Research by Author & Topic

Publications by Stephen Zuckerman on Uninsured/Uncompensated Care

New data on health insurance coverage from the American Community Survey show extensive variation in rates of private and public coverage and uninsurance across congressional districts in the United States. Rates of private coverage are lowest in districts that have higher poverty rates which tend to be concentrated in the South and West and uninsurance remains most serious in districts with low rates of private coverage. This analysis identifies the districts in which residents would have the most to gain from health reforms that are designed to increase health insurance coverage toward a higher and more uniform national standard.

The ongoing debate in California over two competing 2007 proposals for universal health coverage highlights both the strengths and weaknesses of the current insurance system in the District of Columbia as a platform for coverage expansion. The District's advantages include its relatively small uninsured population and existing mechanisms for administering a public coverage program tied to income. But its fiscal base is relatively small compared with California's, its largely unregulated insurance market could lead to severe adverse selection problems for new programs, and it is at much greater risk for border-crossing by both individuals and businesses in response to reform.

This study, funded by the Maine Health Access Foundation, presented alternative estimates of the costs of health care that uninsured Maine residents receive and determined how much public revenue was available to offset those costs. Using data from health care providers, the study estimated that the costs of caring for the uninsured in Maine were $138 million in 2005, with hospitals and Veterans' Affairs facilities identified as the largest providers. Estimates based on household survey data from the Medical Expenditure Panel Survey showed that uncompensated care costs for the uninsured were only $81 million in 2005. The report discusses possible reasons for the large discrepancy between these two sources. Our review of federal and state funding sources in 2005 suggests there were roughly $110 million available to offset these costs of caring for the uninsured.

The Maine Health Care Access Foundation funded this profile of Maine health insurance coverage. According to data from the Current Population Survey, 124,000 Maine residents did not have health insurance during the 2004–2005 period. The majority (84%) of uninsured people were adults. Just over half of Maine residents who were uninsured came from low-income families residents. Low-income young adults (ages 19–34) were particularly at risk for being uninsured, and one-quarter lacked coverage. Over 86,000 of Maine's uninsured people were workers. Forty-seven percent of this uninsured group were low-income, over half (55%) were employed by firms with fewer than 25 workers, and just over two-thirds worked in industries with low rates of job-based health coverage. Over two-thirds (67%) of Maine's uninsured people came from families with one or more full-time worker, while another 19 percent are from families with a part-time worker.

This data brief documents the decline in health coverage from employer-sponsored insurance (ESI) for low-income adults and children between 2000 and 2004 and how this varied across states. During this period, uninsurance rates for low-income children fell by more than 2 percentage points, because Medicaid and SCHIP coverage expanded to offset the reduction in ESI. Without public programs serving as the same coverage safety net, uninsurance rates for low-income adults increased nearly 3 percentage points in the same period. The data brief shows that public coverage offset the reduction in ESI for children in states with large and moderate reductions in ESI.

This study examines trends in insurance coverage by geographic area and by subgroups such as age, ethnicity, income, and firm size. It also analyzes differences in the types of insurance that people have in large cities compared to rural communities and small cities throughout Missouri.

This report synthesizes all of the research and analytic work done on the Roadmap initiative, describes three policy approaches that would achieve universal health coverage in the Commonwealth, and describes the issues that would need to be addressed in order to implement the Roadmap options. The report describes each of the building blocks in turn, followed by the mandate alternatives. The cost and coverage estimates were produced using the Health Insurance Reform Simulation Model, developed by Urban Institute researchers. The report also discusses options for financing the coverage expansions, the likely benefits from universal coverage, and the broader economic impacts.

This report presents several options designed to help Massachusetts move to universal health insurance coverage. Each strategy is outlined in the form of a policy proposal and includes analysis of the effects on cost and coverage. The policies all build on an expansion of MassHealth, income-related tax credits, a purchasing pool and government-sponsored reinsurance. These measures in themselves do not yield universal coverage, nor would an employer mandate. The building blocks and an employer mandate combined with an individual mandate would yield universal coverage with a relatively small increase in government costs relative to state GDP and current health spending. (www.roadmaptocoverage.com, June 21, 2005)

Hurricane Katrina destroyed much of the New Orleans health care system. The devastation was especially profound for the low-income uninsured, most of whom depend heavily on a handful of providers. Focusing on the low-income population, this essay examines some of the early responses to the many health care issues that surfaced in Katrina's wake, and discusses emerging issues that both private and public decisionmakers will face. One potential strategy for rebuilding is a health care safety net based on a continuum of care to low-income residents, integrating a network of community clinics with a new but smaller Charity Hospital.

This report discusses the diversity of Connecticut's immigrants, their participation in the labor force, and their access to health care. Connecticut's economy is attracting large numbers of both high- and low-skilled immigrants. Some immigrants-especially Asians-are better educated and out-earn U.S.-born workers, while others--particularly Latinos--are poorer and earn much less. Over 40 percent of Latino non-citizens and a quarter of their children are uninsured. While HUSKY--the state's Medicaid and State Children's Health Insurance Program--covers many immigrant parents and their children, confusion about eligibility and application barriers deter participation. The report offers recommendations to improve health care access for immigrants and their children.