Covering the uninsured: prospects and problems.

Introduction: The Current Status of Health Insurance Coverage I ncreasing the number of Americans with health insurance has been a recurrent focus of federal and state policymaking, and recent trends suggest that the issue continues to warrant legislative attention.The number of people without health insurance coverage in the United States increased in 2001, a reversal of two years of falling rates of uninsurance. According to the Census Bureau, an estimated 14.5 percent of the total population (41.2 million people) lacked health insurance for the entire year in 2001, up from 14.2 percent in 2000—an increase of 1.4 million people. Insurance coverage varies by state of residence, with New Mexico and Texas having the highest average uninsured rates from 1999 to 2001 (23 percent) and Rhode Island and Minnesota the lowest (7.8 percent). Private employment-based insurance remains the primary source of insurance coverage for most Americans, but public programs such as Medicare, Medicaid, and the state Children’s Health Insurance Program (CHIP) are an important source of coverage for millions of elderly and disabled individuals and low-income children and adults. Gaps in private and public coverage leave many Americans without access to health insurance or with only limited coverage. Many workers do not have access to employment-based insurance because they cannot afford it or their employer does not offer it. Coverage in the private, non-group insurance market has been limited because premiums are based on an individual’s age and health status, and are substantially more expensive than group plans purchased by employers. 4 Medicaid and CHIP cover many lowThe Commonwealth Fund is a private foundation supporting independent research on health and social issues.The views presented here are those of the authors and should not be attributed to The Commonwealth Fund or its directors, officers, or staff.