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Posts tagged as “health insurance”

First take/insurance

From a report by the Census Bureau:

Between 2013 and 2014, the majority of metropolitan areas saw an increase in the percentage of people covered by health insurance, according to statistics released today from the U.S. Census Bureau’s American Community Survey, the nation’s most comprehensive information source on American households. The 2014 American Community Survey provides statistics on over 40 social, economic and housing topics for U.S. communities with populations of 65,000 or more.

Between 2013 and 2014, all 50 states and the District of Columbia saw an increase in the percentage of people covered by health insurance.

“American Community Survey statistics inform us of how communities evolve and change, allowing us to see the effects of everything from natural disasters to new laws and policies,” Census Bureau Director John H. Thompson said. “Each new year of statistics provides fresh information for the public to use and compare with the year before, helping to tell America’s story and that of communities from Boston to Honolulu and everywhere in between.”

The percentage of people with private health insurance increased in 18 of the 25 largest metropolitan areas between 2013 and 2014. The Miami metro area, which had one of the lowest rates of private health insurance, had one of the largest percentage point increases from 50.5 percent in 2013 to 54.7 percent in 2014. On the other hand, the Boston metro area, which had one of the highest rates, saw a 1.1 percentage point decrease from 76.7 percent in 2013 to 75.6 percent.

Between 2013 and 2014, 22 of the 25 largest metro areas saw an increase in the percentage of people covered by public health insurance. The largest change was in the Portland, Ore., metro area with a 5.6 percentage point increase from 27.1 percent in 2013 to 32.7 percent in 2014.

Below are highlights of the local-level health insurance, income and poverty statistics that complement the national-level statistics released Wednesday from the Current Population Survey. For more information on the topics included in the American Community Survey, ranging from educational attainment to computer use to commuting, please visit census.gov. (photo/Robert Kauffman)

Well, we have state insurance funds . . .

The widely-expressed fear of a federal health insurance fund - a federal health insurer of last resort - doesn't just seem but is simply weird. If nothing of the sort had been tried before, that, might be another matter; if we had to look solely to other countries for counterparts, that might give some understandable pause too. But there are already a number of more limited programs long in existence. The point that Medicare has done a similar job (it's been underfunded, but still does remarkably well with great efficiency) has been made often enough. But there are other examples too.

Odd that the state insurance funds have been so little mentioned in all of this. A lot of people in the country, and everyone in the Northwest, has been living comfortably with those for years, even if relatively few people pay a lot of attention to them.

A bit of history. About a century ago, a movement developed to provide health protection for workers and compensation (formerly workmen's, now worker's) for injuries and other health issues growing out of the workplace; the gain to employers was some immunity from lawsuits. Wisconsin passed a worker comp law in 1911, and all other states had done the same by 1948; about 98% of workers around the country are estimated to be covered. Among other things, this meant that employers had to provide some sort of insurance for their workers.

Nationally, much of this insurance was and remains private - conventional private insurers writing policies. But a dozen states, responding to concerns (we're talking about the 1910s and 1920s here) by businesses that they couldn't easily afford the premiums, decided to set up their own worker comp insurance funds, not to take over the market as a monopoly, but to provide an alternative to private insurance coverage that had become unaffordable. (Does this situation suggest any parallels to today?) The states doing this included Oregon, Washington and Idaho.

In Oregon, this is the State Accident Insurance Fund (SAIF), set up as a state agency in 1914, and in 1980 re-designated as a state-chartered corporation; but its board of directors is appointed by the governor. It writes about half of the worker comp policies in the state, covering somewhat over a half-million people. There has been some controversy surrounding it, including some legislative complaints about public disclosure. But when another insurer led a ballot initiative effort in 2004 to abolish SAIF and move to an all-private insurance system, 61% of the voters backed SAIF.

Idaho created the State Insurance Fund in 1917, as it site says "for the purpose of providing a reliable source of workers compensation insurance for Idaho employers and to provide security for the payment of benefits to covered workers. The law provides for the State Insurance Fund to be self-supporting from premium and investment earnings. The State Insurance Fund is not tax-supported and the State of Idaho is not liable for any indebtedness incurred by the Fund." There've been a few small dustups concerning the SIF over the years, but nothing massive. It too historically has insured around half of the worker comp cases in the state, with private insurers splitting up the other half.

Washington runs a worker comp insurance program through its Department of Labor and Industries, a direct state agency as opposed to the slight remove in Oregon and Idaho. In its description, "The agency manages claims and pays benefits out of an insurance pool called the Washington State Fund. The fund is financed by premiums paid by employers and employees." That's in line with the Oregon and Idaho programs.

In all three cases, private employers have the option of where to get their worker comp insurance, and not everyone goes for the state option. But the state option numbers do seem stable. One reason may find reflection in an incident in 2002 involving the Association of Washington Business, when the insurance fund there announced a 41% rate increase. Post-outcry, that increase was lowered to 29%, still large and of concern to the business community. But if you follow the link to the AWB's press release, notice the tone: There's a sense that these rates and conditions can be negotiable. They may have recognized that similar negotiations with a private insurer, where no political leverage is to be had, would be a more difficult proposition.

At the same time, these state programs haven't driven private insurers out of the market. A bunch of companies do this, either as a major part of their business or as a smaller stream. Options are out there.

Other states, California being one of them, have similar programs. None are perfect. Most seem to work at least reasonably well.

Well enough, in fact, that the thought has occurred here: Why not extend these worker comp programs to provide health insurance generally?

WA: 867,000, no insurance for you

Kreidler

Mike Kreidler

Only a number, maybe, but what ought to be a big number: 876,000, the number of people in the state of Washington who by year's end are expected to have no health insurance.

Washington Insurance Commissioner Mike Kreidler talked (timely, given the health talk going on in the other Washington) about how his office came up with the estimate. After that, there was a piece of sort-of good news from the state Health Care Authority, that earlier reports about tens of thousands of residents being dropped from the state basic health plan will not materialize. None of that affects the 876,000 estimate, though.

uninsured

Kreidler chart

What this will establish immediately beyond more hand-wringing isn't clear. But maybe it provides a little more impetus to the state's congressional delegation as it considers where to land in the emerging health care policy battle. The commissioner himself seemed to acknowledge as much in his statement - some reliance on solutions coming from a couple time zones away.

From Kriedler's release: (more…)