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Increasing Health Insurance Costs and the Decline in Health Insurance Coverage

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  • Chernew, Michael
  • Cutler, David
  • Keenan, Patricia S.
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    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.

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    Bibliographic Info

    Paper provided by Harvard University Department of Economics in its series Scholarly Articles with number 2660660.

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    Date of creation: 2005
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    Publication status: Published in Health Services Research
    Handle: RePEc:hrv:faseco:2660660

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    1. Farber, Henry S. & Levy, Helen, 2000. "Recent trends in employer-sponsored health insurance coverage: are bad jobs getting worse?," Journal of Health Economics, Elsevier, vol. 19(1), pages 93-119, January.
    2. Janet Currie & Aaron Yelowitz, 1999. "Health Insurance and Less Skilled Workers," NBER Working Papers 7291, National Bureau of Economic Research, Inc.
    3. Sherry Glied & Kathrine Jack, 2003. "Macroeconomic Conditions, Health Care Costs, and the Distribution of Health Insurance," NBER Working Papers 10029, National Bureau of Economic Research, Inc.
    4. Nyman, John A., 1999. "The value of health insurance: the access motive," Journal of Health Economics, Elsevier, vol. 18(2), pages 141-152, April.
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    Cited by:
    1. Fairlie, Robert W. & Kapur, Kanika & Gates, Susan, 2010. "Is Employer-Based Health Insurance a Barrier to Entrepreneurship?," IZA Discussion Papers 5203, Institute for the Study of Labor (IZA).
    2. Cutler, David M., 2010. "Where Are the Health Care Entrepreneurs? The Failure of Organizational Innovation in Health Care," Scholarly Articles 5345877, Harvard University Department of Economics.
    3. van der Star, Sanne M. & van den Berg, Bernard, 2011. "Individual responsibility and health-risk behaviour: A contingent valuation study from the ex ante societal perspective," Health Policy, Elsevier, vol. 101(3), pages 300-311, August.

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