The paper examines how insurance coverage and access to care for the middle class changed between 1999 and 2002, contrasting their experience with that of lower- and higher-income Americans. The authors found that the lowest income population (those below 200 percent of the federal poverty level) was the hardest hit by the economic decline. Low-income adults were particularly adversely affected because the decline in ESI was only slightly offset by the increase in Medicaid and state program coverage. Lower-middle-income adults (200 to 400 percent of the federal poverty level) fared better than low-income adults. Increases in Medicaid and private nongroup coverage offset the declines in employer coverage, and there was no significant increase in the uninsurance rate for lower-middle-income adults. Similar results occurred for lower-middle-income children. Among lower-middle-income adults the number reporting unmet need for care increased significantly, primarily because of unmet need for prescription drugs.
To reuse content from Urban Institute, visit copyright.com, search for the publications, choose from a list of licenses, and complete the transaction.