Commentary

What do the new figures on health insurance coverage imply for access to health care in this country?

Linda Blumberg, Cynthia Perry

Health insurance shields families from financial risk associated with health care expenses and improves access to timely health care—protections that are especially important for low-income families, whose incidence of health problems is higher than average.

Children living in families below the poverty line are eligible for public health insurance through Medicaid or SCHIP. But most states provide no public insurance coverage to poor adults without children, and more than half of all states limit eligibility for parents to levels less than the poverty line. In short, many poor adults do not qualify for Medicaid coverage. For families with incomes below the poverty line, premiums for health insurance purchased through an employer or the nongroup market, when available, can be prohibitively expensive, and premium prices are rising.

Although the percentage of Americans without insurance fell slightly from 2006 to 2007, the share getting private insurance coverage fell, and the share getting public insurance rose. Without the limited safety net of the current Medicaid/SCHIP programs, the rate of uninsurance would likely have been higher, particularly for low-income adults. In all, 45.7 million people still have no insurance. Thirty percent of the uninsured live in households with incomes less than $25,000.

Comprehensive health care reform based on five key components would better support the nation’s families:

• State-based purchasing pools to provide a guaranteed source for purchasing health insurance;
• Income-related subsidies for premiums and out-of-pocket costs;
• Premium subsidies to offset the excess risk plans face in the purchasing pool because those who enroll might have more health problems than the population as a whole;
• A requirement that all individuals enroll in health insurance coverage of some type (public or private), a so-called individual mandate; and
• Strategies to slow the rate of increase in health care spending and to provide care in a more efficiently.

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Read the authors' complete report Making Work Pay II: Comprehensive Health Insurance for Low-Income Working Families