The Center's work on 'Health Policy' Issues

The Center works to ensure that federal and state health insurance programs provide coverage that meets the health care needs of low-income children and families, as well as seniors and people with disabilities. The Center also works to remove barriers preventing eligible families from gaining access to health coverage.


5 Takeaways From Last Week’s Figures on Poverty, Inequality, and Health Coverage

September 25, 2014 at 12:32 pm

Here are five key findings from our analyses (here and here) and blog posts on the new figures from the Census Bureau and Centers for Disease Control and Prevention (CDC).

  1. While poverty and median income improved last year for families with children,poverty rates reached record highs for childless families and individuals.  The poverty rate for individuals not living in families (people living alone or only with non-relatives) rose to 23.3 percent in 2013, the highest in over 30 years.  The poverty rate for childless families (childless couples, older couples or other families whose children have moved away or turned 18, and other relatives who live together), while much lower at 6.2 percent, was also the highest in over three decades.
  1. Income inequality remained historically high.  The share of the nation’s income going to the bottom fifth of households remained at 3.2 percent, tied for the lowest level on record with data back to 1967.  The ratio of the median income of the top fifth of households to that of the bottom fifth topped 12 to 1 for the first time on record, with data back to 1967.
  1. Austerity policies limited progress on jobs, income, and poverty.  Instead of responding to continued weak job growth by creating jobs (such as by expanding infrastructure investments), policymakers adopted various austerity policies that constrained consumer spending and employment growth.  Sequestration budget cuts, for example, lowered appropriations for most discretionary programs by 5 to 8 percent in 2013.  Policymakers also allowed a payroll tax holiday to expire after December 2012 and allowed tax cuts for very high-income individuals to expire (though the latter mattered less for consumer demand since high-income people’s spending is less sensitive to tax changes).  The Congressional Budget Office projected in early 2013 that these measures would reduce economic growth over the year by about 1½ percentage points and lower employment by more than 1 million jobs.
  1. The uninsured rate fell slightly last year and is falling further in 2014, as health reform’s major coverage expansions take effect.  The share of Americans without health coverage fell from 14.8 percent to 14.5 percent in 2013, according to Census’ American Community Survey.  And preliminary data from CDC — the first government survey data that reflect the early impact of the coverage expansions (the Medicaid expansion and subsidized marketplace coverage) — show that the number of uninsured fell by 3.8 million in the first quarter of 2014.
  1. The coverage gap between states that have expanded Medicaid and states that haven’t is widening.  In 2013,before the expansion took effect, some 14.1 percent of the people in the 27 expansion states (including Washington, D.C.) were uninsured, compared to 17.3 percent in the 24 non-expansion states.  Figures for the first part of 2014 show the gap is widening.  For example, CDC data show that 15.7 percent of non-elderly adults in expansion states were uninsured in the first quarter of 2014, compared to 21.5 percent for non-expansion states (see graph).

Census Data Show Improved Health Coverage in 2013

September 22, 2014 at 4:36 pm

We’ve posted our full analysis of the Census Bureau’s new data on health coverage, which show that the share and number of Americans with health insurance improved slightly last year.  (Because the results are for 2013, they don’t reflect the coverage gains in 2014 resulting from health reform’s major coverage provisions, which took effect on January 1 — namely, the Medicaid expansion and subsidized marketplace coverage.)

Census published data from both its Current Population Survey (CPS) and American Community Survey (ACS).  Although the CPS is the most widely used source of health coverage information, changes in its health coverage questions in 2013 — the result of a multi-year Census initiative to improve the reliability and accuracy of the survey’s health coverage estimates — mean the 2013 results can’t be compared to those for prior years.  Thus, for comparisons with earlier years, the ACS is the preferred data source this year.

The Census figures from the ACS show:

  • The share of Americans without health coverage fell slightly, from 14.8 percent in 2012 to 14.5 percent in 2013 (see chart).  The number of uninsured Americans also declined slightly, from 45.6 million in 2012 to 45.2 million in 2013.
  • The share of the population with private coverage remained stable at 65.0 percent in 2013 for the third consecutive year, while the share of the population with Medicaid or CHIP (Children’s Health Insurance Program) remained stable at 15.3 percent.
  • The share of the population enrolled in Medicare rose again in 2013 as another cohort of baby boomers aged into eligibility.
  • Some 14.1 percent of those living in states that have expanded Medicaid were uninsured in 2013, compared with 17.3 percent of residents of non-expansion states.  These results pre-date, and hence do not reflect, the coverage gains due to the Medicaid expansion.  This means that the coverage gap between expansion and non-expansion states will widen further in 2014.

 

Click here to read the full paper.

Coverage Gap Widening Between Medicaid Expansion States and Others

September 18, 2014 at 11:53 am

People in states that have adopted health reform’s Medicaid expansion had a lower uninsured rate in 2013 (before the expansion took effect) than people in non-expansion states — and non-expansion states are falling further behind in 2014, several recent government and independent surveys reveal.

Some 14.1 percent of the people in the 27 states (including Washington, D.C.) that have expanded Medicaid lacked health insurance in 2013, compared to 17.3 percent in the 24 non-expansion states, according to the Census Bureau’s American Community Survey (see chart).

Next year’s Census data, which will reflect the substantial coverage gains expected in expansion states in 2014 due to the expansion (which took effect January 1), should show a further widening of this coverage gap.

Results from several independent surveys — and this week from the Centers for Disease Control and Prevention (CDC), the first government survey data showing health reform’s early impacts — show that this is already happening.  For example, the Urban Institute’s Health Reform Monitoring Survey found that the uninsured rate for non-elderly adults in expansion states fell from 16.2 percent to 10.1 percent between the third quarter of 2013 and the second quarter of 2014, compared to a decline from 20.0 percent to 18.3 percent in non-expansion states.

Health reform’s Medicaid expansion creates a pathway to coverage for all non-elderly adults with incomes up to 138 percent of the poverty line, including, for the first time, low-income adults without children.  However, the 2012 Supreme Court decision upholding health reform made the expansion a state option.  States can opt in to the expansion at any time; the federal government will pick up all of the cost through 2016 and nearly all of the cost thereafter.

Census Data Show Continued Wide Disparities in Health Coverage

September 17, 2014 at 11:46 am

Certain groups of Americans continue to be uninsured at particularly high rates, the new Census Bureau data show.  African Americans and Hispanics, residents of the South and West, adults under age 35, and households with incomes under $50,000 had uninsured rates in 2013 well above the national average of 13.8 percent (see chart).  Hispanics’ 24.3 percent uninsured rate, for example, was nearly twice the national average.

These estimates, from the Current Population Survey (CPS), are the best source for comparing coverage rates among population groups in a single year but can’t be compared to CPS estimates from previous years because of changes to the CPS questions for 2013.  For health coverage trends over time, one should look instead to Census’ American Community Survey data, which we discussed yesterday.

Health reform’s major coverage expansions — the Medicaid expansion in many states to cover more low-income adults and the availability of subsidies for private marketplace coverage — will help reduce the disparities in health coverage among population groups.  But the expansions didn’t begin until 2014, so the new Census figures for 2013 don’t capture those coverage gains.  The Centers for Disease Control and Prevention released data yesterday covering the first quarter of 2014, and they show that the coverage gains in 2014 were greatest among some of the groups with the highest uninsured rates, including young adults, Latinos, and low-income households.

Census Report Shows Rise in Full-Time Work, Undercutting Claims by Health Reform Opponents

September 17, 2014 at 9:55 am

Yesterday’s Census Bureau report shows that the share of workers with full-time, full-year work rose in 2013, while the share with part-time, part-year work fell.  This finding further undercuts assertions that health reform is causing a large increase in part-time employment — as proponents of a House measure to change health reform’s rules on covering full-time workers claim.

Health reform requires employers with at least 50 full-time-equivalent workers to offer coverage to full-time employees — defined as those who work at least 30 hours a week — or pay a penalty.  Critics claim that employers are shifting some employees to part-time work to avoid offering them health insurance.  But the data provide scant evidence of such a shift.

To the contrary, part-time work became less frequent last year.  “An estimated 72.7 percent of working men with earnings and 60.5 percent of working women with earnings worked full time, year round in 2013, both percentages higher than the 2012 estimates of 71.1 percent and 59.4 percent respectively,” according to the new Census report.  These data are consistent with a recent Urban Institute analysis that found little evidence that health reform has increased part-time work.

The share of involuntary part-timers — workers who’d rather have full-time jobs but can’t find them — tells a similar story.  If health reform were distorting hiring practices, as critics assert, we’d expect the share of involuntary part-timers to be growing.  Instead, as the chart (based on Labor Department data) shows, it’s down by 1½ percentage points from its post-recession peak.  My colleague Jared Bernstein finds that this pattern is typical for this stage of a recovery.

Later this week, the House will consider a proposal (part of a so-called “jobs bill”) to raise health reform’s threshold for full-time work from 30 to 40 hours.  But this step would make a shift toward part-time employment much more likely — not less so.

Only about 7 percent of employees work 30 to 34 hours (that is, at or modestly above health reform’s 30-hour threshold), but 44 percent of employees work 40 hours a week and thus would be vulnerable to cuts in their hours if the threshold rose to 40 hours.  Employers could easily cut back large numbers of employees from 40 to 39 hours so they wouldn’t have to offer them health coverage.

If you exclude workers at firms that already offer health insurance and thus won’t be tempted to cut workers’ hours, more than twice as many workers would face a high risk of reduced hours under a 40-hour threshold than under the current 30-hour threshold, according to New York University economist Sherry Glied.

There’s little evidence to date that health reform has caused a shift to part-time work.  There’s every reason to expect the impact to be small as a share of total employment, as we have explained.  And raising the cutoff for the employer mandate from 30 to 40 hours a week would be a step in the wrong direction.