The Plank

More People Have Health Insurance. Thank Uncle Sam.

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The Census Bureau just released the latest figures on income, poverty, and health insurance enrollment. And my very hasty take--based on a quick reading of the data and highlights, plus e-mail exchanges with some experts--is that overall the news is, for a change, good: The percentage of people without coverage actually declined in the last year, according to the figures, from 15.8 percent of the population to 15.3 of the population. 

But before anybody gets the idea that we no longer need health care reform, take a closer look at the numbers. Enrollment in private insurance continued to decline in percentage terms, mostly because the percentage of people with employer-sponsored coverage fell from 59.7 to 59.3. The reason the overall numbers look good is rising enrollment in public insurance programs, particularly Medicaid.

In other words, if not for more robust public insurance, it's likely far more people would be without medical coverage. And that's true of the long-term, as well. Employer-sponsored insurance has declined over the last 30 years or so, as rising costs have made it harder for employers and employees to pay for it. If not for the expansions of eligibility for Medicaid and establishment of the State Children's Health Insurance Program, many more people would be without insurance and, as a result, struggling to pay their medical bills.

So the case for expanding public insurance--ideally, to help cover everybody--isn't weaker because of the new numbers. If anything, it's stronger. Among other things, if you read the report itself, you'll see that the state with the second* largest increase in
health insurance is Massachusetts. That's almost certainly a result of the new reforms there, which have swelled enrollment in state insurance programs. 

Again, this is all my initial take. (I haven't even read the full report yet!) In the hours, days, and weeks to come, experts will sort through this data and quite possibly come up with new, even contradicatory, insights.

Two things to keep an eye on: How much of the rise in public insurance enrollment was driven by program expansions at the state level and how much was driven by rising joblessness, which presumably increased the number of people eligible for these programs? Keep in mind these numbers are actually a year old. And, as this Kaiser Family Foundation study shows, many states expanded their insurance programs during 2007--but had to stop after that.

Also, what role did the population's aging have on these numbers, by bumping up the portion of Americans covered via Medicare?

*Update: I originally wrote that Massachusetts had the highest increase in insurance coverage, but a friend just pointed out that West Virginia's rate was slightly higher. Also, I ditched the original title of this item, because it was dull.

*Update 2: Here is Paul Krugman with a reminder that 2007 was the end an economic expansion. The numbers should be a bit better. And yet employer-sponsored insurance continued to decline while overall uninsurance is lower than it was in 2000, at the end of the last expansion.

And here is Lynn Blewett, from the Univeristy of Minnesota's State Health Access Data Assistance Center, with more details:

Our analysis of the data shows that the increase in coverage is being driven by government-funded health insurance. The number of people under 65 who are publicly insured increased from 46.3 million to 48.6 million--an increase of over 2 million. Kids accounted for about 1 million of the increase, as the number of children who are publicly insured went from 22.1 million to 23.0 million. Programs like SCHIP and Medicaid are lifelines for providing Americans with the health care they need, especially during times when the economy is soft and more people feel vulnerable to losing employer-sponsored health insurance. 

--Jonathan Cohn 

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