Map of life expectancy at birth from Global Education Project.

Tuesday, November 28, 2006

Spinning our wheels

The latest information on health insurance coverage for the U.S. population has recently been released by the CDC. (PDF, but not large.) These estimates are based on the National Health Interview Survey, an ongoing series which yields nationally representative data. (The methodology is similar to that used for the Johns Hopkins study of civilian casualties in Iraq, so according to the U.S. government, obviously you shouldn't believe it.)

Anyhow, the results are about what I would have expected. In order to make sense of it, though, you have to break the results out by age group. Remember, first of all, that nearly everyone 65 and older has insurance thanks to Medicare. It isn't comprehensive insurance, but it is far better than nothing. So changes over time in the percentage of the population who are insured are partly affected by the increasing proportion who are over 65. That's going to automatically tend to drive the percentage who are uninsured down.

First, the snapshot. In January-March of this year, the estimate is that 14.5% of the total population was uninsured at the time of the interview. (That's 42.4 million people.) 18.2% had been uninsured for at least part of the previous year, and 10.1% had been uninsured for all of a year or more. Those numbers have fluctuated only slightly over the past decade. They were actually a tiny bit higher in 1997, then they came down a bit and hit a low point in 2005 -- 14.2% uninsured at the time of the interview, and 17.6% uninsured for part of the past year. Now they appear to have bumped up, but one quarter does not a trend make.

However, this apparent stability masks a lot of change. One of the most important trends is that the percentage of children under 18 who lacked insurance fell steadily from 1997 through 1995, due to the Supplemental Childrens Health Insurance Program (SCHIP), an enhancement to the Medicaid program that enabled families who were "near poor" or medically indigent (i.e., having large medical bills) to buy into the Medicaid program for their children at subsidized rates. In fact, the percentage of near poor children with public insurance coverage increased dramatically, from about 24.3% to more than 52.7%, from 1997 to the present; while the percentage with private insurance fell, from about 55% to 33.9%. Unfortunately, in the first quarter of this year, the expansion of the SCHIP population no longer kept up with the loss of private insurance, the the percentage of near poor children who were uninsured bumped up for the first time in 10 years.

The working age population (age 18-64) has also been losing private coverage since 2001, when 73.7% had it. In the first quarter of 2006, 69.8% had private insurance at the time of the interview. The percentage with public insurance has gone up a bit in that period, from 9.4% to 12.2%, but as you can see, that's not enough to make up the difference.

So, over the past decade, the expansion of SCHIP has enabledthe proportion of near poor children without insurance to decrease slightly in spite of rapid loss of private benefits; while the proportion of working age people without insurance has increased, in spite of more people obtaining public benefits. The overall proportion of the population which is uninsured has fluctuated without much of a trend, thanks to SCHIP and the growing numbers of people turning 65, in spite of the erosion of private benefits. It's too early say, but 2006 may be a turning point, where the uninsured population begins to expand significantly. Most informed observers believe it is indeed happening, as employers continue to eliminate health insurance benefits or require greater contributions from workers and states cut back on Medicaid eligibility.

The bottom line? We've been going nowhere, and now we're starting to slip backwards. Of course, we have more important priorities, like establishing a Shiite theocracy in Iraq at the cost of hundreds of thousands of lives. That noble cause is worth far more than insuring that our own people have health care -- even though we could do it for a small fraction of the cost.

No comments: