Increasing health insurance costs and the decline in insurance coverage

Abstract

Objective: To determine the impact of rising health insurance premiums on coverage rates.

Data sources & study setting: Our analysis is based on two cohorts of nonelderly Americans residing in 64 large metropolitan statistical areas (MSAs) surveyed in the Current Population Survey in 1989-1991 and 1998-2000. Measures of premiums are based on data from the Health Insurance Association of America and the Kaiser Family Foundation/Health Research and Educational Trust Survey of Employer-Sponsored Health Benefits.

Study design: Probit regression and instrumental variable techniques are used to estimate the association between rising local health insurance costs and the falling propensity for individuals to have any health insurance coverage, controlling for a rich array of economic, demographic, and policy covariates.

Principal findings: More than half of the decline in coverage rates experienced over the 1990s is attributable to the increase in health insurance premiums (2.0 percentage points of the 3.1 percentage point decline). Medicaid expansions led to a 1 percentage point increase in coverage. Changes in economic and demographic factors had little net effect. The number of people uninsured could increase by 1.9-6.3 million in the decade ending 2010 if real, per capita medical costs increase at a rate of 1-3 percentage points, holding all else constant.

Conclusions: Initiatives aimed at reducing the number of uninsured must confront the growing pressure on coverage rates generated by rising costs.

Figure 1

Change in Coverage and Change in Premiums. Circles Represent 64 MSAs, weighted by the Number of CPS Observations in each MSA. Private Premium Data are from the KPMG Survey of Employer-Sponsored Health Benefits (1988; ; and the Kaiser Family Foundation/Health Research and Educational Trust Survey of Employer-Sponsored Health Benefits (1999)

Figure 2

Actual and Projected Increase in Uninsured Due to Premium Growth, 1999–2010. Estimates Based on Analysis Relating Changes in Market-Level Premiums to Coverage Rates for Total Nonelderly Population in 64 MSAs, Controlling for Individual, Market, and Policy Variables. All Other Variables are Held Constant. See Methods Section for Details on Projections.