Hostname: page-component-76fb5796d-x4r87 Total loading time: 0 Render date: 2024-04-28T06:15:41.005Z Has data issue: false hasContentIssue false

Holes in the Health Insurance System-Who Lacks Coverage and Why

Published online by Cambridge University Press:  01 January 2021

Extract

Lack of health insurance coverage is a large and growing problem for millions of American families. Rising health care costs and economic insecurity continue to threaten the bedrock of the health insurance system - employer-sponsored coverage - while states’ fiscal situations and the escalating federal deficit complicate any efforts at reform. Providing health insurance coverage to the millions of uninsured remains a major health care challenge for the nation and understanding the current health insurance environment, who the uninsured are, and why they are uninsured is critical when considering health care reform. This paper aims to define the problem of the uninsured, providing an overview of the uninsured in America and the roles and limits of private and public insurance. Following this discussion, the paper describes the current health insurance environment and examines the prospects for improving coverage.

Type
Symposium
Copyright
Copyright © American Society of Law, Medicine and Ethics 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

U.S. Census Bureau, Health Insurance Coverage in the United States: 2002, Consumer Income Pub. no. P60-223 (September 2003), at <http://www.census.gov/prod/2003pubs/p60-223.pdf> (last visited June 17, 2004).+(last+visited+June+17,+2004).>Google Scholar
Congressional Budget Office, How Many People Lack Health Insurance and For How Long? Table 1 (Washington, D.C.: U.S. Government Printing Office, 2003).Google Scholar
Short, P. F. and Graefe, D. R., “Battery-Powered Health Insurance? Stability in Coverage of the Uninsured,” Health Affairs 22, no. 6 (2003): 244–55.CrossRefGoogle Scholar
The Henry J. Kaiser Family Foundation, Fact Sheet: Medicare at a Glance (April 2003), at <http://www.kff.org/medicare/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=14184> (last visited June 17, 2004).+(last+visited+June+17,+2004).>Google Scholar
2003 Medicaid enrollment estimates from Congressional Budget Office, March 2004 Baseline Medicaid and the State Children’s Health Insurance Program (Washington, D.C.: U.S. Government Printing Office, 2004).Google Scholar
See U.S. Census Bureau, supra note 1.Google Scholar
The Henry J. Kaiser Family Foundation, “Health Insurance Coverage in America: 2002 Data Update,” The Kaiser Commission on Medicaid and the Uninsured Report (December 2003), at <http://www.kff.org/uninsured/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=29340> (last visited June 17, 2003), hereinafter cited as 2002 Data Update.+(last+visited+June+17,+2003),+hereinafter+cited+as+2002+Data+Update.>Google Scholar
2002 Data Update, supra note 7.Google Scholar
2002 Data Update, supra note 7.Google Scholar
Calculations based on The Henry J. Kaiser Family Foundation, “The Uninsured: A Primer,” The Kaiser Commission on Medicaid and the Uninsured (December 2003), at <http://www.kff.org/uninsured/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=29345> (last visited June 17, 2004).+(last+visited+June+17,+2004).>Google Scholar
2002 Data Update, supra note 7.Google Scholar
Garrett, B., Employer-Sponsored Health Insurance Coverage: Sponsorship, Eligibility, and Participation Patterns in 2001 (Washington, D.C.: Kaiser Commission on Medicaid and the Uninsured, 2004).Google Scholar
See Garrett, , supra note 12.Google Scholar
See Garrett, , supra note 12.Google Scholar
See Garrett, , supra note 12.Google Scholar
The Henry J. Kaiser Family Foundation and Health Research and Educational Trust, Employer Health Benefits 2003 Annual Survey (September 2003), at <http://www.kff.org/insurance/ehbs2003-1-set.cfm> (last visited June 17, 2004), hereinafter cited as Employer Health Benefits report.+(last+visited+June+17,+2004),+hereinafter+cited+as+Employer+Health+Benefits+report.>Google Scholar
See Garrett, , supra note 12.Google Scholar
See Garrett, , supra note 12.Google Scholar
Employer Health Benefits report, supra note 16.Google Scholar
Congressional Budget Office, supra note 2; Haley, J. and Zuckerman, S., “Is Lack of Coverage a Short- or Long-Term Condition, The Kaiser Commission on Medicaid and the Uninsured Report (June 2003), at <http://www.kff.org/uninsured/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=14352> (last visited June 17, 2004).+(last+visited+June+17,+2004).>Google Scholar
2002 Data Update, supra note 7Google Scholar
2002 Data Update, supra note 7.Google Scholar
The Henry J. Kaiser Family Foundation, “The Uninsured and Their Access to Health Care,” The Kaiser Commission on Medicaid and the Uninsured (December 2003), at <http://www.kffr.org/uninsured/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=29284> (last visited June 17, 2004).+(last+visited+June+17,+2004).>Google Scholar
Further discussion of Medicaid eligibility provided in The Henry J. Kaiser Family Foundation, The Kaiser Commission on Medicaid and the Uninsured, The Medicaid Resource Book (July 2002), at <http://www.kff.org/medicaid/2236-index.cfm> (last visited June 17, 2004), herein after cited as The Medicaid Resource Book.+(last+visited+June+17,+2004),+herein+after+cited+as+The+Medicaid+Resource+Book.>Google Scholar
Ross, Cohen D. and Cox, L., “Preserving Recent Progress on Health Coverage for Children and Families: New Tensions Emerge,” The Kaiser Commission on Medicaid and the Uninsured report (July 2003), at <http://www.kff.org/medicaid/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=14355> (last visited June 17, 2004).+(last+visited+June+17,+2004).>Google Scholar
Calculated based on data provided in Cohen Ross and Cox, supra note 25.Google Scholar
First estimate provided in 2002 Data Update, supra note 7; remaining estimates based on The Kaiser Commission and Medicaid and the Uninsured and Urban Institute analysis of the March 2003 Current Population Survey (Unpublished data).Google Scholar
The Henry J. Kaiser Family Foundation, “Medicaid’s Role in Long-Term Care,” The Kaiser Commission on Medicaid and the Uninsured (March 2001), at <http://www.kff.org/medicaid/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=13732> (last visited June 17, 2004).+(last+visited+June+17,+2004).>Google Scholar
The Medicaid Resource Book, supra note 24, 1729.Google Scholar
See Ross, Cohen and Cox, , supra note 25.Google Scholar
See Ross, Cohen and Cox, , supra note 25.Google Scholar
2002 Data Update, supra note 7.Google Scholar
2002 Data Update, supra note 7.Google Scholar
2002 Data Update, supra note 7.Google Scholar
2002 Data Update, supra note 7.Google Scholar
Estimate based on The Kaiser Commission and Medicaid and the Uninsured and Urban Institute analysis of the March 2003 Current Population Survey (Unpublished data).Google Scholar
2002 Data Update, supra note 7.Google Scholar
2002 Data Update, supra note 7.Google Scholar
2002 Data Update, supra note 7.Google Scholar
2002 Data Update, supra note 7.Google Scholar
2002 Data Update, supra note 7.Google Scholar
2002 Data Update, supra note 7.Google Scholar
2002 Data Update, supra note 7.Google Scholar
2002 Data Update, supra note 7.Google Scholar
2002 Data Update, supra note 7.Google Scholar
2002 Data Update, supra note 7.Google Scholar
2002 Data Update, supra note 7.Google Scholar
2002 Data Update, supra note 7.Google Scholar
2002 Data Update, supra note 7.Google Scholar
2002 Data Update, supra note 7.Google Scholar
2002 Data Update, supra note 7.Google Scholar
Holahan, J. and Wang, M., “Changes in Health Insurance Coverage During the Economic Downturn: 2000–2002,” Health Affairs, Web Exclusive, W-4 (2004): 3142.CrossRefGoogle Scholar
See Holahan, and Wang, , supra note 52.Google Scholar
Gabel, J. et. al., “Health Benefits in 2003: Premiums Reach Thirteen-Year High as Employers Adopt New Forms of Cost Sharing,” Health Affairs 22, no. 5 (2003): 117126.CrossRefGoogle Scholar
See Gabel, J. et. al., supra note 54.Google Scholar
Cutler, D. M., Employee Costs and the Decline in Health Insurance Coverage, Working Paper No. 9036 (Cambridge, Mass: National Bureau of Economic Research, 2002).CrossRefGoogle Scholar
See Holahan, and Wang, , supra note 52.Google Scholar
Boyd, D. and Wachino, V., “Is the State Fiscal Crisis Over? A 2004 State Budget Update,” The Kaiser Commission on Medicaid and the Uninsured (January 2004), at <http://www.kff.org/medicaid/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=30459> (last visited June 17, 2004).+(last+visited+June+17,+2004).>Google Scholar
Boyd, D., “The Current State Fiscal Crisis and Its Aftermath,” The Kaiser Commission on Medicaid and the Uninsured (September 2003), at <http://www.kff.org/medicaid/loader.cfm?url=/commonspot/security/getfile.cfm&PageIDs22130> (last visited June 17, 2004).+(last+visited+June+17,+2004).>Google Scholar
Smith, V. et. al., “States Respond to Fiscal Pressure: State Medicaid Spending Growth and Cost Containment in Fiscal Years 2003 and 2004,” The Kaiser Commission on Medicaid and the Uninsured (September 2003), at <http://www.kff.org/medicaid/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=22126> (last visited June 17, 2004).+(last+visited+June+17,+2004).>Google Scholar
See Boyd, and Wachino, , supra note 58.Google Scholar
Smith, V. et. al., “States Respond to Fiscal Pressure: A 50-State Update of State Medicaid Spending Growth and Cost Containment Actions,” The Kaiser Commission on Medicaid and the Uninsured (January 2004), at <http://www.kff.org/medicaid/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=30453> (last visited June 17, 2004).+(last+visited+June+17,+2004).>Google Scholar