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More Than One In Four Workers Will Be Uninsured In 2013
As Coverage Becomes More Unaffordable, Health Affairs Article Says  

Researchers Base Findings On Relationship Between Growth
In Health Care Spending And Personal Income

BETHESDA, MD—More than one in four American workers under age 65 will be uninsured in 2013 (nearly 56 million people); the increase will be driven by workers’ increasing inability to afford health insurance, according to new projections posted today on the Health Affairs Web site.

Authors Todd Gilmer and Richard Kronick of the University of California, San Diego, base their estimates of the uninsured on federal projections of health spending, personal income and other population characteristics. Their work was supported by the California HealthCare Foundation.

Because growth in per capita health spending is expected to outpace median personal income by 2.4 percentage points per year, health care coverage will continue to decline, because more Americans will find it unaffordable. While factors such as changes in employment patterns and demographic shifts have some mild effects on health care coverage, cost has the biggest effect.

For each 1 percent increase in health spending relative to personal income, the number of uninsured people increases by 246,000, the researchers say. As a result, according to their projections, 11 million more people will lack coverage in 2013 than in 2003. Based on estimates from the Institute of Medicine, this is expected to lead to an increase of 4,500 deaths annually and an increased annual loss of human capital of $16-$32 billion.

“Regardless of whether health care benefits are being paid out of employer’s or employee’s pocket, and without regard to the amount of premium contribution that employees are required to make, there is a remarkably tight relationship between affordability and coverage rates,” the authors say.

“It is unlikely that we will be able to solve the problem of the uninsured without some form of universal health insurance requiring contributions from some combination of employers, employees, and taxpayers,” they continue. “It is also unlikely that either our current system of employer-sponsored coverage or an alternative system of universal coverage will be sustainable without more effective efforts at cost containment.”

The authors add that the accuracy of their estimates of health care coverage will depend on how closely actual health spending and personal income mirror the federal government’s projections.

The ten-year projections show a smaller differential between health care spending and personal income than in the recent past. Between 1999 and 2002, per capita health care spending spiked 9.8 percent a year while median personal income rose only 2.2 percent. As a result, the authors say, uninsurance among nonelderly workers rose 1.5 percentage points, from 22.3 percent in 1999 to 23.8 percent in 2002.

Gilmer is an assistant professor in the UCSD School of Medicine’s Department of Family and Preventive Medicine. Kronick is a professor in that department and chief of the Division of Health Care Sciences at UCSD.

You can read the article at content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.143.

Health Affairs, published by Project HOPE, is the leading journal of health policy. Peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org. The full text of this Health Affairs Web Exclusive is available free of charge to all Web site visitors for a two-week period following posting, after which it will revert to pay-per-view for nonsubscribers. The abstracts of all articles are free in perpetuity. Support for the publication of this Web Exclusive was provided by the California HealthCare Foundation; Web Exclusives are also supported in part by a grant from the Commonwealth Fund.

©2005 Project HOPE–The People-to-People Health Foundation, Inc.