Trends in Private Insurance, Medicaid/State Children's Health Insurance Program, and the Healthcare Safety Net

Implications for Vulnerable Populations and Health Disparities

Authors

  • Alexandra E. Shields,

    1. Harvard Medical School, Harvard University, and Harvard/Massachusetts General Hospital Center on Genomics, Vulnerable Populations, and Health Disparities, and Institute for Health Policy, Massachusetts General Hospital/Partners HealthCare, Boston, Massachusetts, USA
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  • Mary McGinn-Shapiro,

    1. Georgetown Public Policy Institute, Georgetown University, Washington, DC, USA
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  • Paul Fronstin

    1. Employee Benefit Research Institute, Washington, DC, USA
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Address for correspondence: Alexandra Shields, Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Institute for Health Policy, Massachusetts General Hospital, 50 Staniford St., Ste. 901, Boston, MA 02114. Voice: 617-724-1048; fax: 617-724-4738.
 ashields@partners.org

Abstract

This chapter examines trends in private and public health coverage, as well as implications for vulnerable populations and health disparities. We find that there has been erosion in employment-based health benefits. Both the percentage of employers offering coverage and the percentage of workers with coverage declined in recent years. Those with coverage face eroding benefits and increased cost sharing. Within the public sector, Medicaid enrollment has decreased, with benefits increasingly restricted. Although State Children's Health Insurance Program (SCHIP) enrollment has increased among low-income children, the future of SCHIP remains uncertain. Meeting the healthcare needs of Americans and reducing health disparities requires both the provision of health coverage to all and sufficient comprehensiveness of benefits within private and public programs to meet enrollees' healthcare needs. Our findings suggest that we have a long way to go in reaching these goals.

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