Health insurance in the United States P1

The term health insurance is commonly used in the United States to describe any program that helps pay for medical expenses, whether through privately purchased insurance, social insurance or a social welfare program funded by the government. Synonyms for this usage include "health coverage," "health care coverage" and "health benefits."

In a more technical sense, the term is used to describe any form of insurance that provides protection against the costs of medical services. This usage includes private insurance and social insurance programs such as Medicare, which pools resources and spreads the financial risk associated with major medical expenses across the entire population to protect everyone, as well as social welfare programs such as Medicaid and the State Children's Health Insurance Program, which provide assistance to people who cannot afford health coverage.

In addition to medical expense insurance, "health insurance" may also refer to insurance covering disability or long-term nursing or custodial careneeds. Different health insurance provides different levels of financial protection and the scope of coverage can vary widely, with more than 40 percent of insured individuals reporting that their plans do not adequately meet their needs as of 2007.

The share of Americans with health insurance has been steadily declining since at least 2000. As of 2010 just under 84% of Americans had some form of health insurance, which meant that more than 49 million people went without coverage for at least part of the year. Declining rates of coverage and underinsurance are largely attributable to rising insurance costs and high unemployment. As the pool of people with private health insurance has shrunk, Americans are increasingly reliant on public insurance. Public programs now cover 31% of the population and are responsible for 44% of health care spending. Public insurance programs tend to cover more vulnerable people with greater health care needs. Many of the reforms instituted by the Affordable Care Act of 2010 were designed to extend health care coverage to those without it.

Enrollment and the Uninsured

According to the United States Census Bureau, roughly 55% obtain insurance through an employer, while about 10% purchase it directly. About 31% of Americans were enrolled in a public health insurance program: 14.5% (45 million – although that number has since risen to 48 million) had Medicare, 15.9% (49 million) had Medicaid, and 4.2% (13 million) had military health insurance (there is some overlap, causing percentages to add up to more than 100%).[3] Employers are allowed to pay employees cash in lieu of health insurance, but this is uncommon as it is subject to strict IRS regulations.

Trends in private coverage

The percentage of non-elderly workers with employer-sponsored coverage has been falling, from 68% in 2000 to 61% in 2009, the latest year for which data is available. While the primary cause of falling rates of insurance is the rising cost of health care for employers, the economic downturn since 2008 has swelled the ranks of the uninsured, in large part because workers who lose their jobs also lose employer-sponsored insurance. Over 1 million workers lost their health care coverage in January, February and March 2009. Approximately, 268,400 more workers lost health care coverage in March 2009 than in March 2008, so the decline of employer sponsored insurance has likely accelerated in recent years.

Trends in public coverage

As a smaller and smaller share of the public is covered by private insurance, public insurance has grown more essential. In 2000, 10.5% of the public was covered by Medicaid, while 13.5% had Medicare. By 2010, those figures had risen to 14.5% and 15.9% respectively.

A report published by the Kaiser Family Foundation in April 2008 found that economic downturns dramatically increase the public's reliance on state Medicaid and SCHIP and can cause significant financial strain for the programs. The authors estimated that a 1% increase in the unemployment rate would increase Medicaid and SCHIP enrollment by 1 million, and increase the number uninsured by 1.1 million. State spending on Medicaid and SCHIP would increase by $1.4 billion (total spending on these programs would increase by $3.4 billion). This increased spending would occur at the same time state government revenues were declining. During the last downturn, the Jobs and Growth Tax Relief Reconciliation Act of 2003 (JGTRRA) included federal assistance to states, which helped states avoid tightening their Medicaid and SCHIP eligibility rules. The authors conclude that Congress should consider similar relief for the current economic downturn. Funding for Medicaid and SCHIP was in fact expanded significantly under the 2010 health reform bill.

Status of the uninsured

Based on self-reported census data, in 2010, more than 49 million people in the US (more than 16% of the population) were without health insurance as defined in the questions asked. The percentage of the non-elderly population who are uninsured has been generally increasing since the year 2000. Among the uninsured population, some 40 million were employment-age adults (ages 18 to 64), and more than 28 million worked at least part-time. About 37% of the uninsured live in households with incomes over $50,000.

According to the Census Bureau, more than 40 million of the uninsured are US citizens. Another 9.7 million are non-citizens, but the Census Bureau does not distinguish in its estimate between documented and undocumented migrants. It has been estimated that nearly one fifth of the uninsured population is able to afford insurance, almost one quarter is eligible for public coverage, and the remaining 56% need financial assistance (8.9% of all Americans). An estimated 5 million of those without health insurance are considered "uninsurable" because of pre-existing conditions.

The costs of treating the uninsured must often be absorbed by providers as charity care, passed on to the insured viacost-shifting and higher health insurance premiums, or paid by taxpayers through higher taxes.

Death

Since people who lack health insurance are unable to obtain timely medical care, they have a 40 percent higher risk of death in any given year than those with health insurance, according to a study published in the American Journal of Public Health. The study estimated that in 2005 in the United States, there were 45,000 deaths associated with lack of health insurance.

A Johns Hopkins Hospital study found that heart transplant complications occurred most often amongst the uninsured, and that patients who had private health plans fared better than those covered by Medicaid or Medicare

Reform

The Affordable Care Act of 2010 was designed primarily to extend health coverage to those without it by expanding Medicaid, creating financial incentives for employers to offer coverage, and requiring those without employer or public coverage to purchase insurance in newly created state-run health insurance exchanges. The CBO has estimated that roughly 33 million who would have otherwise been uninsured will receive coverage because of the act by 2022.

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Categories: Health Insurance, United States