Study Finds Public Health Insurance Programs Result in Only Small Reduction in Uninsured
A new study of public health insurance programs in four states found that the programs only led to a small reduction in the number of uninsured residents and enrolled a number of individuals who could have received coverage from private insurance, raising doubts about the potential for a similar program at the national level. The study, conducted by Richard Kronick and Todd Gilmer of the University of California-San Diego and appearing in the January/February issue of Health Affairs, examined public health insurance programs for low-income adults who did not qualify for Medicaid in Oregon, Washington, Tennessee and Minnesota to determine their "effect on the health insurance status of low-income adults." According to the study, the programs had "partial successes," but about 30% of low-income state residents still lacked health insurance after the states implemented the programs. Among adults with incomes less than 100% of the federal poverty level, the programs reduced the number of uninsured and led to only minor "crowding out" -- the public coverage of individuals who otherwise would have private coverage. But among adults with incomes between 100% and 200% of the federal poverty levels, the programs did lead to crowding out; combining the four states across this population, 45% of the increase in insured adults could be attributed to crowding out of private coverage. The study found that the Oregon program had "virtually no crowding out" of private health insurance and "relatively little" crowd-out in the program in Washington, where 80% of enrollees would have lacked health coverage without the program. However, the study found that 42% of the enrollment in Tennessee's program resulted from crowding out of private insurance and 100% of enrollment in the Minnesota program resulted from a decrease in private coverage, despite the "greater explicit protections against crowding out" in the latter two states. It is also possible that some of the enrollees in the state programs might have been crowded out of Medicaid. As a result, the study concluded that "there is much uncertainty about the amount of crowding out we might expect if similar programs were implemented in other states."
The study also predicted that a national public health insurance program similar to the programs examined in the four states would only lead to a small reduction in the number of uninsured adults in the United States, which currently stands at 31 million. According to the study, only 5.7 million to 7.6 million adults would likely enroll in a national program similar to the programs in the four states, which would "still leave a sizable problem." In addition, only about four million to five million of the enrollees in the national program would have lacked health insurance without the program, "with most of the remaining enrollees 'crowded out' of private insurance." The study concludes, "If expanded programs of subsidized insurance for low-income adults are to greatly reduce the numbers of uninsured persons, they must be designed, implemented, financed and marketed more successfully than were the programs we studied" (Kronick/Gilmer, Health Affairs, January/February 2002). An abstract of the study, titled "Insuring Low-Income Adults: Does Public Coverage Crowd Out Private?" is available at http://188.8.131.52/1130_abstract_c.php?ID=http://184.108.40.206/Library/v21n1/s31.pdf. Note: You must have Adobe Acrobat Reader to view the study.This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.