Expanding uninsurance through premiums
Insurance Premium Cost-Sharing and Coverage Take-up
Kaiser Family Foundation
February 2007
One of the many reasons an individual may be uninsured is that she or he decides an employer’s offer of health insurance is too expensive. Several studies have noted the likelihood that a worker will decline an employer’s offer of health insurance increases with the amount he or she is required to contribute. Alternatively, employees may obtain coverage through a spouse, opt for publicly provided coverage if eligible, or decide to do without coverage entirely. This issue brief looks at the connection between premiums and the percent of workers who enroll in employer plans using the two most recent years of the Kaiser/HRET Employer Health Benefits Survey (EHBS). Several of these analyses suggest that the required worker share of the premium can be an obstacle to coverage that raises concerns about the affordability of private health coverage.
http://www.kff.org/insurance/snapshot/chcm020707oth.cfm
Comment:
By Don McCanne, MD
As long as individuals are required to pay some portion, if not all, of the premium for health insurance, take-up will never be 100 percent. Even with an individual mandate to purchase insurance, take-up will still not be 100 percent since too many individuals simply do not have the funds to pay the required contribution.
Entering “universal coverage” into Google just now produced over 23 million responses. Everyone is calling for universal coverage. Yet when you look at the new proposals and the various coalition efforts, none of them would result in universal coverage. Either the proposals have serious flaws such as the individual mandate requirement, or, worse, many of the hyped coalition efforts have no substantial proposals at all.
Right now many are calling for solutions that involve “shared responsibility.” That is code language for reducing the employers’ responsibilities for funding care and shifting more of it to individuals, especially in the form of individual mandates to purchase insurance and in greater cost-sharing when accessing care.
If we are serious about achieving universal coverage, we will have to adopt policies that will make enrollment completely automatic for absolutely everyone. That means that we cannot make enrollment dependent on partial or full payment of a premium.
There is only one proposal that would automatically achieve 100 percent enrollment: single payer. And, oh yes, it’s also the only proposal that would make both health care coverage and health care access affordable as well.
When these coalitions and pseudo-reform advocates claim that they are supporting “universal coverage,” there seems to be an aura of political correctness that prevents us from using the four-letter “l” word that would describe them precisely. But at least we could tell them that their pants are on fire!
(Is anyone up for a national “PANTS ON FIRE” campaign?)