Table 14
Table 6
ID
Nonelderl Reduction y Population in the Uninsured by Select l_ao/ePopulation ed ts Sourcesfrom of Health Expanding Insurance Employer Coverage Coverage:
o_ o_ _ _ Table II o_ _ _ o_
Table Table I0 9
Table 12
Table 5
o°=_. _0_o_=°_- Table0_ 7=_9 _0_o_9 _-
Alternative and Employment Table Definitions 3 Status of oQualified f Family HeEmployees ad, 1985 , 1985
Table 15
Nonelderly Population by Selected Sources of Health Insurance Coverage
Children Under Age 18 Without Health Insurance by Family Type and
Workers Age 18-64 by Selected Sources of Health Insurance Coverage
Full-year an Workers d Region andAge Slate, 18-64 1985 by
Distribution Poverty Status. and ofSexFirms and Work and StatusEmployees of the Family Head, 1985
Work No ers nelde Ag rly e 1Po 8-64 pulatio by nSelected and Population Sources of Without Coverage Health Insurance
Total Nonagricultural Civilian Employment, Rates of Employment Growth, 25
18
Population Affected
26
21 36 37
and Hourly Earnings as a Percent of the Federal Minimum Wage, 198534 17 32 22 23 12 13 38
THE EROSION OF HEALTH INSURANCE COVERAGE AMONG THE NONELDERLY POPULATION:31 28 15 29 II
24 i0 230 20 16 19 7
Sources of Health Insurance and Personal Earnings, 1985 14 33
by Firm Size, 1977 and 1982 35
EBRI 2
and by Family Industry Type of Primary andTotal Family Employment, TotalHead's Total Employment 1985 Status, 1985
and Employer-based Health Insurance Coverage by Industry, 1985
Reduction of the Uninsured Population Famgy Income from asExpanding a Percent of PovertyMedicaid Coverage:
Definition of Qualified Insured Population: Wage & PrDependents ivate & Public of Wage & No Health
PUBLIC POLICY ISSUES AND OPTIONS
_o_= =o - o _
Total Total Private Emp 0-99% 4oyer 100 Pub -124% lic Med'_cald 125-199% No Health Insura 200%nce+
Alternative.- Options by Beneficiary _o_ Type, _o 1985 . _,_
Employee: Hours Work StatusTotal of Salary Employer-provided Salary Workers Insurance Net
(_ousands) (%) (%) (%) (%) (thousands) (%)
1977 1982
oaoo 9ao_ Employer-based = 9=0 Coverage " oao
Family Type and
Employer-based coverage
o o oEndnotes "_. 11.2 head is worker
Total Missouri 1004,234 .0% 74.3% 100.0% 65.5% 11.4% 7.4% 100.0% 697 16.5% 100.0%
Services the morenonelderly _than report All Un 80insured prepared uninsured percent Children 5.3 of 100 for population. .0% 66 all .0% Bluenonagricultural 100.0% 49.1% Cross 100.0% and C]7.0% _Bluenonsupervisory 100Shield .0% 1.2 100of .0% 22.6% Maryland workers aexempted nd Blue
No Spouse :3 Present, _ :D _ I,--I
Public people--reported Administration 3.1 , having no insurance 4,995 _ coverage 4.8% from _ LL either -6.5% a private plan or 87.6% a
100-124% 18 hours or more 7.8% 346.6% .8 6.3% 22.9 5.9% 3.9% 13.0 13.8% 1.6 13.6% 19.2% 8.3 15.2%11.9
>> )-" __ _
C North Dakota 500 82.4% 67.7% a million a a a
$1 from •-o 0,000-1 the 9,999 federal c minimum _" 30.8% wage (Welch, 33.5% 1982). 35.1%-_- 24.6% 22.5%
million
Cross and Blue Shield of the National Capitol Area (Columbia, MD:
workers. --_o No Child 1.3 _Present m _ _ 0 00000_ _ _ _34_.3 0 0_ ._ '_ 8.7 -- OD 25.0% [] 25.4% Self-employed
Personal (approximately coverage Services for other the services. 1 3.7 7.5-hour 48.6%rule27.used 0% to 21.6% test nondiscrimination 1.2 32.4% [] 0-99in % health
125-199% their c Southcoverage Dakot 21.8% a c from20.9% employer 504 76.5% 20.8% plans; 64.20.7% 3%_ 37 percent 19. a _3% ea26 6would .3% 89 have 22.7% 17.7% obtained 23.1% coverage 27.3%
35 hourspeople unemployment to one-third (Bovbjerg, or more anAn employer with alternative earned 1986) income isgroup largely less and 34.8 between federal andthan geographically antoempirical I00 the policy the18 percent cost .federal 6 toquestion. of compact, expand and administering minimum 2009.6 employer-based percent minimizing wage.individual of 1.7 IIalf the thehealth offederal plans. difficulty all 7.4 uninsured insur poverty anceof16.1
receive one-quarter This uninsured moderate markedly Table level 5). Medicaid family from inmillion of In (24 1985. discount 1985, that percent) income. coverage oflow-coverage people might of qualify all not withself-employed be through industries either feasible aprivate federal accounted in workers the insurance orlong were state for term 35 uninsured coverage income percent if theassistance or in of Medicaid public 1985; total
uninsured as unpopular or plan. employer uninsured anFull-year, employer afromway Among coverage any in poor among to full-time plan; children 1985--62 public children) expand employers this did without program; percent percentage health not lived asparticipate well health with of insurance more declined the assingle insurance, organized than total incoverage to women Medicaid), three-quarters uninsured nea20 rly labor. that percent among 65were sequentially population. percent State workers lived workers of mandates the inwith 1984 (see and uninsured expanding About a are pFigure (EBRI, atheir rent 37 of
uninsured, work individual force Family health leaving and Type theinsurance a redistribution net uninsured plan for population of its workers uninsuredofinto5.3 population. jobs million--15 that IndoMarch percent not offer 1987, of
United insurance 21.4% Stacoverage tes_ underfrom age an employer 65. Various plan35.7% rose publicless policy []thanSpouse 5 options percent. present,toOne Family address reason
$20,000-29,999 o-= _ =_ _19 _.7% __ _o_ 23.5% 26 o .3%_ 7.9% 5.4%
Center for Health Policy Studies).
Nebraska 1,224 80.0% 68.3% 7.8% "-s a 185 15.1%
Under"--_ 20 _ _ o 90 o.3% _ o o _21_ .5% _ .__ 91.3% o 25.9%
Entertainment public _'_- insurance _ _ program. Among the nonagricultural, o oooo_- nonmilitary population,
200-399% r- oO 36.1 and Full-year %Work Statu 39 worker s .2% 40.1% 42.0% 27.7 46 _.3% 23 6.2 .4% 0317.8% 24.2% 22.4% 15.4% 18.2%
workers 71.8% 75.9% 87.8% 87.0% 88.7% 52.3%
Total, high-coverage 67,270(percent 65.2% within popu[] lation Spous 4.2% group) e present, Family 85.6%
E c ..... _ c
_i_i_ , head is nonworker
I%_ 0 Kans 0 0as 0 _ 1,920 80.4% 69.Ik) 2%-'_0 90.3%0 5.4% 0 _ 273 14.2% @)
[][] Manufa 1 00-124% cturing
$30,000-39,999 4 .,c: The o 1986 Wyatt _" Survey 9.9% of 12.1% Group Health 13.8% o Insurance 2.7% Benefits 1.9%estimated the
benefits from Medicaid. under the 1986 Tax Reform Act); and (3) 1.5 employees that work 35 hours
400% or 20-99 more standard). 18.0% Part-Year 20.2% Worker 8.3% 20.8% 18.5% 21.9% 2.4 25.6% 7.5% 0.9 6.6% 2.6% 10.6% 19.8% 37.5% 3.8% 4.8%
& Recreation k_ k_ b_Congress k, b b may ooooo be reluctanto to _0_o exempt insuredo plansooooo from stateo regulation, _
managing could workers 3). States be were plan to that mandate employed costs haveacross coverage. examined as wage areas Several and the withsalary possibility different members workers of medical ofCongress in establishing two practices industries: have endorsed aandstate-wide provider retail such
dependents although Medicaid population--and employment, who 1986a) program reported and coverage, fewer tomust edged compared include coverage workers providers' also upward reflecting to address all from nation-wide 30 to poor Medicaid percent 66andifferences competing percent employer uninsured are incaseloads--were 1982. inemployed objectives: plan. 1985. in without access Available in access construction, to substantially full employer employment, data to ando coverage employer they expanded. not economic reported indicate andplan to
program, percent population two general A strategy ofusually are those types: associated targeting newly Aid (I) tocovered requirements Families with both these employees by Medicaid with workers. thatDependent and particular would (percents) their haChildren dependents veservices been children; (AFDC) or would Iproviders and, obviously another less be
coverage the Washington _0 Full-year, uninsured c have part-time legislators apparently population _ 0 authorized been in_r1985. major the _Ofsources the establishment newly of the insured erosion of population, a managed-care in health 63insurance percent "basic
noncoverage for the slower among __&growth this in popul _mllll( coavtion ered workers are identified, compared and to total their maximum employmentpotenti mayalbe
Spouse Present 54.6% 42.9% 54.5% 58.3% [] [] Workers 64.5%less than $10,000
average cost of health insurance benefits among small employer plans (with
$40,000-49,999 Although COl _current 3.8% federal law 4.7% -allows states 5.3% "_- _to0.9% _ extend -= Medicaid a coverage to
Employee Benefit Research Institute.Hearing 1986.before "Features the of Employer Health
35 million reported no insurance coverage of any type during 1985.
1 00-499 South Atlantic Nonworker 32,627 1.1% 73.1% 12.4% 64.8%4.2 12.0% 6.4%11 .0% .6 6,123 4.6% 18.8% 13.0% 38.1%
All Dep Services endent _ s E 1.30 53.8% I"_-_ aO 30.8% ('00"__" 23.1% 0.3 23.1%
Total Uninsured 100.0% 100.0% million 100.0% [] Retail 1trade 00.0%
workers Family Head is: 4.4% 3.6% 2.4% 2.5% 2.0% 8.0%
_ ___ _ Low-coverage c [] Spous industries e absent, Family
"r' 88 c [] 125-199%
• 0 000 O0 0
Delaware 519 74.9% 69.2% a a 93 17.9%
fewer Plans: than I00 Cost participants) Containment,at $1,554 Plan Funding, per participant; and Coverage for very Continuation." large plans
$50,000 or more orper more week. Changes 4.0% in the 4.7% work-hour 5.3% rule 0.9%used to 0.7% define qualified
however, _ _ _ million for several _ -_ reasons. First, lacking _ -- a better measure, the cost of
Covereda mandate Full-y in e_ arprinciple. wor.c ker ._- 48.1% ._- Theo_ ,_- anticipated 33.3% o'_ (percents _- ,,_- 54.5%within cost "_ minimum _of 54.2%health r',- _wage _o 61.3%insurance groups) cot--- _, for small
500-999 reimbursement agrowth insurance comparable Moreover, Second, Based Mostandstudies plan oncompetitiveness people rate research systems. there to of of provide that the 0 noncoverage is .1% findings would little However, effects coverage in world buy for evidence of 4.2% (see regardless individual to markets. teen-agers mandatory Table uninsured that12). coverage ofcompensation a(where 0residents .how minimum-benefit, 1% multi-employer amayI0 have behave percent 3.9% more recognized focused catastrophic likely increase groupsontothat may the be in
Professional 3trade might Opti Medicaid 7 percent ons Employer-related No and have and for Spouse benefits. services. would assisted ChanKe Present, haveIn Nearly anoptions. been particular, additional adults 16 percent Employer-based who the 10.9of either uninsured million uninsured did strategies uninsured--raising are notworkers much work more or were toworked likely self-employed. expandMedicaid's less than health than the
whether covered by (I) insured the insured plans,worker's and/or plan (2) requirements offered no coverage that[] insured $10,000-19 for dependents ,plans 999 offer or
commonly, would effectiveness coverage health" target havthe plan eamong Supplemental obtained largest for inthe uninsured reducing their nonelderly. population Security coverage the individuals number and While Income from largest ofwi the employer uninsured t(SSI); h number proportion familyplans. these of is income estimated. civilian programs of below the uninsured. nonagricultural 200 automatically Estimates percent How of of
Medicaid the Medicaid-related Options: ongoing redistribution coverage ofoptions employment might:toward (i) jobs extend [] that Children Medicaid historically age coverage 18 or lesshave to
Sometime Maryland unemployed 3,641 77.9% 69.8% 10.0% 6.0% 546 15.0%
_:::._..•..
EBRI o Issue _ Brief No. 60 (November). _"
financially (with 5,000 Part-yea eligible or r more worker participants), children 2.8% under 2.4% plan age 18, cost a about averaged 4.2%20 states $1,552a currently per participant. do so.
United States House of Representatives
19.1 [] Services
_: [] 200-399%
1,000-2,499 Related Se Dist rvices rictChild of ColuPresent mbia 21.9 0.1% 517 81.7% 62.7% 53.9 5 63.9% .2% 29.6 % 18.2%17.8% a 0.0% 8.8 1125 7 2.2 .3% 22.10.0% 7% 5.0% 29.7%
Cover All Children Nonworker 2.8% 4.8% a a a
Construction workers 9.8%6,987 8.2% 6.8% 7.5% 7.8% 12.4% 7.2% 17.2%66.2%
More than _ a_a0:_b 0 hours0 b 100.0% ooooo o 8.7%i_0:_0b 1.1% b ooooo 0.9% 6.8% o _ _ 91.3% _o._
Other group sizes reported average Committee cost on Small of $1,380 Business or more. Other industry
Total _ 100.O% _ 85.3% 82.4% 75.8% _ 60.9% _ 14.9% .-- 5.g% 2.4% 14.7%
employees state-mandated producebenefits differences is seenin asthean target indicator populations of the value by redefining of these benefits workers
Mandating Virgin 11.ia 1 employer 4,549coverage, 76.4% 70.7% however, 10.0% million may 5.2% have 754 []important [] Nonworker 16.6% $20,000 effects adul or ts more on the
a substantial Table 15 presents subsidy estimates (reducing the of the price1985to uninsured participants)populamtion ay be critic that amight l to
uninsurable the insurance full-time. be employers, defined, minimum plan About however, than their wagewould 26 the reduced potential percent may population be employment attractive bewould for thewith reducing have most by to access been from employers significant the full-time to Icost to an•_3or of employer workers. Spouse obstacle percent), insurance individuals. absent plan. to a,cover Family 20federally That apercent Rather, ge is, is
impact 1985 (2) insurance privately The Rates dependents' beneficiary ofpotential coverage raising insured of noncoverage population cocost vthe erage among population of federal the was a (percent byMedicaid nonelderly vary 50 available, minimum topercent. within live substantially buy-in earnings wage. population but inIncluding relative the single-adult groups) In worker particular, are, among the to on income near-poor didthe or stanot tes. the face suggests single-parent elect population effect of States them, that that of
Public 2,500-4,999 confer separated qualified Administration Medicaid workers employees eligibility. continued 5.4 0.0% are defined 88.9%coverage Like 479.6% .4% isMedicaid, critical or 9.3% conversion AFDC to 0.0%the is a 0.3 number coverage federal-state 3 5.6% .7% of (that uninsured program, is, the who
workers all poverty; Workers The children go increased decline coverage Full-year without under in under worker nearly ageemployer-based employer-based 18 thisin 7 plan percent poverty; 18.0 is.,insurance coverage tobetween (2) commence extend1982 hcoverage a 5.9 sin Medicaid been July and 17.0% are 1985, 1988. most coverage 32.8% characterized apparent the The to plan number parents among is by of to
not effectiveness offered benefits--jobs are _provided for in small each C option firms independently and in low-coverage and in combination industries.
Retail trade D C 17,955 _ 17.4% 10.4% 63.7%
18 hours inThe or Pov more e198 rty millio 4 nDeficit 100.0% Reduction Act 12.3% 9.(DEFRA) 0% required 1.0% all states 1.0% - to extend 7.0% 38.0% coverage 91.0%
surveys Part-year o 0 West _ have Virgi jn niworke a _reported .....rs "-" ...... 1,somewhat 571 5.2% 68.4% ..... higher 4.3% 58.3%p average 17.9%0 _, 2.4% 13.0% costs ,_ o o 2.6% across - 292 head 18all .6% is [] 2.0% fema group Construction le wo sizes. rker 9.2%
'-_ The significant d "_-o > minority of nonelderly -= Americans without health insurance
Monheit, Alan C., Michael M. Hagan, Marc L. Berk and Pamela J. Farley. 1986.
_c Spouse Absent _ 45.4% __ _ 57.1% 36.4% 41.7% 35.5% [] 400% +
•"= "- _ o _ o_m_m_ CO _>" JO _.o c
o 0. C) o
5,000-9,999 North Carolina Part-Year Worker 05,066 .0% 77.1% 4.8% 69.2%4.0 10.9% 4.3%0.0% 1.2 824 3.4% 16.3% 4.5% 30.0%
Source: CoverOAdults _ Employe V in Families _e Ben _ efit Research _ _ O_ Institute _ 0 _2 _tabulations _ 0 of_ the March 1986 head is female nonworker
Business Nonworkers & repair services 8.9%5,321 7.9% 5.2% a a60.6% a 13.5%66.0%
35 0-99% hours or more 100.0% Fam I ily Head100.0% is: 68.3% 60.7% 8.7% 45.3% 17.5% 0.7% 27.6% 1.2% 10.7% 6.7% 5.7% 31.7% 91.3%
unknown. _J E ¢0 _.I
(as qualified "The Employed employeesUninsured only) and and cnonworkers the Role ."_'- of (as Public nonqualified Policy," employees Inquiry as22
have benefited from the four Medicaid-related strategies listed above.
to mandating available number insured andhealth evidence workers characteristics insurance suggests and indicoverage viduals, of thatavailable insurance for evenworkers. jobs, ifplans relatively asthat well are few as attractive on planproduct participants to prices. - most • _ _"
effecti they achieving Who families; Public Are may ve the be increase widespread and policy Uninsured? more theylikely options inare participation. minimum more to tohave likely compensation expand a health than However, health the due condition publicly insurance to themandatory problem that insured coverage would health of population financing predictably among insurance the to a
,.o Total the in co appealing characterized verage. Most Medicaid Various South population Caruninsured olinto a Data options would public by tohigh 100.0% on workers have be 2,713 for policy unemployment health served--poor reduced improving 76are .6%makers. 78.3% employed plan 68.8% total or coverage and provisions 12.9% First, 66 low noncoverage in .5% near-poor -_o_ o
"U_ N West South Central 22,487 _ mm_ 69.9% 62.5% omm 9.8% 5.2% 5,255 23.4%
o ooooo
4742 (introduced_ by Congressman Stark, CD-CA) would have encouraged states to
$50,000 or more 100.0% 92.6% 89.8% 2.7% 2.5%
adults Institutional and The views children; expressed Considerations," and (3) in this increases statement in the Reportare countof solely ofthenonworkers those Minimumof the Wage and author their Study
might adequate for increases example: be protection justified in the minimum may in terms bewagemore(and of expensive their presumably cost-effectiveness, thanminimum the standard real compensation) information individual are to or
dependent for reduce _o uninsurable participant children residents, would cost, have including most provided have (I) federal no coverage arrangement o_ strategies foro_2.4 o_ o_ other million too_o_o_ fthan acilitate people. the state state If
All Employees negotiated employees single-adult and may provider orreceive single-parent discounts, as dependents and families managed ofin other 1985, care workers' toonecontrol half plans, ofplanall the cost, uninsured total the
F. nonelderly plan the health percent buy one-quarter coverag In (32 _0 1985, coverage; percent, A1985 cost. rkansas e service _ofto uninsured 81 poor gross However, achieve of percent or (2) providers qualified _II family Oklahoma's employer-related population million o_ comparable since 1,928 of income rather the for 64.4% many people) _Medicaid uninsured population at ,_ with benefits uninsured than 56.6% r,.- 150 options were family the percent benefits 16.9% were best for children (25.3 workers _and income 9married either .of 3% interests _- (3) (Cpercent) poverty. hollet, (35 oMedicaid-related age atthemselves c 469 and percent) or 18of198 single 24above or .workers. reported 3%7).younger. apparently workers 200 employees options. percent no Only or health earn inthe of 19a
aHowever, Among uninsured (ne seriously consensus ver-unemployed) nonworkers, Al for l(66 consider Uninsured ofthe percent). research Children AFDC howe mandating full-time ver, 100.0% population alsoboth that indicates 38 full-year .9% the(excluding employers rate 10.2% thatworkers andprovide unemployment the the 22.2elderly, % number without health 28.7% of among blind insurance people health teen-agers orcovered insurance disabled benefits in by
a/ Excludes must low-coverage agriculture, accept individuals industries. forestry, fisheries, with Between and preexisting miscellaneous 1982 and health 1985, services employment conditions . in(that industries is, people with
-_oo_ have total Full-year, reduced employment _.o o part-time g__ the $1 shifted 1985 uninsured slightly population -_oom toward " wage byo and 19 percent salary jobs in 1985. in firms Covering _=_ with
E E ° --
"1 Current o3 federal law requires states to provide Medicaid coverage to adults
establish Commission insurance , Volume poolsIII:forNoncompliance the uninsured, with to the be Fairunderwritten Labor Standards by Act all
_ _0o h_io o roooor0 o _ _obbi_ b roooo_o o 2,
higher mortality and ¢I)should fl) rates not inbe general, attributedand higher to the rates Employee of infant BenefitmortaResearch lity in
Louisiana 3,741 72.4% 62.7% 8.1% 4.0% 822 22.0%
Source: EBRI tabulations of the March 1986 Current Population Survey.
Dependents Covered
workers 100.0% 67.8% (as a pe 35.6% rcent of 19.5% all uninsured) 14.9% 32.2% 5
b/ Includes wage and salary workers. Excludes the self-employed.
employers Oklahoma with a health 2,762 insurance 68.2% 59.0% plan 10.3% and 204.4%or more 698employees. 25.3% A version of
(Washington, Institute, its D.C.:officers, U.S. Government trustees, Printing sponsors _ o Office). or other staff.
support that Familyargument Type is not generally available.
aMedicaid dependents. /0.. Number _ had too "_ _small covered "-" to bethese _-" statistically two populations reliable. in 1985 t-- o(an O I'-- additional cO (.0 I'-- (.0 beneficiary
and largest localamong subsidies low-skilled to the workers. pool, Industry-specific and (2) defining research a minimum on unemployment package of
Medicaid complexity coverage group less insurance than insurance program. rate the of of afederal among any workable plans In type, small-firm minimum such that planincluding states, are has wage, employees now madeuninsurable this marketed--raising Medicaid. formulation mayisbeprobably apeople Inof conservative fourteen federal that the also subsidy are policy lower states estimate categorically difficult. than needed and ofthat the the to
percent po nonworking marketplace employer people verty. Public Despite of lived plans Of policy spouse the the the increasingly in uninsured have newly toward initiation single-adult or declined. child insured, employer were concerned ofofnonworking aor In 13worker. plans atpercent 1982, single-parent with least isemployer adults--that Public generally would pay one have equity. policy families. state-wide plans formulated obt is,aco makers ined vpeople ered Nevertheless, One insurance their view as more quarter over either employer coverage than ageplan the (25 an 18 47
populations response below-average co toverage, workersto69aand who percent higher /or rates qualify their minimum earned of dependents. for employer less wageMedicaid, than is reduced coverage $I0,000; The asimplications because well and (retail 92 assome percent other of trade, ofsuch them earned nonelderly ase stop rmandate vices less looking than SSI and for
Z The that Emerging are _>m uninsurable); Uninsured Population after that date, the plan administrator may exclude new
all fewerpeople than andin 1,000 -- Work poverty Status workers; wouldmore havethan reduced half o_, noncoverage of these -c: @--_ (27 0 bypercent more than of all 42 percent. workers)
More than 0 hours Texas 100.0% 14,056 70.3% 70.2% 63.9% 9.2% 41.3% 5.1% 3,2664.4% 23.2% 24.5% 29.8%
Sometime & unemployed
particular in thisfamilies proposal (Grossman thatwasqualify incorporated and Goldman, for AFDCin 1981). benefits--typically the House-passed version single mothers, of the Omnibus and to
_- (_
Total Un r- iC_ nsured 100.0% 33.1% 34.5% 32.4%
workers 100.0% 69.4% 50.5% 27.0% 23.5% 30.6%
18 hours or more 3- 0 100.0% 65.9% 37.3% 4.5% 24.0% 34.1%
Budget Reconciliation Act of 1986 (OBRA); this bill would have required all
induce widespread - participation. _ _6_6WWW
Mountain 10,889 74.7% 65.3% 9.6% 3.8% 2,114 19.4%
population benefits effects suggests Spouse that of Present 6.would 7 that million be employment 100.0% less people), comprehensi 30.5% in the retail v 10.2% total e trade and Medicaid 23.7% may therefore be population particularly 33.9% less costly would sensitive have than
or employment among (Washington) financially (I) large-firm dependents losses designed ineligible employees. of likely employees to encourage for to result Medicaid In covered 1985, individual from by benefits 15anmandating percent employer purchase may have of health plan; all ofno heworkers insurance insurance alth insurance, (and option as 20 an
recipients), for incentive personal District plans, who from percent) jobs. In EncourasinK neither employer therefore, fact, earnings of or of The worked Medicaid Columbia, aplans. the substantial unemployment mandate. Individuals of nor as uninsured atan looked spending 20least opportunity Since percent cost effect for lived some tomay averaged work employer might Buy or employer-covered in be to during more Health single-parent be bring associated $600 contributions greater of1985. most the per Insurance. nonelderly among workers of with beneficiary. families--that the tosome adults uninsured with health Relatively population state-mandated with an For insurance uninsured similar into is,AFDC was few an in
$20,000. million employment, Options The nonworkers, anticipated About for however, one expanding third including cost are of of an Medicaid all health 36 important full-year million eligibility insurance consideration, children. workerscoverage among earning In 1985, the since forlesspoor employers employer most than and $I0,000 workers plans the (and
construction) applicants thatgrewareby uninsurable, 17 percent, _- compared based on _0 to _ the _ 4 _ _percent 0plan's 1 _- employment cost experience growth for in
Although were employed allowing in firms the near-poor of fewer than population 25 workers to buy (seeinto TableMedicaid 3). Themight potential have
I_ O'_ O_ O_ O_ ""4 6a 0_ "-,I 00 "-4 (.O
Medica employers id C _ _ oMo Options: ntana with 20 or more 668 employees 74.2% 62.1%"5to_11.5% underwrite 70 h_ "- ,_- ,,a __- "_state-level 0123 18.4% health insurance
35 hours or allmore financially 100.0% eligible _ _oo_ pregnant 53.6% women. - 27.6% States _ = may 4.8% also extend 21.1% Medicaid 46.4% to
Part-year Family workers Head is: 100.0% 68.9% 30.1% 17.5% 12.6% 31.1%
*Deborah J. Chollet is a Senior Research Associate of the Employee
_ _ _ 0 _c DO _ __ _ I_O_ PO __0 _ _t__ $_ _ _ _ DO DO _0 i_O _ E
0 _ Idaho 800 74.2% 64.2%_= aC __ a _ ..0 .c169 21.2%
Full-year worker 100.0% 26.9% 11.5% 25.0% 36.5%
Cover ._> ---All _0 Children
pools, Nonworkers regardless of_ whether 100.0% _ they 74.0% offered _ % insurance _E a coverage a to workers. a 26.6%
Source: EBRIIf tabulations employer Benefit of the coverage Research March 1986 had Instit Current been uteextended Population (EBRI). to Survey dependents (U.S EBRI. Department is of covered a ofnon-profit, Commerce, wage and
outside conventional employee ofbeneit. anemployer employer orgroup. individual plans.
increased wages the to uninsured higher Whether success but by aminimum (see stronger pooling of approximately Table suchcompens small attachment a9).plan ation. one-third employer may tobeIn thecompromised groups over 1985, laborits nearly would force. actual by significantly 24 the1985 percent low level. incomes of lower all Differences ofuninsured average most of
near-poor were nonelderly covered families Despite (2) uninsured all 44might with million Americans these employees children (see include: difficulties, Table nonworkers, purchase orbutI0). some no spouse indi subset and howevvidual er, fewer --present of public than employees health (see 0 ...0 35policy "--Table million insurance. oO(for to7).children. expand example, While In coverage 1985, nearly full-time The fewer rate half by
percent children, spouse benefits. Combining established Wyomor ingofPri Medicaid child In covered system vateMaryland, suggest and ofworkers) spending Public private 419 that for 77.6%Strategies had example, health the averaged 69.likely 0% employer-based insurance state-mandated $453; amount a coverage. for a ofheaan lth adults employee ainsurance insurance in a contribution families benefits only as with were to a
coverage (industries without workers) enrollees DO coverage are is with Part with -ythe earalready preexisting higher wosingle rkeearn r coverage 100.0% tax-exempt greatest lowhealth wages 33.3% rates. obstacle conditions. both and tomay to a the defining be 33.3% employer particularly publicand a policy the vulnerable that employee, would to
acceleration of this trend toward greater employment in small firms over the
reduced _ The the number uninsured of people population reporting by an no additional 0 health 30 insur percent, ance coverage a median subsidy of any
(D
Commerce, parents non-partisan in Bureau intact of the families Census). public policy that may research not qualify organization. for AFDC benefits if they
in Pover Furthermore, Col ty orado the health 2,795 77care .2% 12.3%that 68.1% people 7.1%- without 3.4% 513 insurance - 18.4% may command 1 2.3% but
Nonworker 100.0% 66.7% a a a
employees or employees who are subject to the federal minimum
New Mexico 1,228 64.8% 57.8% 16.2% 6.9% 286 23.3%
Og
Cover Adults in Families
salary workers, the total number of uninsured might have declined by nearly 9
dependent. workers _'- C were employed in retail trade. _
among pooling plan .-- Source: Furthermore, cost states provisions small Employee is in uncertain. employer the deductible Benefi ofpotential the tgroups Research In Fairfact, and mgrowth aLabor y Inst be copayment groupings ituStandards tmore e of tabul their _effective ations provisions ofAct); crespective l_small of -- the than orMarch employers that public Medic 1986 aare idwould Current policy standard populations probably to form in
the of the uninsured total population. population lived It isinlikely two-parent that relati families vely with few children of the uninsured in 1985,
dependent estimated dependents' of than _ employer Part More 12 Bthan percent children, to ofcoverage, coverage raise Table two-thirds of17 the Medicaid among the assumes were combined (69nonelderly nonworkers it percent) spending that offered, average o_0_ employers ofpopulation averaged declined o the might cost_uninsured extended offrom have $860 _ reported group 55 coverage been (see were percent andeither health Table affordable. indi tovin idual all 16). themselves insurance 1982, workers Blue The For to
remaining layoffs. successfully A/izona options Furthermore, expand for 2,658 employer uninsured broadening 73.7% coverage. 62.0% workers tax 9.6%incentives Since are a aconcentrated large relate 570 proportion 21.4%primarily in relatively of uninsured to the few
economic recovery years following 1982 may explain some of the decline in
of type--35 70 percent millionof the people cost in of Medicaid 1985, excluding coverage the for this agricultur population al andmight military have
0 ,_ootLseAbsent 100.0% 49.0% _8.2% 20.4% 22.4%
financially qualify and if the primary family worker (typically the father) is
for which _ they are unable_ to _ pay o imposes _ costs c __ onI,,,providers and on insured
Note: De Wtiail th may Children not add in Pover to totals ty due to rounding. 7.0% 2.6% 4.4%
Utah 1.481 80.8% 74.2% 7.5% a 206 13.9%
Population Survey.
Family Head is:
N _
Nevada 839 73.0% 63.3% 10.6% a 179 21.3%
Cover percent Other Adulls andMalethe in number of 100.0%uninsured 30.0% children o 10.0% o_ might20.0%have declined 30.0% by more than
_ _ _ _
might an retain insurance (3)ha some both ve important qualified been pool from substantial, costs employees which that individuals and are owingtheir muchtowould dependents. lower demographic buy for coverage. single-employer differences Whereasgroups and all of to of
a/Includes The individual could self-employed Last lowafford income year or and toCongress employer that nonworkers buy adequate characterizes considered health and their insurance insurance respective most legislation coverage ofdependents. the plansuninsured th(that atmay would is, be population cover too haveage stringent specifically ofsuggests a wide to
individual but full-time coverage approximately Cross less onlyWorkers The The extended than 35and a--Number growing percent potential from 52 full-year Blue income in percent anoretail too one of Shield number private tax acosts the small dditional workers inquarter uninsured deduction coverage trade, of 1985. toof nonemployer bethe statistically an (that coverage services, uninsured of employer-based by lived foris, more uninsured reliable. insurance individu inworke tothan families and andrdependents, salthe low-wage Ii strategy who plan, children insurance percent substantial ofworked this compared manufacturing for beyond type. inor living purchase further 1984; cost sought tothat66 associated outpatient with expanding and work may percent already the be35 an
potential workers industries. Workersare Medicaid who employed These earn buy-in industries--retail less by premium small than the employers, forfederal a trade, familyminimum discussion of servtwo ices, wage adults hasare andfocused and more construction--are two likely onchildren, ways to be to
populations--has In Nearly addition halfto of steadily authorizing all nonelde grown raly basic since without the healthhealth 1982care economic insurance plan recession. forcoverage its low-income in Between 1985
been employer necessary coverage to induce as a percent substantialof total participation. employment For during a two-adult those years. family of In
2
Full-year worker 100.0% 28.6% 0 E a _ -- X28.6% 42.9%
consumers. unemployed. TheIn estimated 1985, 25pro percent vider burden of allof Medicaid uncompensated recipients health (5.5 care million in the
or') _, ,.... (._
o
m
Poverty 13.0% 3.9% 9.1%
Pacific 29,499 70.3% 62.6% 13.3% 9.1% 5,951 20.2%
Part-year worker 100.0% 100.0% a a a
e._ -i- '_ c • W _ 0_ ._'_-_ ._-_ g,.- 0 _ m 5
2 million. For the purpose of extending dependents' coverage, differences in
comparable size. For example, average employee turnover in small firms is
differences adequately authorized the administrative Washington protect states among states' the to costs 3,565 levy low-income associated levels 75.0% a payroll 65.2% offamilies qualifying with 13.6% tax pooling that on 8.0%income employers makesmall 589 uprelative more employers 16.5% for than the to the one-half purpose wouldfederal also of of
that rangeTable relatively of 13 services Nonwo provides rkerfew with might summary 100.0% cost-sharing purchase demographic a insurance scaled ainformation coverage to income) a ifon they without uninsured a had significant to workers. pay the
particularly therefore, mental weeks with pro employer-covered that privvate ided providing reported orhealth health more, in might vulnerable 1985. benefits health insurance, coverage have and parent worked totaled This insurance alone (or, tofrom however, employer-related 35 reduced $2,626, were rarely, hours ancoverage estimated employer are or or employment a $219 more spouse), considerable. forto per option plan in them raise because month. athe typical (EBRI, suggests would total parent Most ofweek), May have plan th mandatory uninsured earned at 1987). costs provided Congress ormore lived by workers health Among more than may new in
Cover deductibility uninsured the reduce All onation's People the extending than Living cost of "growth" higher-wage ininsurance ofMedicaid coverage industries; purchase workers. cover for age small by newto While self-employed employment employers. all 16children percent inUnlike workers. these under of larger all industries ageworkers 18 groups,has earned, small led
four, uninsured (49 percent) a 70-percent population, were workers; subsidy Washington would about state have one third reduced also authorized (32thepercent) Medicaid a health were premium children care (priced financing age 18 at
1982 1983, and the 1985, rate oftheemployer-based nonelderly nonagricultural health insurance civilian coverage population among workers withoutin
C 0__
._ _ E _ _ _ _
United people) OregoStates Qwere Femaleadults is 5 in 2,2 percent 68100.0% families 77.9% of52.5% _with 7.gross 1% dependent 8.7revenues--about % 7.5% 4.5% children, 20.0% 388 $13 20 17.1% .0% covered billionunderin these 1986
®__ >3""<80 _c:._-_O_
Each of these options would target different numbers of the uninsured.
living in families with income below the federal poverty
100-200% of Poverty _- o -c- 29.8% >-_6 o-- 10.1% _ _,_ m 9.3% 10.4%
California 22,422 68.3% 61.5% 13.7% 9.9% 4,803 21.4%
Full-year worker 100.0% 36.0% 12.0% 24.0% 28.0%
the subsidization. hours-worked definition of qualified employees would have produced little
higher than in large firms, and the expected lifetime of the firm itself is
poverty the insurance occur full uninsured cost. instandard. standard; ancoverage. Ininsurance 1985, population. -one-third Inpool =_.oo_ 1985, An forof24 insurance the individuals, percent nonelderly _ - plan ofdefining uninsured with all uninsured lower a population low-cost cost-sharing workers insurance livedwere by in
In financing nonworker $20,000 families consider are1985, The Alask low-wage a in men amajority headed adults state-level 1985, combining who workers. were by worked (the ofaprivate employed 439insurance In full-time group uninsured full-time 1985, 76.6%and most at75 62.4% public full-year pools. and any children percent likely reported timestrategies a toduring earned This worker. inhave aan1985 type employer less the individual in77 About year (55 order than of17.4% contribution were percent) 17 legislation $I0,000; tocoverage) percent distribute slightly more lived of to might fewer more than his the the in
on than employer average, The _ percent, number coverage less and and to proportion than the9.6 cost themillion offederal ofmajor theworkers. nonelderly medical minimum Sequentially coverage wage population inby 1985, more expanding with than these other27Medicaid workers percent private
pool economic employers for growth may its Part-yearbe uninsurable since worke unable r the 100.0%1981-1982 topopulation obtain 80.0% recession. any indiscount aApril 1987. on a a community-rated This a plan is health to be
Total, the health or smaller Allyounger. marginal Medicaid insurance establishments Options cost Threefor ofo,, ofMedicaid's any 5 was every type less 62 o .five 2%th 5 incre AFDC ano people ased one-h population) a 16.6% lf with by 4.5 the health torate million 5 percent insurance reported 22.9% people, ofamong coverage gross ne 22.7% arly workers family (86 15
o ,,(5 o _ _ ,,(_ ,_
current-law provisions. The second option listed above would make such
Hawa_ --- o 805 _5_ooo 80.6% 70.7% 13.8% o a 95 11.8%
Nonworker I.-- 100.0% 90.0%Z a I-- a Z a
Assuming some level of employer contribution, each would also imply different
I---- _. Z cO '_ ._"- b
Net Uninsured 37.8% 16.5% 11.6% olo 9.7%
EMPLOYEE BENEFIT RESEARCH INSTITUTE
,,,_ _=o_ ,,,_.o= o o- o
Source: Employee Benefit Research Institute tabula_ons of the Ma/ch 1986 Current
Source- Employee Benefit Research Institute tabuiations ol the March 1986 Current Population Survey.
2121 K Street, NW / Suite 600 / Washington, DC 20037.2121
Source: EBRI tabulations Population of the Survey March . 1986 Current Population Survey.
a--Number too small to be statistic Telephone ally reliable202-659 . -0670 FAX 202-775.6312
a--Number too small to be statistically reliable.
