Few avenues exist for inexpensive health insurance for families. Both private insurance and publicly funded programs have struggled to rein in costs and provide coverage. Unfortunately, uninsured Americans number more than 45 million. The 2009 reauthorization and expansion of the Children's Health Insurance Program, or CHIP, and the 2010 health reforms aim to make health insurance more affordable and reduce the number of uninsured.
Employer-Sponsored Health Insurance
Sixty-one percent of Americans under age 65 have health insurance through an employer. Employer-sponsored health insurance generally provides coverage for the worker and her dependents. Increasing health-care costs have caused employers to shift costs to employees, who must cope with higher premium costs, co-pays and deductibles. According to the Kaiser Family Foundation, between 1999 and 2008, premiums for employer-sponsored insurance rose 119 percent, with the average annual family contribution rising to $3,354. Some employers have slashed benefits or eliminated health insurance altogether.
Employees sometimes switch to high-deductible plans, opting for only catastrophic coverage for their families.
Although most families have access to employer-sponsored health insurance, a significant number of employers do not offer coverage. These tend to be small businesses as well as certain categories of businesses, including retail, service, construction and agriculture.
Private Market Health Insurance
The most expensive health insurance is that purchased by individuals or individual families. According to a Kaiser Family Foundation survey, people buying their own insurance report that premiums increased by an average of 20 percent in 2009. Overall, 77 percent reported a premium increase. Although most paid the increase, 16 percent switched to lower-cost coverage. The lower-cost coverage usually translated to less comprehensive coverage or higher deductibles.
Medicaid
Medicaid, together with CHIP, is a public program for certain low-income persons. According to the Kaiser Family Foundation, it provides health coverage for 56 percent of low-income children and their families.
State and federal governments jointly fund Medicaid. Eligibility levels vary by state. However, if a family is eligible, there is no cost for services. For families, eligibility is limited to those with single parents and is tied to the federal poverty level, or FPL, which in 2008 was $22,025 for a family of four, according to the U.S. Census Bureau.
CHIP
Originally enacted in 1997, CHIP, was reauthorized and expanded in 2009. CHIP targets children, pregnant women and their families with incomes too high to qualify for Medicaid but too low to afford private market coverage. Like Medicaid, CHIP is a joint state-federal program with eligibility levels varying by state. Unlike Medicaid, CHIP has a sliding scale buy-in program for coverage that varies with a family's income.
Eligibility varies by whether one is a child, a pregnant woman or a parent. For example, Michigan covers children under 200 percent of FPL, pregnant women under 185 percent of FPL, and parents at 37 percent of FPL. For New Jersey, the figures are 350 percent, 200 percent, and 200 percent, respectively.
Health Reform
The Patient Protection and Affordable Care Act of 2010 aims to improve access and affordability of health insurance. Implementation, however, will take several years.
References
- Kaiser Family Foundation: Health Care Costs and the Middle Class: More Costs and Less Coverage, July 2009.
- U.S. Center for Medicare and Medicaid Services: The Children's Health Insurance Program, 2010.
- Center for Children and Families: Facts and Statistics, 2009.
- Kaiser Commission on Medicaid and the Uninsured: Characteristics of the Uninsured: Who is Eligible for Public Coverage and Who Needs Help Affording Coverage?, February 2007.
- Kaiser Commission on Medicaid and the Uninsured: Health Coverage of Children: The Role of Medicaid and CHIP, 2009.
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