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Programs to help the poor purchase nongroup health insurance may not have the intended effect

Employment-based health insurance coverage is declining in the United States. In fact, many recent efforts to increase insurance coverage promote the purchase of individual versus group insurance. But based on earlier trends, such programs may simply widen coverage gaps between the less educated, poor, and minority groups and others, concludes a study supported by the Agency for Healthcare Research and Quality (HS07253).

The study found that in the late 1980s, lower income and less wealthy households were much less likely to purchase nongroup insurance than higher income and wealthier households. Also, minorities had less than half the odds of non-Hispanic whites, and people with less than a high school education had less than half the odds of college graduates, of purchasing nongroup insurance. These findings held after adjustment for other factors affecting health plan purchase, such as health status and attitudes toward health care.

A number of States have established programs aimed at making health insurance financially more accessible to uninsured residents, often subsidizing premiums based on a sliding scale for lower income individuals. If premium subsidies are to be used to "level the playing field" for income as a potential barrier to obtaining health insurance in subsidized programs, these findings support some subsidy. However, for the uninsured, the price of nongroup insurance appeared to play a more abstract than particular role, since the majority who remained uninsured never priced insurance. Only 37 percent of uninsured households had ever priced health insurance, and only 4.2 percent reported ever being refused or limited in coverage.

University of Washington researchers Barry G. Saver, M.D., M.P.H., and Mark P. Doescher, M.D., M.S.P.H., based their findings on analysis of data from 2,574 households participating in the 1987 National Medical Expenditure Survey (NMES) who were either uninsured or purchased nongroup, private health insurance for 1987. They correlated minority group membership, educational attainment, income, and wealth with the purchase of nongroup insurance.

See "To buy, or not to buy: Factors associated with the purchase of non-group, private health insurance," by Drs. Saver and Doescher, in the February 2000 Medical Care 38, pp. 141-151.

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