults covered through an employer increased by about 6.1 million, more middle and higher income workers joined the ranks of the uninsured, and low-income adults received little benefit from the rise in employer-based insurance.

State Shortcomings
      Even the most generous state assistance programs fail to reach a large proportion of uninsured adults, a second Urban Institute study found. Study author Brenda Spillman, a senior research associate at the Urban Institute, analyzed 1997 data on public program approaches in 13 states, classified as limited, moderate or comprehensive based on their requirements for Medicaid and other assistance programs. According to the survey, the limited- approach states face larger coverage gaps and only bridge those gaps about 13% of the time, while comprehensive-approach states had about a 30% success rate. "That there is variation among states is not surprising. What is surprising is the magnitude of the variation, even for adults with incomes below the federal poverty level. It is also notable that such a large proportion of low-income adults remains uninsured even in those states that offer the most assistance," Spillman said. Across the nation, only eight states have comprehensive programs, while 27 have limited programs, leading Spillman to predict a dim future for the uninsured. "Barring a federal initiative, it is difficult to imagine that states are going to greatly expand their efforts to provide health care coverage for adults," she concluded.

Health Care 2000 ... Whatever?
      According to a third study, voters' interest in health care issues has declined since 1992, and they displayed only tepid support for "comprehensive change" in the health care arena. However, although voters showed little interest in large-scale health care reforms, they had concerns about a number of specific issues, including a Medicare drug benefit, the future of Medicare, patients' rights and the uninsured. Voters also expressed apprehension about the potential costs of legislative proposals. "Health care in this election is not about fundamentally changing the system. It is about solving specific issues that bother voters," lead study author Robert Blendon, professor of health policy and political analysis at the Harvard School of Public Health said. He added, "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" (Health Affairs release, 7/17).