This report, released by the Center for Rural Affairs and the Center for Community Change, highlights the unique challenges of rural health care.  The report notes that rural communities have a lower rate of employer-sponsored insurance because rural economies rely more heavily on small businesses and self-employment.  The report also finds that rural areas have twice the rate of underinsurance as urban areas and that rural residents pay 22 percent more for health coverage than those living near metropolitan areas.

Full Report: http://www.communitychange.org/library/CCC-sweet-hivfin.pdf/idea_view 

Center for Rural Affairs and Center for Community Change. (2009). Sweet the bitter drought why rural America needs health care reform. Jon Bailey, Sally Kohn & Angie Evans

This Families USA report uses 2008 data from the U.S. Census Bureau and the Urban Institute to estimate the 2009 national and state-level uninsurance rates. It estimates that the number of uninsured working Americans has increased by 4 million since 2008, totaling over 50 million uninsured American residents.  The report notes that states with higher unemployment rates have suffered greater percentage losses in health coverage, with the highest percentage losses coming in Oregon, Michigan, South Carolina, Nevada, and North Carolina.  However, the report also notes that insurance rates among children have remained high throughout the recession largely due to the success of Medicaid and the Children’s Health Insurance Program (CHIP).

From the Report:

The current recession has put the job-based coverage of millions at risk. For many, losing a job means losing the coverage that their employer provides. While the safety net of public health insurance programs, including Medicaid and the Children’s Health Insurance Program (CHIP), provides coverage to some who lose their job-based coverage, current eligibility rules limit who qualifies for coverage based on income and family status. In most states, for example, a child is eligible for Medicaid or CHIP if that child’s family income is at or below 200 percent of the federal poverty level ($36,620 for a family of three in 2009). However, the eligibility levels are much lower for parents than they are for children. The median income eligibility level among the 50 states for working parents is 67 percent of the federal poverty level—only $12,268 in annual income for a family of three in 2009. Even worse, in 42 states, Medicaid is simply not available for adults without dependent children unless those adults are permanently disabled.

Families USA. (2009). One-two punch: unemployed and uninsured.

Full report:  http://www.familiesusa.org/assets/pdfs/one-two-punch.pdf

This U.S. Census Bureau report shows that the number of Americans without health insurance rose from 45.6 million to 46.3 million between 2007 and 2008 but that the percentage of uninsured residents held constant at 15.4 percent.  The bureau reports that the number of uninsured children has dropped to its lowest level since 1987 at 7.3 million, and that the number of Americans covered by public insurance increased by 4.4 million between 2007 and 2008 to 87.4 million.  The report also provides details on insurance coverage by region. 

From the Report:

Full Report: http://www.census.gov/prod/2009pubs/p60-236.pdf 

This article argues that the insurance data provided by the U.S. Census Bureau likely overestimates the number of uninsured Americans.  The authors argue that Medicaid enrollees are undercounted, noting that fewer survey respondents report Medicaid coverage than program administrative data indicates are enrolled in the programs.  The authors suggest that other data sources be considered to provide better estimates of the uninsured and highlight the importance of estimating the scope of insurance coverage given the use of those figures in calculations of health care reform costs.

Klerman, J.A., Davern, M., Call, K.T., Lynch, V., Ringel, J. Understanding the current population survey's insurance estimates and the Medicaid 'undercount.' Health Affairs, 28(6):w991-1001. DOI: 10.1377/hlthaff.28.6.w991. http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.6.w991

Authors: Jacob A. Klerman, Michael Davern, Kathleen Thiede Call, Victoria Lynch, Jeanne Ringel

On September 10, the Commonwealth Fund issued a report examining provisions of the State Children’s Health Insurance Program (SCHIP) expansion under the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) (Financing News Pulse 2/6 edition).  The report examines provisions of the bill pertaining to outreach, enrollment, health quality, and measurement.  The report recommends: “giving funding priority to states that will adopt or maintain key simplifications, providing clarity on the relationship between express-lane procedures (which allow states to use relevant findings from other public programs when determining children’s enrollment eligibility) and error measurement, ensuring quality measures focus on priority health needs for children, and building quality measurement and improvement capabilities into electronic health information systems.” 

From the executive summary:

The Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009 has the potential to transform children’s health care in the United States. The authors of this report analyze selected provisions of the legislation that involve outreach and enrollment, as well as child health quality and measurement. Using input from interviews with a range of stakeholders and a panel of experts, the report provides a set of recommendations for the federal government officials charged with implementing CHIPRA. Recommendations include: giving funding priority to states that will adopt or maintain key simplifications, providing clarity on the relationship between express-lane procedures (which allow states to use relevant findings from other public programs when determining children’s enrollment eligibility) and error measurement, ensuring quality measures focus on priority health needs for children, and building quality measurement and improvement capabilities into electronic health information systems, among others.

The Commonwealth Fund. (2009). Implementation choices for the Children's Health Insurance Program Reauthorization Act of 2009. Simpson, Lisa, Fairbrother, Gerry, Touschner,  Joseph, & Guyer, Jocelyn.

From the report: http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2009/Sep/1315_Simpson_implementation_choices_for_CHIPRA_911.pdf

This four-part report series released by the Robert Wood Johnson Foundation and the Kaiser Commission on Medicaid and the Uninsured calculates how many uninsured Americans could gain coverage through variations of health reform being currently being considered in Congress.

From the reports:

Non-Elderly Uninsured: If Medicaid were expanded to 133 percent of the FPL and subsidies were provided to those with income between 133 and 399 percent of the FPL, an estimated three quarters of the 43.9 million non-elderly uninsured would be eligible for financial assistance in obtaining coverage. Specifically, some 38.7 percent would be eligible for Medicaid and 37.2 percent would be eligible for subsidies to purchase coverage. Fewer than ten percent of the uninsured have income of at least 400 percent of the FPL and would not qualify for subsidies. Another 14.2 percent are non-citizens who would not be eligible due to their authorization status or because they have resided in the United States for fewer than five years.

Childless Adults:  In 2007, 25.1 million non-elderly childless adults were uninsured, accounting for 57.2 percent of the uninsured non-elderly in the United States. Under the reform options modeled here, 38.4 percent of uninsured childless adults or 9.6 million would be eligible under a Medicaid expansion to 133 percent of the FPL. Another 37.5 percent or 9.4 million have incomes between 133 and 399 percent of the FPL and would be eligible for subsidies to purchase insurance in a reformed market. Eleven percent or 2.8 million would not be eligible for either a Medicaid expansion or a subsidy due to their income being at least 400 percent of the FPL, but would still be required to purchase coverage under an individual mandate. Another 13.0 percent of uninsured childless adults would also not be eligible for Medicaid or subsidies because they are either unauthorized immigrants or authorized immigrants who have been in the country for less than five years

Urban Institute (2009). How will the uninsured be affected by health care? Lisa Dubay and Allison Cook

Full reports:

Non-Elderly Uninsured: http://www.rwjf.org/files/research/47860nonelderly.pdf

Uninsured Parents: http://www.rwjf.org/files/research/47860parents.pdf

Uninsured Childless Adults: http://www.rwjf.org/files/research/47860childlessadults.pdf

Uninsured Children: http://www.rwjf.org/files/research/47860kids.pdf