OP-ED | Connecticut’s Unisured Rate Up, Especially for Higher Income Households
New Census data on the number of uninsured in Connecticut included a surprise this year. About 194,000 Connecticut residents were uninsured last year, up almost 22,000 from the year before.
People without health coverage are less likely to get needed care, more likely to be diagnosed later for diseases like cancer, tend to be in worse health, pay higher prices for their care, and risk financial ruin.
While this increase reverses a four-year trend of reducing the number of uninsured and mirrors rising national rates, we are still doing far better than other states. The number of uninsured rose among all races, possibly erasing some progress in reducing disparities. Hispanics, residents with less education, non-citizens and part-time workers remain at highest risk of lacking coverage in Connecticut. The recent narrowing of racial disparities in coverage may be reversing. Unfortunately, none of this is unexpected.
The surprise was the rise in uninsured among higher income Connecticut residents. In 2015, residents of households with incomes below $25,000 accounted for 20 percent of all uninsured Connecticut residents while households with incomes over $100,000 accounted for 21 percent, about the same number. That’s surprising enough but, by last year those higher income households accounted for 25 percent of uninsured state residents, while residents in the lowest income households accounted for only 16 percent of the Connecticut’s uninsured. While it’s still true that the highest rate of uninsured is among households with incomes between $25,000 and $50,000, their rate is the only one that dropped last year. Among household income ranges, only those over $100,000 saw an increase in the number of uninsured from 2015 to 2017.
The likely causes of this counter-intuitive trend is the rising cost of health insurance and eroding employer-sponsored coverage.
Employer-sponsored coverage dropped a bit last year, impacting all workers including higher income households. But that rate has been steadily dropping for years, down from 69 percent in 2008 to 60 percent last year. Contrary to common perception, the Affordable Care Act isn’t the reason. The downturn long pre-dated implementation of the ACA. The recession had far more impact on coverage in Connecticut than the ACA. During the recession, between 2008 and 2013, employer-sponsored coverage in Connecticut fell by 213,000; after ACA expansions, from 2013 to 2017, it fell only 32,000. Medicaid also grew more in Connecticut during the recession, likely due to employment losses, than in the ACA expansion. Losing employer coverage forces many into the individual insurance market, if they can afford it.
Higher income state residents shoulder the entire burden of rising healthcare costs as they do not qualify for insurance subsidies or public coverage programs. Insurance premiums grew substantially in 2017. While the Connecticut Insurance Department lowered requests from insurance companies, approved premium increases averaged 25 percent and reached as high as 53 percent for some plans. The stunning increases were prompted by the Trump administration decision to discontinue the federal risk adjustment program. That program equalized rates between insurers making rates more fair and removing incentives to avoid costly people. Steadily rising prices for healthcare services also contributed to premium increases last year. By law, the insurance department is not allowed to consider affordability in reviewing rate increases.
While lower income state residents remain at highest risk of being uninsured, the burden on higher income Connecticut residents is growing. Federal insurance subsidies and public coverage like Medicaid remains out of reach for these families. Without national health reform, their best hope is that Connecticut find a way to lower healthcare costs. We know how to do that, and what doesn’t work. Let’s get to it.
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