Wealth, income, and the affordability of health insurance

Health Affairs

Volumn 28, Issue 3, 2009, Pages 887-896

  Bernard, Didem M ^a,b   Banthin, Jessica S ^a,b   Encinosa, William E ^a,c  

^a AGENCY FOR HEALTHCARE RESEARCH AND QUALITY   (United States)

^b Center for Financing Access and Cost Trends   (United States)

^c Center for Delivery Organization and Markets   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; COMPARATIVE STUDY; HEALTH CARE; HEALTH CARE COST; HEALTH INSURANCE; HEALTH SERVICE; INCOME; PRIVATE HEALTH INSURANCE; PUBLIC HEALTH INSURANCE;

ADULT; COST SHARING; FEMALE; FINANCING, PERSONAL; HEALTH BENEFIT PLANS, EMPLOYEE; HEALTH CARE REFORM; HEALTH POLICY; HUMANS; INCOME; INSURANCE COVERAGE; INSURANCE, HEALTH; MALE; MEDICALLY UNINSURED; MIDDLE AGED; MULTIVARIATE ANALYSIS; SOCIOECONOMIC FACTORS; UNITED STATES; YOUNG ADULT;

EID: 66749175829     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.28.3.887     Document Type: Article

References (32)

1. Estimates of the uninsured population are for the first half of the year. See M.C. Chu and J.A. Rhoades, "The Uninsured in America, 1996-2007: Estimates for the U.S. Civilian Noninstitutionalized Population under Age Sixty-five," Statistical Brief no. 214, July 2008, http://www.meps.ahrq. gov/mepsweb/data-files/publications/st214/stat214.pdf (accessed 8 December 2008)
2. Authors' calculations based on MEPS data. Nonelderly adults are ages 21-64.
3. J.S. Banthin, P. Cunningham, and D.M. Bernard, "Financial Burden of Health Care, 2001-2004," Health Affairs 27, no. 1 (2008): 188-195;
4. J.S. Banthin and D.M. Bernard, "Changes in Financial Burdens for Health Care: National Estimates for the Population Younger than Sixty-five Years, 1996 to 2003," Journal of the American Medical Association 296, no. 22 (2006): 2712-2719;
5. and L.J. Blumberg et al., "Setting a Standard of Affordability for Health Insurance Coverage," Health Affairs 26 (2007): w463-w473 (published online 4 June 2007; 10.1377/hlthaff.26.w463).
6. M.K. Bundorf and MV Pauly, "Is Health Insurance Affordable for the Uninsured?" Journal of Health Economics 25, no. 4 (2006): 650-673. (Pubitemid 43994194)
7. R.W Seifert and M. Rukavina, "Bankruptcy Is the Tip of a Medical-Debt Iceberg," Health Affairs 25 (2006): w89-w92 (published online 28 February 2006; 10.1377/hlthaff.25.w89).
8. S.T. Parente and R. Feldman, "Do HSA Choices Interact with Retirement Savings Decisions? Tax Policy and the Economy?" in Tax Policy and the Economy, vol.22, ed. J.M. Poterba (Chicago: University of Chicago Press, 2008), 81-108.
9. P.D.Jacobs and G. Claxton, "Comparing the Assets of Uninsured Households to Cost Sharing under High-Deductible Health Plans," Health Affairs 27, no. 3 (2008): w214-w221 (published online 15 April 2008; 10.1377/hltaff.273.w214).
10. We are aware of one prior study examining this relationship: M. Starr-McCluer, "Health Insurance and Precautionary Savings," American Economic Review 86, no. 1 (1996): 285-295. (Pubitemid 126420176)
11. In MEPS, each panel of households is interviewed five times over two and a half years to collect data reflecting a two-year reference period. The asset section of the instrument is administered in Round 5.
12. For further details, see Exhibits 1-5 in the Technical Appendix, available online at http://content.healthaffairs.org/cgi/content/full/28/3/887/ DC1.
13. At this time, 2003 is the most recent year for which edited asset data are available.
14. End-of-year insurance status is used to be consistent with asset data, which are collected at year's end.
15. Alternatively, we assigned private insurance to families only if everyone in the family had private insurance. All results are robust to this alternative definition.
16. Age, sex, race and ethnicity, marital status, education, and risk-preference measures and occupation are from the family head - the oldest nonelderly adult (age 21-64). The indicator for self-reported physical or mental health (fair, poor, good, very good, excellent) is from the person with the worst health in the family. The chronic condition indicator captures whether anyone in the family has a chronic condition.
17. Our results are robust to including those with public insurance in the models in which the dependent variable is a (0,1) indicator set, to 1 for the privately insured.
18. The logistic regression results are presented in Appendix Exhibit 11, online as in Note 10. Predicted enrollment rates are mean predictions for the subpopulations.
19. Poor (low income) is family income below 100 (100-199) percent of the federal poverty level. See Appen- dix Exhibit 6, online as in Note 10.
20. Families with public insurance were excluded. Those with public insurance tend to have lower asset holdings than the privately insured and the uninsured. Income quartiles were constructed based on the sample of uninsured families and those with private insurance.
21. The median is the preferred measure of central tendency because the distribution of wealth has a positive skew, with relatively few households holding a large proportion of the wealth. The median is less sensitive then the average (mean) to extreme observations, providing a more accurate representation of the wealth and asset holdings of the typical household.
22. See Appendix Exhibits 7-9, online as in Note 10.
23. See Appendix Exhibit 10, online as in Note 10.
24. Six million is the number of nonelderly adults ages 18-64 who held individual policies as of the end of the year (point-in-time estimate) in 2005. The number of people younger than age sixty-five with individual coverage anytime during the year for 2005 was 12.1 million.
25. America's Health Insurance Plans, Individual Health Insurance 2006-2007: A Comprehensive Survey of Premiums, Availability, and Benefits, December 2007, http://www.ahipresearch.org/pdfs/Individual-Market-Survey-December-2007.pdf (accessed 15 December 2008)
26. A.C. Monheit et al., "Community Rating and Sustainable Individual Health Insurance Markets in New Jersey," Health Affairs 23, no. 4 (2004): 167-175. (Pubitemid 38952396)
27. Authors' calculations based on premiums reported in MEPS-HC
28. Banthin et al., "Financial Burden";
29. and Banthin and Bernard, "Changes in Financial Burdens."
30. J. Gruber and A. Yelowitz, "Public Health Insurance and Private Savings," Journal of Political Economy 107, no. 6 (1999): 1249-1274;
31. and V.K. Smith, E. Ellis, and C. Chang, "Eliminating the Medicaid Asset Test for Families: A Review of State Experiences" (Washington: Kaiser Commission on Medicaid and the Uninsured, 2001).
32. S. Dorn, "Health Coverage Tax Credits: A Small Program Offering Large Policy Lessons," February 2008, http://www.urban.org/UploadedPDF/ 411608-health-coverage-tax.pdf (accessed 16 March 2009).