Health Insurance Is a Family Matter is the third in a series of six reports planned
by the Institute of Medicine (IOM) and its Committee on the Consequences of
Uninsurance. This series of studies represents a major and sustained commitment
by the IOM to contribute to the public debate about the problems associated with
having more than 38 million uninsured people in the United States. This very
broad research effort also represents a significant contribution from The Robert
Wood Johnson Foundation for which we are grateful....
In response to continuing concerns over access to health care by theuninsured, the W. K. Kellogg Foundation in 1998 launched an initia-tivecalled "Community Voices." The goal of the initiative is to assistlocal organizations in strengthening community support services,giving the underserved a voice in the debate over health-care access,and identifying ways to meet the needs of those
The estimated proportion uninsured was higher among the poor (22%) and near-poor (17%) compared
with non-poor residents (4%).
Poverty status is determined by household size at the time of the survey and household income in the
calendar year preceding the survey. A household of four people was considered “poor” (below the
federal poverty guideline) in the 2008 survey if total income in 2007 was below $21,000 (see Table 13,
Botanical Medicine for Women’s Health is being published
at an interesting time and speaks simultaneously to a
number of converging constituencies. It is a time of growing
stress on both the medical system and the patient.
Medical care is in crisis with large numbers of underinsured
or uninsured patients needing care. Costs are
rising from the practice of increasingly technical medicine
while patients complain of the decreasing time and
attention they are receiving from their medical providers.
Further, the burden of chronic disease is growing in an
Some analysts have wondered why uninsured people would purchase health insurance as the result of a mandate (Cassidy, 2010; Kling, 2010). After all, for many people the penalty would cost less (at least in the very short-term) than a policy. Health insurance mandates differ from some other requirements, such as the requirement to pay taxes: In exchange for compliance, enrollees individually receive a tangible good—health insurance—that they value.
Health economics provides a framework for considering how changes in the price of health insurance affect coverage.
In October 2005, an Angelina County, Texas, court held a woman accountable in an automobile
crash that resulted in the death of her 1-month-old son who was not properly restrained in the
vehicle. The woman forgot the child’s car seat and let a friend hold the child in her lap while a
14-year-old, unlicensed, uninsured driver drove the vehicle. The car slammed into an oncoming
pickup truck and rolled over, killing the boy. The woman pleaded guilty to negligent homicide
charges and was sentenced to a deferred three-year prison sentence and is required to attend...
Health insurance makes a difference in whether and when people get necessary medical care, where they
get their care, and ultimately, how healthy people are. Uninsured adults are far more likely than the insured
to postpone or forgo health care altogether and less able to afford prescription drugs or follow through with
recommended treatments. Problems getting needed care are less common among children, who are
generally healthy, but disparities in access to care between uninsured and insured children are as great as
the adult differences.
Having private health insurance obviously also improves access to needed care at the right time if
no other form of health coverage is available and “safety-net” providers (who provide services irrespective
of ability to pay) are in the minority. In the United States, there is evidence suggesting that uninsured
individuals wait to receive treatment until they need emergency care – for which hospitals are under an
obligation to provide services to those in need – but obtain less primary and preventative services (Docteur
et al., 2003).
Tax compliance researchers begin with the supposition that people compare the marginal benefit of noncompliance (reduced tax payments, for example) with the expected marginal costs, which account for both the likelihood of punishment and its severity. That perspective provides an approach for evaluating the effective penalties uninsured people could anticipate under an individual health mandate.
Uninsured low-income childless adults are a diverse group that includes men and women living in all
parts of Wisconsin. About half of these adults are working full time or are self-employed, working full
time. Over half have not had a checkup during the past two years. Twenty-two percent of low-income
uninsured childless adults have a chronic condition; that is, have been diagnosed as having arthritis, heart
disease, diabetes, cancer, or a stroke.
Medicaid and the S-CHIP provide coverage to certain low-income populations that meet eligibility requirements.
The programs play a particularly important role for children, aiming to cover nearly all low-income uninsured
children. The role of Medicaid for adults is far more limited however, covering only some low-income parents
and disabled individuals, leaving most childless adults ineligible, regardless of how poor they are. Recent
growth in Medicaid and S-CHIP enrollment of children has filled in the sizable gap created by decreased
employer-sponsored insurance since 2000.
When surveyed, Americans consistently support guaranteeing health insurance for more people. Options for
reforming the current health insurance system and decreasing the number of uninsured continue to be debated.
Most proposals recognize that in order to make health insurance affordable for the majority of the uninsured,
premiums will need to be subsidized for the lowest income groups. However, rising health care costs and fiscal
constraints to expanding public coverage, pose a significant challenge for reform.
The costs of uncompensated care are estimated to be about $41 billion in 2004. Projected
government spending available to pay for the care of the uninsured in 2004 is $34.6 billion—about 85%
of the total uncompensated care bill. More than half of all funds for uncompensated care come from
the federal government, with the majority (70%) of federal dollars flowing through Medicare and
Medicaid. Most government dollars for uncompensated care goes for hospital care—which is paid
indirectly to hospitals based partly on the share of uncompensated care they provide.
The Affordable Care Act increases insurance company accountability by supporting States’
review of premium increases, setting standards for the amount of premiums spent on benefits
versus overhead (i.e., medical loss ratios), and posting insurance price information for
transparency. A Small Business Health Care Tax Credit, reinsurance for early retirees, and
premium assistance for uninsured people with pre-existing conditions have already provided
targeted relief for millions of insured and uninsured Americans, and these changes are making a
If you are getting benefits as a wife or husband based on
your spouse’s work, when you report the death to us, we
will change your payments to survivors benefits. If we need
more information, we will contact you.
If you are getting benefits based on your own work, call
or visit us, and we will check to see if you can get more
money as a widow or widower. If so, you will receive a
combination of benefits that equals the higher amount.
You will need to complete an application to switch to
survivors benefits, and we will need to...
Our empirical analysis uses two different data sources: the RobertWood Johnson Foundation’s 1997
Employer Health Insurance Survey (EHIS) and MEDSTAT MarketScan commercially insured health
claims and eligibility information for 1998–1999. We ﬁrst use the EHIS data to examine turnover
patterns and their relationship to ﬁrm and employee characteristics. The EHIS data reveal that small
ﬁrms are very heterogeneous; the heterogeneity concerns workers’ turnover rates, besides workers’ age
distribution and other health-related demographic variables.
Other researchers have studied the issues examined here. Excellent articles by Blumberg and Nichols
(2004), Chernew and Hirth (2004), and Gruber and Madrian (2004) have carefully documented many
reasons why so many Americans are uninsured. There is no single and simple explanation about why
many ﬁrms refuse to offer insurance and why employees sometimes refuse to accept these offers. The
problem is complex. In this article, we focus on labor market turnover and expectations to explain ﬁrms’
insurance offer decisions.
Generally, empirical studies have considered the effect of subsidies on health insurance coverage. But mandates to obtain health insurance often include monetary penalties for noncompliance, and thus a mandate with a penalty also affects the relative price of health insurance by making it costlier to be uninsured. In this respect, the health economics literature is an obvious starting point to search for information about the possible effects of mandates on coverage choices.
Based on results of the 2008 Family Health Survey, the majority of Wisconsin residents in 2008 had
health insurance for the entire past year. That is, they were continuously covered during the 12 months
prior to the survey interview. An estimated 4,868,000 residents (89%) were insured for all of the past 12
An estimated 319,000 Wisconsin household residents (6%) had no health insurance of any kind during
the past 12 months. Another 276,000 residents (5%) had health insurance for part of the year and were
uninsured for part of the year. Together, an estimated...
These estimates were obtained by asking respondents several questions about their current health
insurance coverage. Separate questions were asked about Medicare, Wisconsin Medicaid, BadgerCare
Plus, private health insurance, employer-sponsored health insurance and other kinds of health care
coverage for each household member. Those without any current health care coverage were considered
uninsured at the time of the interview. (See Table 5, page 18, for specific types of health insurance