increasing health insurance costsandthe declinein（增加医疗保险costsandthe下降）.docVIP

Increasing Health Insurance Costs and the Decline in Insurance Coverage Michael Chernew University of Michigan and NBER David Cutler Harvard University and NBER Patricia Seliger Keenan NBER October 2004 This work was funded by the Economic Research Initiative on the Uninsured, the National Institute on Aging, and the Sloan Foundation. Abstract Objective: To determine the impact of rising health insurance premiums on coverage rates. Data Sources Study Setting: Our analysis is based on two cohorts of non-elderly Americans residing in 64 large MSAs surveyed in the Current Population Survey in 1989-1991 and 1998-2000. Measures of premiums are based on data from the Health Insurance Association of America and the Kaiser Family Foundation/Health Research and Educational Trust Survey of Employer-Sponsored Health Benefits. Study Design: Probit regression and instrumental variable techniques are used to estimate the association between rising local health insurance costs and the falling propensity for individuals to have any health insurance coverage, controlling for a rich array of economic, demographic, and policy covariates. Principal Findings: Over half of the decline in coverage rates experienced over the 1990s is attributable to the increase in health insurance premiums (2.0 percentage points of the 3.1 percentage point decline). Medicaid expansions led to a 1 percentage point increase in coverage. Changes in economic and demographic factors had little net effect. The number of people uninsured could increase by 1.9 to 6.3 million in the next decade if real, per capita medical costs increase at a rate 1 to 3 percentage points above the GDP growth rate. Conclusions: Initiatives aimed at reducing the number of uninsured must confront the growing pressure on coverage rates generated by rising costs. INTRODUCTION The 1990s were a decade of relative prosperity, yet the percentage of Americans without health insura