Transcript Slide 1

THE
COMMONWEALTH
FUND
The Continuing Erosion of Health
Benefits Among Workers with Low
Wages
Sara R. Collins, Ph.D.
The Commonwealth Fund
National Academy of Social Insurance
Roundtable on The Growing Inequality in Workers’
Health Benefits
January 28, 2005
Growth in Job-Based Premiums Compared
to Earnings Growth
Percent change from previous year
Premiums
18%
Worker's Earnings
12%
11%
13%
14%
11%
9%
9%
5%
1%
3%
2%
0%
1988
1993
1996
1999
2001
2002
2003
Source: J. Gabel, et al. “Health Benefits in 2004: Four Years of Double-Digit Premium
Increases Take Their Toll on Coverage,” Health Affairs, Sept/Oct 2004.
2004
THE
COMMONWEALTH
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Deductibles Rise Sharply, Especially in
Small Firms, Over 2000-2004
$900
PPO in-network and out-of-network deductibles
2000
$750
2004
676
$600
510
420
$450
$300
383
210
319
157
232
$150
$0
In-network
Out-network
Small Firms,
3-199 Employees
In-network
Out-network
Large Firms,
200+ Employees
Source: J. Gabel and J. Pickreign, Risky Business: When Mom and Pop Buy Health Insurance for
Their Employees (New York: The Commonwealth Fund, April 2004); KFF/HRET Employer Health
Benefits 2004 Annual Survey.
THE
COMMONWEALTH
FUND
Working Adults with Health Benefits from
Own Employer, By Income, 1987-2003
Percent of Workers with Health Benefits from Own Employer
70%
66%
66%
62%
60% 63%
63%
58%
50%
45%
44%
42%
40%
38%
30%
20%
19%
18%
14%
64%
58%
Fourth
36%
Third
16%
Second
12%
10%
Lowest
quintile
20
03
20
01
19
99
19
97
19
95
19
93
19
91
19
89
0%
19
87
Highest
Quintile
Source: Analysis of the March 2004 Current Population Survey by Danielle Ferry,
Columbia University, for the Commonwealth Fund.
THE
COMMONWEALTH
FUND
Working Adults with Own ESI or Any Private
Coverage by Income Quintile, 2003
Percent of workers age 19-64
Any Private*
Own ESI
100
87
71
80
60
40
20
47
33
58
64
93
63
36
16
0
Lowest
Quintile
Second
Third
Fourth
Highest
Quintile
*Includes ESI any source and private individual coverage
THE
Source: Analysis of the March 2004 Current Population Survey by Danielle Ferry, ColumbiaCOMMONWEALTH
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University, for the Commonwealth Fund.
Working Adults Who Are Uninsured, By Income
Quintile, 1987-2003
Percent of Workers Uninsured
50%
52%
48%
47%
50%
48%
44%
39%
40%
Lowest
Quintile
Second
33%
35%
30%
25%
Third
21%
15%
6%
11%
Highest
Quintile
20
03
20
01
19
93
Fourth
5%
4%
19
91
19
89
8%
5%
2%
19
87
0%
9%
19
95
10%
18%
19
97
19
99
*
20%
*In 1999, CPS added a follow-up verification question for health coverage.
Source: Analysis of the March 2004 Current Population Survey by Danielle Ferry,
Columbia University, for the Commonwealth Fund.
THE
COMMONWEALTH
FUND
Job Compensation in the American
Workforce
Undesignated Wage Rate
8%
Higher Compensated:
Lowest Compensated:
Wage $15/hr or more and
ESI
37%
Wage less than $10/hr
26%
Wage $10–15/hr
24%
Wage $15 or more but no
ESI
5%
Mid-Compensated:
29%
THE
COMMONWEALTH
FUND
Note: ESI defined as employer-sponsored insurance.
Source: S.R. Collins et al., Wages, Health Benefits, and Workers’ Health, The Commonwealth Fund, October 2004.
Paid Sick Leave by Workers’ Job Compensation
Levels
Percent
Lowest compensated
Mid-compensated
Higher compensated
100
73
80
54
52
60
40
68
36
35
20
0
Paid Time Off to See Doctor During Work
Some Days of Paid Sick Leave**
Hours**
Note: Lowest compensated are all workers with wage rate <$10/hr; mid-compensated are workers with wage rate
$10–15/hr and those with $15/hr or more but no employer-sponsored insurance; higher compensated
are workers with wage rate $15/hr or more and have employer-sponsored insurance.
THE
**Differences by compensation group statistically significant at p<.01.
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Source: The Commonwealth Fund Biennial Health Insurance Survey (2003).
Percent of Workers with Health Problems by
Job Compensation Level
Percent
Lowest compensated
Mid-compensated
Higher compensated
50
36
29
25
24
0
Health Problems**+
Note: Lowest compensated are all workers with wage rate <$10/hr; mid-compensated are workers with wage rate
$10–15/hr and those with $15/hr or more but no employer-sponsored insurance; higher compensated
are workers with wage rate $15/hr or more and have employer-sponsored insurance.
THE
**Differences by compensation group statistically significant at p<.01.
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+Either fair or poor health, disability, or one of four chronic conditions: heart disease, cancer, diabetes, arthritis
Source: S.R. Collins, et al., Wages, Health Benefits, and Workers’ Health, The Commonwealth Fund, October 2004
Preventive and Primary Care Varies by Workers’
Job Compensation Levels
Percent
Lowest compensated
100
80
Mid-compensated
89
74
84
Higher compensated
91
85
74
66
64
54
60
40
20
0
Regular Doctor
Blood pressure check in
Cholesterol check in past
(Age 19–64)
past year (Age 19–64)
five years (Age 19–64)
Note: Lowest compensated are all workers with wage rate <$10/hr; mid-compensated are workers with wage
rate $10–15/hr and those with $15/hr or more but no employer-sponsored insurance; higher compensated are
THE
COMMONWEALTH
workers with wage rate $15/hr or more and have employer-sponsored insurance.
FUND
Source: S.R. Collins et al., Wages, Health Benefits and Workers’ Health, The Commonwealth Fund, October 2004.
Women’s Preventive Care Varies by
Workers’ Job Compensation Levels
Percent
Lowest compensated
100
80
80
84
Mid-compensated
89
Higher compensated
82
88
72
60
40
20
0
Pap Test* (Age 19–64)
Mammogram^ (Age 50–64)
Note: Lowest compensated are all workers with wage rate <$10/hr; mid-compensated are workers with wage rate $10–15/hr and
those with $15/hr or more but no employer-sponsored insurance; higher compensated are workers with wage rate $15/hr or more
and have employer-sponsored insurance.
* Pap test for women ages 19–29 in past year and for women ages 30–64 in past three years
^ Mammogram for women ages 50–64 in past two years
Source: S.R. Collins, et al., Wages, Health Benefits, and Workers’ Health, The Commonwealth Fund, October 2004.
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COMMONWEALTH
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Low and Mid-Range Compensated Workers
Are Most Likely to Report Access Problems
Percent reporting the following problems due to cost:
Lowest compensated
Mid-compensated
Higher compensated
50
42 44
29 27
30
24 23
25
12
26
20
14 14
6
7
6
0
Did Not Fill a
Did Not See
Skipped
Did Not See
Any of the Four
Prescription
Specialist
Medical Test,
Doctor When
Access
When Needed
Treatment, or
Sick
Problems
Follow-Up
Note: Lowest compensated are all workers with wage rate <$10/hr; mid-compensated are workers with wage
rate $10–15/hr and those with $15/hr or more but no employer-sponsored insurance; higher compensated are
THE
COMMONWEALTH
workers with wage rate $15/hr or more and have employer-sponsored insurance.
FUND
Source: S.R. Collins, et al., Wages, Health Benefits, and Workers’ Health, The Commonwealth Fund, October 2004
Lowest and Mid-Range Compensated Workers
More Likely to Spend Large Shares of Income on
Out-of-Pocket Medical Costs
Percent
Lowest compensated
Mid-compensated
Higher compensated
30
22
17
15
5
0
Spent 5% or more of income on out-of-pocket costs**
Note: Lowest compensated are all workers with wage rate <$10/hr; mid-compensated are workers with wage rate
$10–15/hr and those with $15/hr or more but no employer-sponsored insurance; higher compensated
THE
are workers with wage rate $15/hr or more and have employer-sponsored insurance.
COMMONWEALTH
FUND
**Differences by compensation group statistically significant at p<.01.
Source: S.R. Collins, et al., Wages, Health Benefits, and Workers’ Health, The Commonwealth Fund, October 2004
Low and Mid-Range Compensated Workers
Are Most Likely to Report Problems Paying
Medical Bills
Percent who had the following problems in past year:
Lowest compensated
Mid-compensated
Higher compensated
60
50 49
33
30
30
28
8
23
22
10
25
16
6
9 11 9
0
Not Able to
Contacted by
Had to Change
Medical
Any Medical
Pay Medical
Collection
Way of Life to
Bills/Debt
Bill Problem or
Bills
Agency
Pay Medical
Being Paid Off
Outstanding
Bills
Over Time
Debt
Note: Lowest compensated are all workers with wage rate <$10/hr; mid-compensated are workers with wage
THE
rate $10–15/hr and those with $15/hr or more but no employer-sponsored insurance; higher compensated are
COMMONWEALTH
FUND
workers with wage rate $15/hr or more and have employer-sponsored insurance.
Source: S.R. Collins, et al., Wages, Health Benefits, and Workers’ Health, The Commonwealth Fund, October 2004
Policy Implications
• Employment linked to health care access,
protection from catastrophic medical costs,
ability to take sick leave
• Employer-based insurance system alone
insufficient to provide coverage to all Americans
• Current structure of system unlikely to change in
near future:
– Strong public support
– Relative efficiency in financing coverage
– Federal fiscal constraints
• Coverage expansions will likely need to build on
structure of current system
– Creating Consensus
– Proposals of 2004 election cycle
• Policy options to insure more equitable health
insurance coverage should remain on policy
agenda
THE
COMMONWEALTH
FUND
Commonwealth Fund Biennial
Health Insurance Survey (2003)
• Random nationally representative sample of adults 19
and older living in continental U.S.
– Over-sampling of low income, African American, and
Hispanic households
– 4,052 adults age 19 and older
• Worker sample: 1,963 part-time and full-time workers,
not self-employed, ages 19-64; representing about
107 million workers.
• 25-minute telephone interview conducted by PSRA
International:
– September 3, 2003 through January 4, 2004 (2003)
• Results weighted to correct for disproportionate sample
design and to make sample representative of adults
living in the U.S.
• Response rate: 50%
THE
COMMONWEALTH
FUND
Acknowledgments
Karen Davis, President, The Commonwealth Fund,
S.R. Collins, K. Davis, M.M. Doty, A. Ho, Wages, Health
Benefits, and Workers’ Health, The Commonwealth
Fund, October 2004.
Cathy Schoen, Vice President, The Commonwealth
Fund
Michelle M. Doty, Senior Analyst, The Commonwealth
Fund, S.R. Collins, K. Davis, M.M. Doty, A. Ho, Wages,
Health Benefits, and Workers’ Health, The
Commonwealth Fund, October 2004.
Alice Ho, Research Associate, The Commonwealth
Fund, S.R. Collins, K. Davis, M.M. Doty, A. Ho, Wages,
Health Benefits, and Workers’ Health, The
Commonwealth Fund, October 2004.
Visit the Fund at: www.cmwf.org
THE
COMMONWEALTH
FUND