Private Insurance: The Facts
From Families USA:
Costly Coverage: Premiums Outpace Paychecks examines how the combination of stagnant wages and skyrocketing health insurance costs is placing a growing strain on family budgets. These state-specific reports show how health insurance premiums for families and individuals have risen over the last decade compared to earnings. (August 2009)
What Is a "Special Enrollment Opportunity" and Why Should I Care about It? discusses who may have the option of signing up for job-based health coverage when it isn't open season. (June 2009)
Why Employers Should Share the Responsibility of Paying for Health Care discusses five reasons why it makes sense to require employers to contribute to the cost of health coverage, known as an "employer responsibility requirement." (June 2009)
Investing in Health Coverage: It Just Makes Sense explores four key reasons why we all have a stake in making sure everyone has health coverage. (June 2009)
Hidden Health Tax: Americans Pay a Premium discusses how private health insurance premiums are higher, in part, because the costs of uncompensated care for the uninsured are shifted to those who have insurance, a "hidden health tax." The report quantifies this "tax" for family and individual coverage. (May 2009)
Too Great a Burden: Americans Face Rising Health Care Costs reveals how many Americans face very high health care costs and shows the magnitude of the health care cost crisis. The report provides data on how many people are in families that will spend more than 10 percent or 25 percent of their pre-tax income on health care in 2009. (April 2009)
Squeezed! Caught between Unemployment Benefits and Health Care Costs examines COBRA coverage and unemployment benefits and finds that, to maintain their employer-based coverage under COBRA, most unemployed workers would have to devote an unrealistically high proportion of their unemployment check to health insurance. (January 2009)
The Hidden Link: Health Costs and Family Economic Insecurity examines the crisis in family health care costs and shows why it will be impossible to restore family economic security without health reform that achieves quality, affordable coverage for all. (January 2009)
Failing Grades: Illinois Fails to Protect Consumers in the Individual Health Insurance Market focuses the broader discussion of inadequate consumer protections for the individual market on Illinois, examining how the state falls short in protecting consumers, leaving them vulnerable to insurance company abuse. The report also includes recommendations for reforms needed in the private market. (September 2008)
Empty Promise: Searching for Health Insurance in an Unfair Market discusses how the individual health insurance market differs from the employer market and examines what happens to consumers who seek coverage in the individual market. Problems in the individual market include policies that don't provide quality coverage; policies that are very expensive or that cost more than advertised; and the fact that many applicants cannot obtain a policy at any price. (August 2008)
Fighting Revocations and Limitations of Health Insurance Policies addresses the insurance company practice of revoking an individual's health insurance or suddenly eliminating coverage for health services long after the person has enrolled (known as "post-claims underwriting"). It also discusses what consumers and advocates can do about the practice. (July 2008)
The Facts about Prior Approval of Health Insurance Premium Rates discusses several insurance industry myths about the consequences of prior approval. The prior approval process is used by most states to make sure that insurance companies' proposed premium increases are not excessive. (June 2008)
Failing Grades: State Consumer Protections in the Individual Health Insurance Market. Laws protecting consumers purchasing health coverage in the individual market vary across the country. In many states, insurance companies can deny coverage, raise premiums significantly, refuse to cover treatment for certain conditions, and even revoke the coverage of policyholders who have been paying premiums for years. (June 2008)
Medical Loss Ratios: Evidence from the States presents the results of a 50-state survey we conducted in March and April 2008 that determined which states have laws or regulations that establish a minimum "medical loss ratio" (a percentage of premium dollars that must be spent on medical care). (June 2008)
Post-Claims Underwriting Survey presents the findings of a survey we conducted in April and May 2008 of all state insurance departments regarding laws in their states that prohibit insurers from limiting or rescinding health insurance policies after they have been issued. (June 2008)
Reinsurance: A Primer aims to help policymakers and advocates better understand what reinsurance is and how it can make coverage easier to obtain and more affordable. It also identifies some of the benefits of reinsurance to aid lawmakers as they design reinsurance programs to meet the needs of their states. (April 2008)
Reward/Penalty Plans for Wellness: Coming Soon to an Office Near You? Encouraging healthy lifestyles is important, but might some wellness plans place your access to health care at risk? This piece explores some of the hidden effects that reward/penalty plans for wellness may have on consumers, as well as the problems that these plans might present in both employer-sponsored coverage and Medicaid. (January 2008)
Maine's Dirigo Health Reform of 2003 is a thorough examination of the state's health care expansion. It discusses program eligibility, how much people pay for the different types of coverage, what benefits they receive, how the expansion is financed, how it reforms the state's insurance regulations, lessons learned so far, and the future of health reform in Maine. (November 2007)
Massachusetts Health Reform of 2006 is a thorough examination of the state's far-reaching expansion in health coverage. The report discusses who is eligible, how much enrollees pay for the different types of coverage available, what benefits they receive, who is providing coverage, the individual mandate, and how the reform is being financed. It also discusses what lessons state advocates have learned from the process of getting the legislation passed. (August 2007)
Retail Medical Clinics: Okay in a Pinch, but No Substitute for Real Health Coverage provides an overview of the growing trend of clinics popping up in stores such as Wal-Mart, Target, and CVS. While their convenience is appealing, the tradeoff may be piecemeal services that lack appropriate oversight. Consumers should use such clinics only to supplement care from their regular primary care physician. (August 2007)
A Pound of Flesh: Hospital Billing, Debt Collection, and Patients' Rights provides an overview of some of the progressive reform measures that state policymakers have implemented to help families struggling with medical debt. (March 2007)
Six Reasons to Be Wary of High-Deductible HSA Plans (December 2006)
Stop Bad Ideas—HSAs: Missing the Target examines the effects that HSAs will have on those without health insurance and on the health care system overall. (November 2006)
Premiums versus Paychecks: A Growing Burden for Workers (October 2006)
- use the drop-down menu on the right-hand side of the page to find your state
- click on "Other Resources"
- click on "Premiums versus Paychecks: A Growing Burden for [your state]'s Workers"
Understanding How Health Insurance Premiums Are Regulated discusses the state and federal regulation of health insurance premiums. (September 2006)
H.R. 2355, The Health Care Choice Act: The Wrong Prescription for America's Health Care Needs discusses how this legislation, sponsored by Rep. Shadegg and favored by the Administration, would undermine state laws designed to protect health care consumers. (August 2006)
Testimony by Ron Pollack, Executive Director, Families USA, before the National Association of Insurance Commissioners, Health Insurance and Managed Care Committee, discusses state insurance reforms that will help consumers and those that won't. (June 12, 2006)
High-Risk Health Insurance Pools provides answers to key questions about high-risk pools, including who they help and how they are financed. The report also includes a list of questions consumers should ask if they are considering joining a high-risk pool, as well as a checklist for advocates. (May 2006)
Summary of S. 1955: The Health Insurance Marketplace Modernization Act outlines the legislation that introduces Small Business Health Plans (SBHPs) and exempts private insurers from many state laws and regulations governing health insurance. 5 pp. (March 23, 2006)
What Consumers Need to Know about Buying Health Coverage from Associations (July 2005)
What Consumers Need to Know about Health Savings Accounts (July 2005)
What Consumers Need to Know about Purchasing Health Insurance as an Individual (July 2005)
Paying a Premium: The Added Cost of Care for the Uninsured quantifies, for the first time, the dollar impact on private health insurance premiums of care provided to the uninsured. Includes data for each state. | Press Release| Map of Family Premiums, 2005| Map of Family Premiums, 2010 (June 2005)
Have health insurance? Think you're well protected? Think Again! This one-page fact sheet provides quick stats on how health care expenses overwhelm even insured working families, forcing many into bankruptcy. (February 2005)
The Administration has put forth several proposals, including Association Health Plans (AHPs), designed to expand health coverage to the uninsured. How Will Association Health Plans Affect Minority Health? Separating Fact from Fiction analyzes the real impact that AHPs will have on the health care access of uninsured racial and ethnic minorities. (February 2005)
HSAs: Why High-Deductible Plans Are Not the Solution This fact sheet examines the effects that health savings accounts (HSAs) will have on those without health insurance and on the health care system overall. (January 2005)
Health Care: Are you better off today than you were four years ago? Health care has emerged as one of the top concerns of Americans in recent years. To understand what forces are driving this change, Families USA posed a variation of a question raised by Ronald Reagan more than two decades ago: When it comes to health care, are we better off today than we were four years ago? The results of our analysis show that the answer is a clear no. | en español (September 2004)
What's Wrong with Tax-Free Savings Accounts for Health Care? Tax-free personal savings accounts for health care have become the latest cure-all for the problems facing our health care system. This Issue Brief uses a hypothetical company to examine how such accounts undermine the pooling of risk -- the basis for insurance. (November 2003)
Tax-Free Savings Accounts for Medical Expenses: A Tax Cut Masquerading as Help to the Uninsured: This Issue Brief discusses Health Savings Accounts and Health Savings Security Accounts, two kinds of personal savings accounts that were created by a bill attached to the House Republican Medicare prescription drug legislation. (July 2003)
Health Action In Depth: Some Employers Turn to Troubling New Insurance Plans This article from our newsletter Health Action discusses the emergence of Health Reimbursement Arrangement (HRA) plans, which some employers are touting as a way to contain health costs. However, these plans are more likely to simply shift costs to employees They also threaten to further segment the health insurance market; place far greater burdens on those who require more medical care, such as seniors and those with chronic or serious illnesses; and lead to health care rationing. (January 2003)
Health Action in Depth: Worrisome Changes Loom in the Private Health Insurance Market: This article from our newsletter Health Action discusses skyrocketing health care costs, why such costs are increasing, and how employers are passing many of those costs on to their employees. (November 2002)
More than 725,000 Laid-off Workers Have Lost Health Coverage Since the Recession Began in March A Special Report. (December 2001)
Healthy Pay for Health Plan Executives The managed care industry claims that the cost of patients' rights legislation will make families lose health insurance coverage--a charge that is both misleading and self-serving. This report examines the compensation for the highest-paid executives of 10 for-profit, publicly traded companies that own health plans serving multiple states. A Special Report. (June 2001)
Premium Pay: Corporate Compensation in America's HMOs This report examines the 1996 costs of compensation for top level executives of some of the nation's most profitable HMOs (April 1998)
Skyrocketing Health Inflation 1980-1993-2000: The Burden on Families and Businesses (Print only) An analysis of health care spending of American families and businesses, nationally and state-by-state. Also includes data on sources of payment by families and businesses. (November 1993)
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From the Access Project:
2007 Health Insurance Survey of Farm and Ranch Operators examines health care costs and their consequences for farm and ranch families in the Great Plains states. The majority of respondents had health insurance, yet one in four reported that their health care expenses contributed to financial problems. In addition, farmers and ranchers who purchased insurance in the non-group market were at greater risk of financial hardship than those who obtained insurance through government-sponsored programs or through off-farm or off-ranch employment. (September 2008)
2007 Health Insurance Survey of Farm and Ranch Operators provides key findings from a survey of 2,000 farmers from seven states. It discusses their age, racial and ethnic background, income, and health insurance status, as well as whether health care expenses contribute to other financial problems, overall debt, and reduced access to health care. (September 2007)
The Illusion of Coverage: How Health Insurance Fails People when They Get Sick describes how private insurance fails to protect people from financial hardship when they become ill or are injured. The report discusses the aspects of insurance that lead to medical debt and that hamper people's ability to make meaningful choices when purchasing health plans, as well as the consequences of medical debt. It also provides recommendations on how to provide people with access to comprehensive and affordable insurance products. (March 2007)
From the Alliance for Health Reform:
Health Insurance Exchanges: See How They Run is a webcast that looks at insurance exchanges and examines the following questions: What is meant by a health insurance exchange, and how might it work? Who would be allowed to seek coverage through the exchange? What rules would govern the conduct of plans offering coverage? What’s in it for the consumer? (May 2009)
From the American Constitution Society for Law and Policy:
The Supreme Court’s Two-Front War on the Safety Net: A Cautionary Tale for Health Care Reformers argues that critical components of the nation’s health care safety net have been seriously undermined by the conservative bloc of the Supreme Court. The piece also asserts that the original purposes of Medicaid and the Employee Retirement Income Security Act (ERISA) have been hindered by the Court’s application of progressively stricter limitations on enforcement of federal mandates. (January 2009)
From the American Diabetes Association and Georgetown University Health Policy Institute:
Falling Through the Cracks: Stories of How Health Insurance Can Fail People with Diabetes l Executive Summary Obtaining and keeping quality, affordable health insurance is a challenge for people with diabetes. The culmination of 14 months of research on how people with diabetes fare in the health insurance market, this report shares the challenges and stories of more than 850 people from all 50 states and the District of Columbia. (February 2005)
From the California HealthCare Foundation:
Snapshot: Health Insurance: Can Californians Afford It? This presentation compares health insurance premiums and out-of-pocket expenses to hourly wages and household spending across California and within six local areas. The results show the significant financial pressure that health care costs are putting on insured Californians. The presentation focuses on the small business and individual insurance markets, where the greatest number of uninsured Californians would get their insurance if they thought they could afford it. (May 2005)
California Employers and Consumers Respond to Changing Health Benefits Employers say they feel that costs are more under control today than they were two years ago, but they increasingly are concerned about the negative consequences of employee cost-sharing measures. Not surprisingly, consumers are less satisfied with their health benefits than they were two years ago and are particularly worried about not being able to pay for the portion of health care services that must come out of their own pocket. Also, a significant percentage of people with chronic illnesses, particularly those with lower incomes and poorer health, report having problems paying their medical bills, and some are skipping recommended care as a way of controlling costs. (January 2005)
From the Campaign for America’s Future:
How to Structure a “Play-or-Pay” Requirement on Employers examines not only how to structure an employer coverage mandate, but also the economic and political impacts of such a mandate, as part of health reform. In addition, it offers recommendations for navigating the political issues raised by such a requirement. The authors conclude that the potential negative effects of instituting a mandate are modest and would be outweighed by the benefits. (June 2009)
From the Center for American Progress
Insurers’ Black Box: Now-Secret Claims Denial Rates Could Tell Consumers a Lot about Their Insurance Company discusses the dramatic variation in denial rates among insurance companies in California—the only state that requires such data to be made public. The denial rates suggest insurers may be putting profits ahead of patients’ best interests. The brief argues that health reform proposals must require insurers to release their denial rates to help educate consumers. (October 2009)
Too Sick for Health Care: How Insurers Limit and Deny Care in the Individual Insurance Market reveals the practices insurers use against the roughly one in four Americans who either purchase their insurance in the individual market or have considered doing so. This memo, and the accompanying 50 state fact sheets, examine how insurers in this market offer weak benefits, exclude benefits, cancel coverage, and limit coverage. (July 2009)
From the Center for Studying Health System Change:
Massachusetts Health Reform: High Costs and Expanding Expectations May Weaken Employer Support finds that, while the number of uninsured has declined significantly since the enactment of the state’s landmark health expansion, the high cost of the reform has prompted the state to seek additional financial support from stakeholders, including employers. Improved access to the individual insurance market, the availability of state-subsidized coverage, and the costs of increased employee take-up of employer-sponsored coverage and rising premiums could weaken employers’ motivation and ability to provide coverage. (October 2008)
Trade-Offs Getting Tougher: Problems Paying Medical Bills Increase for U.S. Families, 2003-2007 estimates that 14 million more people had problems paying medical bills in 2007 compared to 2003. Among the non-elderly insured and uninsured, 2.2 million were in families that filed for bankruptcy as a result of medical debt, while a much larger number reported other financial consequences, such as difficulties paying for necessities or having to borrow money. (September 2008)
According to findings in Health and Wellness: The Shift from Managing Illness to Promoting Health, initiatives to promote health and wellness are now commonplace. Much of the impetus has come from employers—primarily large employers—that are incorporating health and wellness activities into benefit designs that place more responsibility on employees for health care decisions and costs. (June 2008)
Behind the Slow Growth of Employer-Based Consumer-Driven Health Plans finds that employees who use a consumer driven health plan (CDHP) are less likely to be given a choice of plans. Also, employers pay approximately the same amount for employees’ CDHPs as they do for traditional plans, but employees in CDHPs are faced with much higher out-of-pocket costs than those in traditional plans. (December 2006)
More Americans Willing to Limit Physician-Hospital Choice for Lower Medical Costs With health care costs on the rise, more Americans are now willing to accept health plans with limited choice of providers and hospitals in exchange for lower out-of-pocket costs. Between 2001 and 2003, the percentage of working-age Americans willing to trade provider choice for lower costs rose from 55 to 59 percent. (March 2005)
Rhetoric vs. Reality: Employer Views on Consumer-Driven Health Care This study, which looks at employer views on consumer-driven health plans in 12 metropolitan areas, finds that employers know more today than in the past about consumer-driven health care plans and that increased knowledge is raising questions about the effectiveness of such plans. In addition, employers are unsure that cost savings will result from consumer-driven care, have concerns about the ability of employees to access the information necessary to make decisions in a consumer-driven system, and are wary of the ability of tiered provider networks to provide sufficient access to quality health care services. (July 2004)
From the Center on Budget and Policy Priorities:
Ensuring Affordable Health Coverage and Health Care Services in an Insurance Exchange finds that any health reform proposal that requires everyone to obtain health insurance must establish mechanisms to make health coverage and health care affordable. It also identifies four key components that any successful exchange should have: minimum standards for benefit packages, limits on the degree of variation in different benefit packages, limits on the number of different plan choices, and a requirement that insurers in the exchange offer the full range of benefit packages. (May 2009)
Rules of the Road: How an Insurance Exchange Can Pool Risk and Protect Enrollees finds that a strong exchange can greatly reduce the problems many people currently face when they must obtain coverage on their own without the help of an employer. It then lays out four key components of an efficient insurance exchange, including minimum standards for the benefits packages offered and a limit on the number of different benefit packages. (April 2009)
In considering the pending reauthorization of the State Children’s Health Insurance Program (SCHIP), some have recommended that Congress use federal funds to subsidize the purchase of private health insurance rather than to expand public health programs such as Medicaid or SCHIP. Comparing Public and Private Health Insurance for Children provides evidence that public health coverage is less expensive than private insurance and provides comparable, and in some cases better, access to health care for children. (May 2007)
Many health and tax policy analysts suspected that Health Savings Accounts (HSAs) would be used as tax shelters for high-incomes individuals. GAO Study Confirms Health Savings Accounts Primarily Benefit High-Income Individuals indicates that HSAs are disproportionately used by affluent individuals. The report also explains how HSAs and high-deductible plans reduce costs for healthy people while increasing out-of-pocket costs for less healthy people. (September 2006)
According to recent data from the Census Bureau, 46.6 million Americans lack health insurance. The Number of Uninsured Americans Is at an All-Time High discusses the increased number of uninsured, the decline in employer-sponsored coverage, and changes in Medicaid and SCHIP enrollment. (August 2006)
Federal and state officials are discussing possible ways to reduce Medicaid expenditures, and one common proposal is to increase the copayments Medicaid beneficiaries must pay. Out-of-Pocket Medical Expenses for Medicaid Beneficiaries are Substantial and Growing explains that out-of-pocket medical expenses for low-income, adult Medicaid beneficiaries have grown twice as fast as their incomes in recent years. These individuals now spend more than three times as much of their incomes on out-of-pocket medical costs as middle-class adults with private health insurance. (May 31, 2005)
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From the Citizens’ Health Care Working Group:
Health Care that Works for All Americans: Health Report to the American People outlines current health care policy issues and formulates recommendations based on the input of thousands of Americans who participated in community meetings held across the country. The report offers insight into many health care issues, including rising costs, quality shortcomings, and access problems. (September 2006)
From The Commonwealth Fund:
Aiming Higher: Results from a State Scorecard on Health System Performance, 2009 finds rising health care costs are making coverage less affordable across the country. The report projects that these costs are also likely to widen gaps in access based on income, insurance status, or race/ethnicity. These nationwide problems underscore the need for comprehensive national reform to expand and improve the quality of coverage. (October 2009)
Failure to Protect: Why the Individual Insurance Market Is Not a Viable Option for Most U.S. Families finds that, over the last three years, nearly three-quarters of people who tried to buy coverage in this market never purchased a plan, primarily due to high premiums. More than two out of five adults with coverage through the individual market reported not getting needed health care because of cost. People with such coverage also spend far more out of pocket than those with job-based coverage and are more vulnerable to catastrophic health care costs. (July 2009)
Setting a National Minimum Standard for Health Benefits: How Do State Benefit Mandates Compare with Benefits in Large-Group Plans? compares state-mandated benefits with the services and providers covered under the Federal Employees Health Benefits Program (FEHBP) Blue Cross and Blue Shield standard benefit package. With few exceptions, the FEHBP plan either meets or exceeds the benefits that state mandates require. Under a national standard, states would still have the option of providing other benefits above the national standard. (June 2009)
Meeting Enrollees’ Needs: How Do Medicare and Employer Coverage Stack Up? finds that elderly Medicare beneficiaries reported greater overall satisfaction with their health coverage, better access to care, and fewer problems paying medical bills than those under age 65 who are covered by job-based plans. This study was designed to examine whether a public plan could potentially improve access to necessary services and reduce the burden of medical bills for individuals under age 65. (May 2009)
Women at Risk: Why Many Women Are Forgoing Needed Health Care examines how rising health care costs coupled with eroding health benefits are having a substantial effect on Americans' ability to get health care, particularly women. In 2007, 52 percent of women reported having problems obtaining needed care due to cost, and 45 percent had accrued medical debt or reported having problems with medical bills. (May 2009)
How Have Employers Responded to Health Reform in Massachusetts? Employees’ Views at the End of One Year reveals that employers have neither dropped coverage nor restricted eligibility for coverage in the state’s first year of health reform. Despite initial concern from critics, researchers have found that employers made no changes to the scope of benefits, range of provider choices, or quality of care available under their plans. (October 2008)
Seeing Red: The Growing Burden of Medical Bills and Debt Faced by U.S. Families reports that the proportion of working-age Americans who struggled to pay medical bills and accumulated medical debt climbed from 34 percent to 41 percent between 2005 and 2007. Families with low or moderate incomes were particularly hard hit, as were the uninsured and adults who had gaps in health coverage. Those experiencing financial hardship due to medical debt reported that they used up all their savings, incurred large credit card debt, or were unable to pay for basic necessities. (August 2008)
According to Universal Mandatory Health Insurance in the Netherlands: A Model for the United States?, the Dutch system may be of particular interest to policymakers and advocates in the current health care debate. Two years ago, the Netherlands launched an initiative to provide health care for its entire population. Not a single-payer system, the Dutch approach combines mandatory health insurance with competition among private health insurers. (May 2008)
Overburdened and Overwhelmed: The Struggles of Communities with High Medical Cost Burdens: The number of people with potentially high medical cost burdens varies widely across the nation. Some of these people lack insurance, while others are insured but are paying a high portion of their income to get that coverage. Federal support will be critical to addressing this problem. (November 2007)
Whither Employer-Based Health Insurance? The Current and Future Role of U.S. Companies in the Provision and Financing of Health Insurance examines the importance of employer coverage in our current health care system, as well as its limitations. It also calls for employers to join other stakeholders in designing a more rational and equitable health care system. (September 2007)
Squeezed: Why Rising Exposure to Health Care Costs Threatens the Health and Financial Well-Being of American Families examines the implications of rising out-of-pocket costs for all privately insured Americans. The report also analyses the experiences of adults with employer-sponsored coverage compared to those insured through the individual market. (September 2006)
Health savings accounts (HSAs) and high-deductible health plans (HDHPs) have been promoted by the Administration as part of the solution for the problems facing the U.S. health care system. Health Savings Accounts: Why They Won’t Cure What Ails U.S. Health Care presents expert testimony that encouraging Americans to join HSAs will only exacerbate the nation’s health care woes. Current evidence shows that HSAs suffer from low enrollment, low satisfaction, high out-of-pocket costs, and cost-related access problems. (June 2006)
The Effect of Health Savings Accounts on Health Insurance Coverage concludes that HSAs are not likely to be an important contributor to expanding coverage among uninsured people because most of them do not face high enough marginal tax rates to benefit substantially from the tax deductibility of HSA contributions. Meanwhile, HSAs could potentially destabilize the small-group market. To the extent that they encourage well-compensated healthy workers to abandon job-based coverage, HSAs could undermine the entire structure of job-based coverage among small firms. (April 2005)
How High Is Too High? Implications of High-Deductible Health Plans finds that high-deductible health plans (HDHPs) are unlikely to have a substantial effect on either costs or coverage and can undermine the basic purposes of health insurance -- to reduce financial barriers to needed care and protect against financial hardship. The authors suggest legislative modifications to protect lower-wage adults and ensure access to early preventive and primary care. (April 2005)
Early Implementation of the Health Coverage Tax Credit in Maryland, Michigan, and North Carolina: A Case Study Health Coverage Tax Credits (HCTCs), which pay 65 percent of beneficiaries' health insurance premiums, constitute an ambitious experiment in using the federal income tax system to subsidize health coverage for the uninsured. To gather more evidence about HCTCs' effectiveness and assess their prospects as a model for broader reforms, researchers visited Maryland, Michigan, and North Carolina. The authors present key findings and propose reforms to improve HCTC's ability to help its current target population and aid policy makers in designing future health insurance credits. (April 2005)
The market for people who buy their own coverage has long been a troubled segment of the health insurance industry. Many states have attempted to reform their individual health insurance market by requiring carriers to sell coverage to all applicants regardless of age or health; creating high-risk pools for those with preexisting conditions; and placing limits on the extent to which premiums can vary by age, sex, or health status. Insuring the Healthy or Insuring the Sick? The Dilemma of Regulating the Individual Health Insurance Market assesses the effectiveness of such regulatory reforms in seven states. (February 2005)
Wages, Health Benefits, and Workers' Health Although employer-sponsored health insurance coverage provides access to health care for many working Americans, low-wage workers are much less likely than their higher-wage counterparts to receive health insurance benefits, have access to primary and preventive care, and receive paid sick days. This report examines the connection between wages, health insurance, access to care, and the effect that this has on the health and economic stability of workers. (October 2004)
From Community Catalyst:
Expanding Coverage for Dependents finds that young adults are one of the fastest-growing groups without health insurance. The report proposes changing state laws to allow young people to remain on their parents’ health insurance plans beyond age 18. However, most states continue to place restrictions on which dependents are eligible for coverage by limiting it to those who are students, who live with their parents, or who do not have access to other forms of insurance. (February 2009)
From the Employee Benefit Research Institute:
Sources of Health Insurance and Characteristics of the Uninsured: Analysis of the March 2008 Current Population Survey examines the factors that affect whether an individual has health insurance and the sources of that coverage. According to the report, the percentage of U.S. residents younger than age 65 who had health coverage through their employer remained at 62.2 percent between 2006 and 2007, but this year’s rise in unemployment and food and gasoline prices suggest a future decline in the number of workers who have or are able to afford employer-based health insurance. (September 2008)
Findings from the 2007 EBRI/Commonwealth Fund Consumerism in Health Survey presents information about the growth of account-based and high-deductible health plans and their impact on the behavior and attitudes of consumers. It provides statistics on the numbers of adults enrolled in consumer-driven health plans, their incomes, health status, and satisfaction rates, the rates at which they actually use their plans, and whether these plans have had an impact on the numbers of uninsured. (March 2008)
ERISA Pre-emption: Implications for Health Reform and Coverage provides an overview of state and local attempts at comprehensive health insurance reform and finds that ERISA limits states’ ability to carry out these reforms. For example, ERISA prevents states from establishing minimum levels of coverage for employer-based plans and limits their ability to fund health insurance subsidies for low-income adults through a tax. (February 2008)
Employment-Based Retirement Plan Participation: Geographic Differences and Trends, 2006 examines the level of participation by workers in public and private-sector employment-based pension or retirement plans. (November 2007)
2007 Health Confidence Survey: Rising Health Care Costs Are Changing the Ways Americans Use the Health Care System is the 10th annual survey to assess the attitudes of the American public regarding the U.S. health care system. It finds that most people (six out of 10) are getting hit with increasingly high health costs. (November 2007)
Employer Sponsored Health Benefits—General Overview and FAQ This section of the Employee Benefit Research Institute's (EBRI) Web site is designed to answer basic questions about major benefit issues and trends. It provides short, graphical answers with links to the detailed data underlying the figures. It also provides references to the relevant EBRI publication.
Health Savings Accounts and Other Account-Based Health Plans examines accounts that can be used to pay for health care services on a tax-favored basis -- HSAs, FSAs, MSAs, and HRAs. The function of these accounts is described, followed by a discussion of issues related to the accounts, whether expectations for the accounts will be met, and recent evidence on their impact. (September 2004)
From the Employee Benefit Research Institute and The Commonwealth Fund:
The 2nd Annual EBRI-Commonwealth Fund Consumerism in Health Care Survey finds that enrollment in consumer-directed health plans (CDHPs) and high-deductible health plans (HDHPs) is virtually unchanged since 2005. These plans are making little headway in reducing the number of uninsured, and they are still plagued by low levels of satisfaction and high out-of-pocket costs that deter beneficiaries from seeking care. (December 2006)
From Government Accountability Office:
Health Savings Accounts: Participation Grew, and Many HAS-Eligible Plan Enrollees Did Not Open HSAs while Individuals Who Did Had Higher Incomes found that the number of individuals participating in HSA-eligible, high-deductible health plans and HSAs has risen significantly since 2004. Adjusted gross income for HSA enrollees in 2005 was about $139,000, compared to $57,000 for other taxpayers. However, many HSA-eligible plan enrollees did not open an HSA, citing their inability to afford one or a belief that they did not need one. (May 2008)
From Health Affairs:
Trends in Underinsurance and the Affordability of Employer Coverage, 2004-2007 focuses on cost increases for the 161 million Americans who have job-based health coverage. Over the period studied, for all adults, expected medical spending rose by 34 percent, or $729. The study also explores the relationship between rising out-of-pocket costs for adults with job-based coverage and rising health care costs overall. (June 2009)
Consumer-Driven Health Care: Promise and Performance analyzes the evolution of consumer-driven health care in terms of its original vision, subsequent implementation, and the transformations it has gone through as it moves into its second decade. Growth of high-deductible health plans and individually purchased insurance has been slower than anticipated. (January 2009) SUBSCRIPTION REQUIRED
How Many Are Underinsured? Trends among U.S. Adults, 2003 and 2007 estimates that there are nearly 25 million underinsured adults, a 60 percent increase from 2003. The rate of increase was steepest among those with incomes above 200 percent of poverty ($10,400 for an individual in 2008), where underinsurance rates nearly tripled. In total, 42 percent of U.S. adults were underinsured or uninsured. (June 2008)
Public and Private Health Insurance: Stacking up the Costs examines different ways of providing health insurance to families with incomes below 200 percent of the federal poverty level. The brief finds that total medical spending is much lower when coverage is provided through Medicaid or CHIP than it is when coverage is provided by private insurance because out-of-pocket spending is much lower. (June 2008)
A Progress Report on State Health Access Reform describes specific state advances in health coverage, including expansions for uninsured children and adults, regulating the individual insurance market, and employer mandates. However, the findings do not predict how long these changes will last. (January 2008)
Financial Burden of Health Care, 2001-2004 presents an analysis of data that shows an increase in out-of-pocket health care cost as incomes remain the same, especially for the privately insured. For a growing number of families, private Insurance no longer provides adequate financial protection. (January 2008)
Employers’ Views on Incremental Measures to Expand Health Coverage examines employers’ views on the importance of health benefits and their perspective on policies aimed at improving employees’ access to coverage and quality care. Employers of all sizes hold a positive view of the value of health benefits in attracting and retaining workers and in improving workers’ health and productivity. (A subscription is necessary to view the full article.) (November 2006)
From the Health Assistance Partnership:
Resources for Programs Serving Consumers with Private Health Insurance -- Learn More About Private Health Insurance This Web page offers a wealth of information on private health insurance, including issue briefs, consumer outreach materials, and links to materials from other organizations. Topics covered include consumer-driven health insurance and HSAs, COBRA, EMTALA and emergency treatments, ERISA (benefit denials and appeals), HIPAA portability of coverage, HIPAA privacy, and TAARA/tax credits.
Health Insurance Portability and Accountability Act (HIPAA) Privacy Regulations: Questions and Answers for Consumer Health Assistance Programs Health privacy regulations that dictate when a person has a right to obtain his or her medical records and other health information and when health plans and other health care entities can share protected information went into effect on April 14, 2003. This report guides consumer health assistance (ombudsman) programs through their rights and responsibilities under these HIPAA privacy regulations. (May 2003)
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From Health and Human Services (HHS)
Insurance at Risk: Small Business Employees Risk Losing Coverage discusses how small businesses and their employees will significantly benefit from health reform. Many small businesses currently struggle to provide the health coverage they and their employees need. (October 2009)
From healthinsuranceinfo.net:
Summary of Key Consumer Protections in Individual Insurance Markets This state-by-state chart provides a quick reference for information on key consumer protections, such as guaranteed issue, pre-existing condition exclusions, and rating restrictions. (April 2004)
healthinsuranceinfo.net Consumer guides to getting and keeping health insurance, written by the Georgetown University Health Policy Institute, are available for each state and the District of Columbia. The guides are available online and are updated periodically as changes in federal and state policy warrant.
From Health Services Research:
Immigrants and Employer-Sponsored Health Insurance examines why foreign-born workers are less likely to have employer-sponsored health insurance coverage. The authors conclude that immigrants have a higher probability of working in a firm that does not offer insurance. (A subscription is necessary to view the full article.) (February 2007)
From the Kaiser Commission on Medicaid and the Uninsured:
Changes in Health Insurance Coverage, 2007-2008: Early Impact of the Recession indicates that the sharp decrease in coverage over this time period (1.5 million newly uninsured adults) was largely due to declines in job-based insurance. Coverage through public programs has bridged some of this gap, but increases in coverage for children were substantially larger than for adults. (October 2009)
Health Care and the Middle Class: More Costs and Less Coverage examines the availability, affordability, and stability of health coverage of families with incomes of $44,000 to $88,000 for a family of four. Overall, health insurance and medical care have become less affordable for the middle class, and one in 10 middle-class, working-age adults have lost health insurance. (July 2009)
Snapshots from the Kitchen Table: Family Budgets and Health Care shows the central role of health care costs and coverage in a household’s economic stability. It finds that health care costs were of particular concern, with many families forgoing doctor visits, skipping prescription medications, and postponing needed care. Even those with health insurance reported delaying care in order to avoid copayments, rising deductibles, and out-of-pocket costs. (February 2009)
The Fraying Link between Work and Health Insurance: Trends in Employer-Sponsored Insurance for Employees, 2000-2007 finds that employer-based coverage has continued to decline, and the uninsured rate has increased among employees and among low-income children with family access to employer-based coverage. Employer coverage is expected to continue to decline as increasing premiums and a worsening economy lead more employers to drop coverage. (December 2008)
Choosing Premium Assistance: What Does State Experience Tell Us? examines the advantages and disadvantages of several state premium assistance programs, which allow families to choose to receive a subsidy to purchase private coverage rather than enroll in Medicaid or CHIP. The brief examines premium assistance programs in six states: Florida, Idaho, Illinois, Oregon, Utah, and Virginia. (May 2008)
From KaiserEDU.org:
A new tutorial entitled Private Health Insurance 101 provides an overview of the private health insurance system. The tutorial outlines basic concepts, including risk spreading, risk selection, and regulation. It also discusses eligibility, coverage, and costs for consumers. (August 2006)
From the Kaiser Family Foundation:
Americans’ Satisfaction with Insurance Coverage provides deeper insight into the tracking polls that have found that Americans positively rate their own health insurance. The data reveal that significant portions of those who rate their insurance positively say they still face problems paying their medical bills or are dissatisfied with certain aspects of their coverage, which casts some doubt on the accuracy of this type of poll. (September 2009)
Individuals with Special Needs and Health Reform: Adequacy of Health Insurance Coverage examines the health care needs and medical expenses of three individuals who require extensive acute and long-term care to discover how reform proposals can best serve those with special health needs. It concludes that a comprehensive benefits package, limits on out-of-pocket expenses, subsidies, and strong Medicaid programs are essential to ensuring that people with special needs are fully supported under health reform. (September 2009)
Explaining Health Reform: What Are Health Insurance Subsidies? explains what insurance subsidies are and how they can help lower-income families and individuals afford health coverage. The brief also examines different ways of structuring subsidies and describes how each would affect the reform proposals that are currently under discussion in Congress. (August 2009)
Retiree Health VEBAs: A New Twist on an Old Paradigm – Implications for Retirees, Unions, and Employers provides an overview of stand-alone VEBA trusts, vehicles through which employers have rid themselves of future obligations to pay retiree health benefits in exchange for making a payment that approximates the projected cost of these benefits. The brief looks at three case studies, including the Big Three VEBAs, and highlights some of the pros and cons of such arrangements for employees, unions, and employers. (March 2009)
Spending to Survive: Cancer Patients Confront Holes in the Health Insurance System highlights the challenges that cancer patients may face in paying for life-saving care even when they have private health insurance. High cost-sharing, caps on benefits, and lifetime maximums contribute to high out-of-pocket costs, while waiting periods and restrictions on eligibility for public programs can leave patients who are too ill to work without an affordable insurance option. (February 2009)
Health Insurance Coverage of Women Ages 18 to 64, by State, 2006-2007 is an updated fact sheet with the latest state-by-state data on health coverage of non-elderly women. It builds on Women’s Health Insurance Coverage Fact Sheet, a related report that provides statistics on health coverage and describes the major sources of health insurance for women ages 18-64, including employer-based coverage, Medicaid, individually purchased insurance, and Medicare. (December 2008)
Ask the Experts: High-Risk Pools is a webcast in which panelists discuss how high-risk pools work, including their funding, the benefits they provide, and the premiums that are charged to enrollees. Panelists also discussed how high-risk pools are a factor in helping stabilize the individual insurance market, as well as what role they might play in a reformed health care system. (July 2008)
How Private Health Coverage Works: A Primer–2008 Update explains how private health coverage in the U.S. works. It discusses the fundamental aims of private health coverage and sorts out the complicated web of state and federal regulations that govern it. (April 2008)
Employer Health Insurance Costs and Worker Compensation analyzes what it costs employers to provide health insurance and the rate at which these costs are growing. Employers’ costs as a percentage of payroll vary across work settings, which makes it challenging for policymakers to establish equitable standards. The report also notes that employees are suffering: Insurance premiums have risen by 78 percent over the last six years while wages have risen by only 19 percent. (March 2008)
How Non-Group Health Coverage Varies with Income examines how often people at different income levels buy individual health coverage when they cannot obtain coverage through their jobs or through public programs. It found that few people at lower incomes buy individual coverage and that, as income increases, coverage rates increase as well. (February 2008)
The Burden of Out-of-Pocket Health Spending among Older Versus Younger Adults: Analysis from the Consumer Expenditure Survey, 1998-2003 compares the ratio of out-of-pocket health care spending to income among people under age 65 to the ratio for people age 65 and older over the period from 1998-2003. It finds that those over 65 spend far more on health care and have substantially lower incomes than do adults under 65. (September 2007)
More than 150 million individuals received health insurance through an employer in 2005, making employer-sponsored coverage the most prevalent form of health coverage for the nonelderly in the U.S. However, recent years have seen erosion in the availability of employer-based health benefits for workers, especially low-income workers. Changes in Percentage of Families Offered Coverage at Work, 1998-2005 shows that from 1998 to 2005, offers of job-based coverage fell across the board. (July 2007)
One of the many reasons an individual may be uninsured is that she or he decides that an employer’s offer of health insurance is too expensive. Insurance Premium Cost-Sharing and Coverage Take-Up looks at how the take-up rate for workers within firms varies with the level of premium contributions in those firms. (February 2007)
Employer-sponsored health insurance is especially important for immigrant families because their eligibility for public coverage, including SCHIP and Medicaid, is restricted. The Role of Employer-Sponsored Health Coverage for Immigrants: A Primer examines the importance of employer-based coverage and the specific hurdles immigrants face in obtaining health insurance. The primer is available in both English and Spanish. (June 2006)
Distribution of Out-of-Pocket Spending for Health Care Services takes a detailed look at out-of-pocket spending for health care, and, in particular, how out-of-pocket costs vary among different groups for different services. Comparisons focus on, for example, what types of drugs and treatments are most often handled out-of-pocket and what share of total health spending occurs out-of-pocket by income bracket. (May 2006)
Retired Steelworkers and Their Health Benefits: Results from a 2004 Survey looks at how the bankruptcies of two steel companies, the LTV Corporation and Bethlehem Steel, affected health coverage for the companies' retirees and dependents. The survey found that although nearly three-quarters of the retirees who responded had obtained replacement coverage or a supplement to their Medicare coverage, many reported that they were less satisfied with their new coverage than they had been with the benefits they lost. Many also had to delay retirement in order to secure replacement coverage. The survey also studied the effects of the Health Coverage Tax Credit (HCTC) enacted in 2002, finding that it played a major role in helping some steel workers renew coverage. (May 2006)
Four in five businesses that now provide retiree health benefits will accept government subsidies for continuing to provide retiree drug coverage that is at least as good as Medicare's coverage when the new drug benefit starts in 2006, according to Prospects for Retiree Health Benefits as Medicare Drug Coverage Begins: Findings from the Kaiser/Hewitt 2005 Survey on Retiree Health Benefits. The survey examined 300 of the nation's largest private-sector employers that provide retiree health benefits. (December 2005)
Changing Health Care Marketplace Project, a Kaiser Family Foundation project, conducts research and analysis on trends in the marketplace, particularly as they affect vulnerable groups like the poor and the elderly, and on policy proposals that involve the private health care system. There have been striking changes in the health care marketplace in the last few years. Some of these changes build on historic trends; others depart, sometimes dramatically, from prior expectations about how the marketplace would evolve. (February 2005)
The Kaiser Health Poll Report provides key tracking information, including historical trends and in-depth analysis of public opinion about timely health care topics.
The Public, Managed Care, and Consumer Protections, a Kaiser Health Poll Report, examines the public's attitudes towards, and experiences with, their health plans, with a specific focus on managed care. The report uses current and historical public opinion data from the Kaiser Family Foundation and other polling organizations. It also looks at current and historical support for legislative action with regards to patients' rights. (July/August 2004)
Assessing State External Review Programs and the Effects of Pending Federal Patients' Rights Legislation examines key features of state external review programs and how they very across states. It also compares features of those state programs with the external review provisions in the patients' rights bills passed by the House and Senate. (March 2002)
From the Kaiser Family Foundation and Health Research and Educational Trust (HRET):
Employer Health Benefits 2009 Annual Survey provides a detailed look at trends in job-based health coverage, including changes in premiums, employee contributions, and cost-sharing. The survey also includes new questions about onsite health clinics, whether employers offer financial incentives to employees for completing health risk assessments, and the impact of the economic downturn. (September 2009)
Health Care Costs: A Primer examines recent trends in health care costs and the factors that contribute to the rapid rise in these costs. This updated primer includes information on the types and sources of health care spending, the demographic factors associated with higher or lower levels of spending, and the impact of higher premiums and out-of-pocket costs on families and employers. (March 2009)
Employer Health Benefits: 2008 Annual Survey provides a detailed look at trends in employer-based health coverage, including changes in premiums, employee contributions, and cost-sharing. The survey also documents the prevalence of high-deductible health plans and includes new questions on the wellness programs and retiree health benefits that are offered by employers. (September 2008)
Employer Health Benefits: A Summary of Findings reports on the rate of growth of health insurance costs, as well as the percentage of employers that offer high-deductible health plans. The findings indicate that, though the growth rate for health insurance costs is at its lowest since 1999, it is still growing faster than both wages and inflation. (September 2007)
Employer Health Benefits 2006 Annual Survey investigates trends in employer-sponsored health coverage, including changes in premiums, cost-sharing, employee contributions, and the prevalence of high-deductible health plans. The study found that insurance premiums are increasing more than twice as fast as workers’ wages and overall inflation. (September 2006)
Employer Health Benefits 2004 Annual Survey is part of an annual series of studies documenting changes in employer-sponsored health insurance, including trends in premium rates and cost-sharing mechanisms. Among its findings, the survey reports that 61 percent of all workers receive health coverage from their employer, down significantly from its peak in 2001, meaning there were at least 5 million fewer jobs that provide health insurance in 2004 than there were in 2001. (September 2004)
From the Kaiser Family Foundation and eHealthInsurance:
Many people are unfamiliar with the individual health insurance market because most Americans get their health coverage through their jobs or from a public program. Update on Individual Health Insurance provides information about the individual health insurance market, including information on insurance purchasers, premiums, retention rates, and cost-sharing. Future reports will provide trend information in such areas as premiums and cost-sharing and data on other topics such as Health Savings Accounts and small business health insurance trends. (August 2004)
From the Kaiser Family Foundation and Hewitt Associates:
Retiree Health Benefits Now and in the Future provides detailed information on retiree health programs offered by large, private-sector employers, including data on eligibility, benefits, premiums, and total costs in 2003. The report also offers insights as to what changes employers say they are likely to make in the near future. (January 2004)
From the Kaiser Family Foundation and the National Women's Law Center:
Access to Care: A State-Level Analysis of Key Health Policies State policies play a critical role in shaping women's access to health care. This report details state activity on a range of polices that affect women's access to care, with an emphasis on private coverage, Medicaid, and reproductive health. Specific policies covered in the report include Medicaid eligibility expansions, managed care protections, and assistance with the costs of prescription drugs. (July 2003)
From Mathematica:
SCHIP Children: How Long Do They Stay and Where Do They Go? highlights findings from a seven-state study examining retention of children in SCHIP and enrollees’ coverage after they leave the program. Once enrollees leave SCHIP, they are far more likely to become uninsured and remain uninsured for some time than they are to obtain private coverage. The findings suggest that the extent to which SCHIP has substituted for private insurance is well below the rates estimated in other studies. (January 2009)
From the National Conference of State Legislatures (NCSL):
Changing Definition of "Dependent": Who Is Insured and for How Long includes a table showing state legislation that extends the age under which young adults can be covered under their parents' health insurance policies. (September 28, 2006)
From the National Council of La Raza:
Employer-Sponsored Health Insurance: Already Poor Access Dwindles Further for Working Latino Families examines the rates at which the Latino community receives employer-sponsored health insurance, which is lower than that of any other major racial or ethnic group in the U.S. Employers are less likely to offer Latino workers health coverage, so Latinos have to seek out other avenues of insurance coverage, which are often unaffordable. (January 2008)
From the National Women’s Law Center:
Nowhere to Turn: How the Individual Health Insurance Market Fails Women looks at the experiences of women seeking coverage in the individual insurance market between July and September, 2008. The report finds that many women face obstacles obtaining comprehensive, affordable health coverage. These challenges include being charged higher premiums than men, a practice known as “gender rating,” and being unable to find affordable maternity coverage. (September 2008)
From the Robert Wood Johnson Foundation:
Coverage When It Counts: What Does Health Insurance in Massachusetts Cover and How Can Consumers Know? details the complex challenges consumers face when making choices about which health insurance plan to purchase. The authors use Massachusetts as an example to suggest a new method for evaluating health insurance plans and make recommendations for states that are working to increase transparency in health insurance pricing. (May 2009)
From the Robert Wood Johnson Foundation, Public Opinion Strategies, and Lake Research Partners:
Key Findings from Qualitative and Quantitative Research among America's Small Business Owners is a national survey that presents the top concerns of small business owners regarding health coverage. It examines how likely small businesses are to continue providing insurance for employees and their views on various health reform measures. Results are broken down by business size and party identification, showing the top five policies for health reform favored by small businesses and what kinds of messages would be most effective in gaining support for health reform. (December 2008)
From State Coverage Initiatives:
Health Insurance Connectors & Exchanges: A Primer for State Officials examines a crucial component of the 2006 Massachusetts health care reform law known as “the Commonwealth Health Insurance Connector Authority,” or simply, “The Connector.” The Connector is presented as a prototype that other states can adapt when seeking to expand health coverage, depending on the specific characteristics in those states. (September 2007)
Reinsurance is when a state opts to cover a portion of private insurer's claims. This "stop-loss" mechanism may cover catastrophic claims above a certain dollar amount, or it may cover claims within a designated corridor. It is an indirect way of reducing premium prices, thereby providing a more affordable option for uninsured workers, and it remains a popular strategy for states that wish to maintain or increase health coverage. More Answers on Reinsurance is designed to serve as a technical guide for states that are interested in building a reinsurance program. (June 2004)
From the Urban Institute:
Variation in Insurance Coverage across Congressional Districts: New Estimates from 2008 reveals which districts face the greatest deficiencies in private coverage and where public coverage has been able to close some of these gaps. Rates of private coverage are lowest in districts that have higher poverty rates, and despite above-average rates of public coverage in these areas, lack of insurance continues to be a serious problem. (October 2009)
Health Savings Accounts and High-Deductible Health Insurance Plans: Implications for Those with High Medical Costs, Low Incomes, and the Uninsured examines the potential for HSAs and HDHPs to reduce health care spending and decrease the number of uninsured. The study finds that the tax structure and incentives built into HSAs make them most attractive to high-income and healthy people who are already advantaged by the current system and that they tend to shift more of the health financing burden onto those needing significant amounts of care. As such, it is not clear that cost containment or reductions in the uninsured will follow. (February 2009)
Health Insurance for Low-Income Working Families proposes comprehensive reforms that are designed to provide coverage for everyone at every income level, while still encouraging work. According to the study, in 2005, only 37 percent of adults in low-income working families had employer-based health insurance, and 42 percent had no health coverage. The proposals include state purchasing pools, individual mandates, and strategies for reducing health care costs. (July 2008)
Increasing Health Insurance Coverage of Workers in Small Firms: Challenges and Strategies: Testimony before the Finance Committee United States Senate calls for a reduction of small business owners that are uninsured. It suggests income-related subsidization of insurance coverage. (October 2007)
Concerns about Parents Dropping Employer Coverage to Enroll in SCHIP Overlook Issues of Affordability addresses the issue of crowd-out—the substitution of public coverage for private coverage. The report compares family medical spending of those who have employer-sponsored health insurance, those who are covered by Medicaid or CHIP, and those who are uninsured. It aims to dispel common misperceptions about CHIP and the people it was meant to serve. (September 2007)
From Watson Wyatt:
Closing the Gap: 2008/2009 Employee Perspectives on Health Care finds that employees are significantly less willing to select health plans with higher premiums and lower-out-of-pocket costs than last year. Higher health costs are forcing many workers to decrease their retirement savings plan contributions as they increasingly experience difficulty paying for basic needs, depleted personal savings, or the need to borrow money. (December 2008)
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