Room: Phillips 231
Time: Mon 10:15 AM-11:45 AM

Health insurance in the United States: Who is covered, what does it cost, and who is paying for it?

Chair: Sharon Long

Session Description

In the United States, non-elderly individuals generally obtain their health insurance in one of three ways -- an employer source, direct purchase in the non-group market, or through a public insurance program. As real rates of growth in health care spending outpace overall economic growth, many policymakers are growing concerned about issues of access and affordability of health insurance. Current reform efforts seek to address these issues through increased regulation of insurance markets and through the creation of subsidies for lower income Americans to purchase coverage in proposed Exchanges.

This session includes three papers that examine key issues around health insurance access, financing, and administration. The first paper by Alice Zawacki and co-authors
use data from private sector employers in the 2000 and 2006 Medical Expenditure Panel Survey-Insurance Component (MEPS-IC) to examine changes in employee-level coverage rates in combination with detailed data on employee premium contributions and the wage and firm size distribution of employers. Their work helps to establish a baseline for evaluating changes due to the health care reform legislation that is anticipated to be enacted in the near future.

The second paper by Brad Herring and co-authors re-visits the issue of the wage-health insurance tradeoff. This issue has been a point of motivation throughout reform discussions as advocates suggest that the wage increases that workers should be getting are instead being used to offset rapidly rising premiums. Herring and colleagues investigate whether workers bear the cost of health insurance premiums in the form of lower wages and whether any wage offsets vary across different workers. To address the problem of unobserved differences between jobs that do or do not offer insurance, they focus on how changes in premiums over time affect changes in wages for full-time workers who remain in the same job providing insurance.

The third paper by Pinar Karaca-Mandic and Jean Abraham focuses on the supply-side of the market for health insurance. In particular, Karaca-Mandic and Abraham examine variation in medical loss ratios across states and over time. This research can inform current policy discussions relating to the creation of federal minimum medical loss ratio requirements. Using information from several secondary sources they investigate how demographics, the regulatory environment, and the structure of insurer, provider, and broker markets relate to state-level medical loss ratios for the group and individual market segments over the 2001 to 2008 period.

Key Terms None Listed

Session Organizer: Jean Marie Abraham (University of Minnesota)

---

Presentations

1. Declines in Employer Sponsored Health Insurance Coverage: Differences by Firm Size

   Presenter: Alice Zawacki (Census Bureau)

   Discussant: Thomas Buchmueller (University of Michigan)

2. Do Workers Bear the Cost of Rising Health Insurance Premiums through Lower Wage Raises?

   Presenter: Bradley Herring (Johns Hopkins University)

   Discussant: Seth Freedman (University of Maryland)

3. How Do Medical Loss Ratios Vary Across States?

   Presenter: Pinar Karaca-Mandic (University of Minnesota)

   Discussant: Steven Pizer (Boston VA and Boston University)