The current decline in private insurance coverage has been offset by an “enormous increase” in public coverage over the past 2 decades–an expansion that might be at an end, according to a report.
“Serious problems could lie ahead if employer-based coverage continues to decline while the availability of public coverage remains the same or is reduced,” said David M. Cutler, Ph.D., and Alexander M. Gelber, Ph.D.
Both Dr. Cutler and Dr. Gelber are affiliated with Harvard University, Boston, and the National Bureau of Economic Research. The investigators said they examined trends in insurance coverage because the net change in coverage over time has been uncertain. It is thought that Americans have been increasingly uninsured for longer periods, but “on the other hand, eligibility for public insurance has been expanded,” the authors noted.
Dr. Cutler and Dr. Gelber compared data from the U.S. Census Bureau's Survey of Income and Program Participation for the years 1983-1986 and 2001-2004.
This survey includes information on many socioeconomic variables for a random sample of 25,946 people in the first study period and 40,282 people in the second (N. Engl. J. Med. 2009;360:1740-8).
“The overall economy was better in 2001-2004 than in 1983-1986, but in each case it was in recovery from a recession,” they said.
The analysis showed that more Americans were likely to experience a period of uninsurance in the second study period (37%) than in the first (35%), in large part because more people lost private insurance.
However, intervals of uninsurance were shorter in the second study period than in the first.
For example, the percentage of people who were uninsured for 2 years or longer was lower in the second study period (20%) than it was 20 years ago (26%), the researchers said
Over the course of the study, the proportion of uninsured periods that ended when people obtained private insurance decreased by 6%, while the proportion that ended when people obtained public insurance increased by 12%, the report found.