Spring, 1998, Vol. 4, No. 2

Health Care and Work: Trends to Watch

By Mary Ohannessian

The health care system in the United States is vast, varied and continually evolving. Managed care, the role of the public sector, technological advancements, the aging of the population and an increasingly comprehensive view of epidemiology are but a few of the challenges in today's health care environment. Central to the complexity of health care is the role of the private sector, as access to health care in America has long been tied to insurance benefits gained through employment. Below provides a starting point from which to think about the major health care issues as they relate to work, poverty and the need to advocate for those who fall both within and outside of the safety net.

Employer-Sponsored Health Insurance
* The percentage of non-elderly (under age 65) with employment-based health insurance is declining, from 69% in 1987 to 63% in 1995, ranging from 75% in Wisconsin to 45% in New Mexico. (ERBI).

* Part-time workers are more likely to be uninsured. In 1995, 63% of full-time workers received employment-based health insurance in their own name, compared to only 20% of part-time workers (ERBI).

* The public sector is becoming the major payor of health care. 54% ($532 billion) of all health care spending came from private sources in 1995 compared to 75% in 1960. Currently, the government accounts for 46% ($456 billion) of health care spending. In 1960 before the enactment of Medicare and Medicaid, the federal government spent only $2.7 billion (ERBI).

Managed Care
* Previously, payments made by private payors functioned to subsidize the care of the uninsured. The growth of managed care as a dominant delivery system for employment-based health insurance has had a major impact on how health care is paid for, reducing the ability for health care providers to "cost shift" and thus provide uncompensated care, particularly in urban areas.

Welfare Reform and the State Child Health Insurance Plan (S-CHIP)
* Historically, Medicaid has been tied to AFDC eligibility. The new time limits imposed by TANF raise questions as to how states will handle the transition between welfare to work with no health benefits. In addition, will ineligibility from TANF due to work requirements and time limits disqualify those individuals from Medicaid?

* Some observers worry that the enactment of S-CHIP, which expands health insurance coverage to low-income children, will erode employment-based health insurance, further jeopardizing the uninsured working poor and burdening the public sector.

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