The 'graying' of group health insurance

Health Affairs

Volumn 25, Issue 6, 2006, Pages 1497-1506

  Keenan, Patricia Seliger ^a   Cutler, David M ^b   Chernew, Michael ^c  

^a YALE UNIVERSITY SCHOOL OF MEDICINE   (United States)

^b HARVARD UNIVERSITY   (United States)

^c HARVARD MEDICAL SCHOOL   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ADOLESCENT; ADULT; AGE DISTRIBUTION; AGED; EPIDEMIOLOGY; FAMILY SIZE; FEE; FORECASTING; HEALTH INSURANCE; HUMAN; INCOME; INSURANCE; MIDDLE AGED; POPULATION DYNAMICS; REVIEW; STATISTICS; UNITED STATES;

ADOLESCENT; ADULT; AGE DISTRIBUTION; AGED; FAMILY CHARACTERISTICS; FEES AND CHARGES; FORECASTING; HEALTH BENEFIT PLANS, EMPLOYEE; HEALTH CARE SURVEYS; HUMANS; INCOME; INSURANCE POOLS; INSURANCE, HEALTH; MIDDLE AGED; POPULATION DYNAMICS; UNITED STATES;

EID: 33845298595     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.25.6.1497     Document Type: Review

References (38)

1. See, for example, P.F. Cooper and B.S. Schone, "More Offers, Fewer Takers for Employment-based Health Insurance: 1987 and 1996," Health Affairs 16, no. 6 (1997): 142-149;
2. H. Farber and H. Levy, "Recent Trends in Employer-sponsored Health Insurance: Are Bad Jobs Getting Worse?" Journal of Health Economics 19, no. 1 (2000): 93-119;
3. S. Glied and M. Stabile, "Explaining the Decline in Health Insurance Coverage among Young Men," Inquiry 37, no. 3 (2000): 295-303;
4. and R. Kronick and T. Gilmer, "Explaining the Decline in Health Insurance Coverage, 1979-1995," Health Affairs 18, no. 2 (1999): 30-47.
5. J. Holahan and A. Cook, "Changes in Economic Conditions and Health Insurance Coverage, 2000-2004," Health Affairs 24 (2005): w498-w508 (published online 1 November 2005; 10.1377/hlthaff.w5.498).
6. K. Swartz, "Changes in the 1995 Current Population Survey and Estimates of Health Insurance Coverage," Inquiry 34, no. 1 (1997): 70-79;
7. and C.T. Nelson and R.J. Mills, "The March CPS Health Insurance Verification Question and Its Effect on Estimates of the Uninsured," August 2001, http://www.census.gov/hhes/www/hlthins/verif.html (accessed 27 April 2006). Changes in 1995 particularly affected reports of group coverage for dependents. The verification question in 2000 particularly increased employment-based coverage for people with higher incomes.
8. See, for example, Cooper and Schone, "More Offers, Fewer Takers";
9. Farber and Levy, "Recent Trends";
10. Glied and Stabile, "Explaining the Decline";
11. and Kronick and Gilmer, "Explaining the Decline."
12. These changes are discussed in Note 3.
13. J. Holahan and M. Wang, "Changes in Health Insurance Coverage during the Economic Downturn: 2000-2002," Health Affairs 23 (2004): w31-w42 (published online 28 January 2004; 10.1377/hlthaff.w4.31);
14. Holahan and Cook, "Changes in Economic Conditions";
15. and J.D. Reschovsky, B.C. Strunk, and P. Ginsburg, "Why Employer-sponsored Insurance Coverage Changed, 1997-2003," Health Affairs 25, no. 3 (2006): 774-782.
16. Cooper and Schone, "More Offers, Fewer Takers";
17. Farber and Levy, "Recent Trends";
18. Kronick and Gilmer, "Explaining the Decline";
19. Reschovsky et al., "Why Employer-sponsored Insurance Coverage Changed";
20. P. Fronstin and S.C. Snider, "An Examination of the Decline in Employment-based Health Insurance between 1988 and 1993," Inquiry 33, no. 4 (1996/1997): 317-325;
21. and S.H. Long and J. Rodgers, "Do Shifts toward Service Industries, Part-Time Work, and Self-Employment Explain the Rising Uninsured Rate?" Inquiry 32, no. 1 (1995): 111-116. Regarding public coverage expansions specifically, while studies have identified a range of estimates of crowding out from Medicaid and SCHIP expansions, none have concluded that public coverage expansions were a major factor in private coverage declines.
22. See D.M. Cutler and J. Gruber, "Does Public Insurance Crowd Out Private Insurance?" Quarterly Journal of Economics 111, no. 2 (1996): 391-430;
23. J.C. Ham and L. Shore-Sheppard, "The Effect of Medicaid Expansions for Low-Income Children on Medicaid Participation and Private Insurance Coverage: Evidence from the SIPP," Journal of Public Economics 89, no. 1 (2005): 57-83;
24. A.T. Lo Sasso and T.C. Buchmueller, "The Effect of the State Children's Health Insurance Program on Health Insurance Coverage," Journal of Health Economics 23, no. 5 (2004): 1059-1082;
25. and J.L. Hudson, T.M. Selden, and J.S. Banthin, "The Impact of SCHIP on Insurance Coverage of Children," Inquiry 42, no. 3 (2005): 232-254.
26. M. Chernew, D.M. Cutler, and P.S. Keenan, "Increasing Health Insurance Costs and the Decline in Insurance Coverage," Health Services Research 40, no. 4 (2005): 1021-1039;
27. and M. Chernew, D. Cutler, and P.S. Keenan, "Charity Care, Risk Pooling, and the Decline in Private Health Insurance," American Economic Review 95, no. 2 (2005): 209-213.
28. S. Glied and K. Jack, "Macroeconomic Conditions, Health Care Costs, and the Distribution of Health Insurance Coverage," NBER Working Paper no. 10029 (Cambridge, Mass.: National Bureau of Economic Research, October 2003).
29. Kronick and Gilmer, "Explaining the Decline";
30. and T. Gilmer and R. Kronick, "It's The Premiums, Stupid: Projections of the Uninsured through 2013," Health Affairs 24 (2005): w143-w151 (published online 5 April 2005; 10.1377/hlthaff.w5.143).
31. See Chernew et al., "Increasing Health Insurance Costs," for additional discussion of the data and the analytic approach.
32. Complete details and results of the regression analysis are available on request from the authors. Send email requests to Patricia Keenan, patricia.keenan@yale.edu.
33. See, for example, Gilmer and Kronick, "It's the Premiums, Stupid";
34. and Chernew et al., "Increasing Health Insurance Costs."
35. U.S. Census Bureau, 2004, "U.S. Interim Projections by Age, Sex, Race, and Hispanic Origin," 18 March 2004, calculated from detail file available at http://www.census.gov/ipc/www/usinterimproj/usproj2000-2050.xls (accessed 15 May 2006).
36. Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey Household Component Data, generated using MEPSnet/HC, http://www.meps.ahrq.gov/mepsnet/HC/MEPSnetHC.asp (accessed 6 May 2006). Mean total health care expenditures were calculated for people with private coverage, by age categories.
37. On medical technology and costs, see J.P. Newhouse, "An Iconoclastic View of Health Cost Containment," Health Affairs 12 Supp. (1993): 152-171.
38. On rising premiums, see J. Gabel et al., "Health Benefits in 2005: Premium Increases Slow Down, Coverage Continues to Erode," Health Affairs 24, no. 5 (2005): 1273-1280.