Why Employer-Sponsored Insurance Coverage Changed, 1997-2003

May/June 2006
Health Affairs, Vol. 25, No. 3
James D. Reschovsky, Bradley C. Strunk, Paul B. Ginsburg

Four and a half million Americans gained employer-sponsored health insurance coverage during 1997–2001, while nearly nine million lost coverage in the ensuing economic downturn (2001–2003), after population growth was accounted for. Macroeconomic trends affecting employment, job quality, and incomes drove most of the coverage changes, although key factors varied during the two periods. Take-up rates affected coverage, mostly reflecting the interaction of premium cost trends and labor-market tightness, but take-up also was influenced by the implementation of the State Children’s Health Insurance Program (SCHIP) during 1997–2001. Coverage among low-income people was most affected by economic conditions and premium costs.

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