Who determines whether we have coverage?
Offer Rates for Smaller Establishments by Business Age
Kaiser Family Foundation
May 6, 2008
Employer-provided health insurance is the primary source of insurance coverage in the United States, covering almost 160 million people or more than 90 percent of the non-elderly privately-insured population. In recent years, the percentage of firms who offer such benefits has been falling; 69 percent offered health coverage benefits in 2000, whereas 60 percent did the same in 2007. Since employers are not required to offer health benefits to their employees, changes in the rate at which they offer such benefits are important for understanding the number of people covered by private insurance. Having access to work-place health insurance is a key determinant of whether or not a person has private coverage.
Researchers looking at the reasons why employers offer coverage have identified a variety of factors. These include both employee characteristics, such as earnings, occupation, part-time versus full-time status, union status, gender, and age, and employer characteristics, such as geographic region, industry, and firm and establishment size.
This issue brief looks at a less well-understood factor that may also affect an employer’s decision to offer health benefits: how long a business has been operating.
The analysis shows that, for smaller establishments, those with younger business ages are less likely to offer health benefits than establishments with older business ages.
http://www.kff.org/insurance/snapshot/chcm050608oth.cfm
And…
How Risky Is Individual Health Insurance?
by Mark V. Pauly and Robert D. Lieberthal
Health Affairs
May 6, 2008
This paper describes the relationship between type of insurance coverage in one period and the likelihood of becoming uninsured in the next. We find that for people at the median health status, becoming uninsured is most likely for those with individual insurance, less likely for those with small-group insurance, and least likely for those with large-group insurance. However, for people in poor or fair health, the chances of losing coverage are much greater for people who had small-group insurance than for those who had individual insurance.
These results are consistent with a complex characterization of the effect of high risk on individual insurance premiums: high risks pay more if they seek individual coverage after they have become high risks, but individual coverage provides better protection (compared to group insurance) against high premiums for already individually insured people who become high risk. Specifically for an initially insured person of average or better risk, dropping or losing health insurance coverage is more likely if the coverage was expensive individual insurance than if it was cheaper and tax-subsidized group insurance. But group insurance has a tear in its net of protection: it leaves a person who becomes a high risk more vulnerable to dropping or losing any and all coverage than does individual insurance.
http://content.healthaffairs.org/cgi/content/full/hlthaff.27.3.w242/DC1
Comment:
By Don McCanne, MD
These two studies released today add to the great body of policy literature that demonstrates that the decision to have health insurance is often removed from the individual and is under the control of extraneous factors.
One study shows that the age of a small business is a factor in whether or not an employee will obtain insurance. The other demonstrates that the individual’s health status while employed by a small business is a factor in whether or not the individual will be able to continue to have coverage.
The consensus today is that everyone should have coverage that ensures affordable access to essential health care. Yet the private insurance model defeats that goal. The insurance industry continues to manipulate access to their products by individuals and employers with the goal of actively avoiding those with high health care costs and passively avoiding those who are unable to pay the premiums for their low-risk pools.
A single payer national health program would automatically include everyone for life. Yet our politicians insist that we continue to try to patch together private plans even though that will always leave us with “tears in the net of protection.” Policies to repair the rents we already have are only resulting in greater rents elsewhere, thanks to the ingenuity and innovation of the private insurance industry.