Fronstin P, Pierron B
EBRI Issue Brief. 1997 Jul(187):1-22.
This Issue Brief examines the issue of uninsured children. The budget reconciliation legislation currently under congressional consideration earmarks $16 billion for new initiatives to provide health insurance coverage to approximately 5 million of the 10 million uninsured children during the next five years. Proposals to expand coverage among children include the use of tax credits, subsidies, vouchers, Medicaid program expansion, and expansion of state programs. However, these proposals do not address the decline in employment-based health insurance coverage--the underlying cause of the lack of coverage, to the extent that a cause can be identified. What is worse, some proposals to expand health insurance among children may discourage employers from offering coverage. Between 1987 and 1995, the percentage of children with employment-based health insurance declined from 66.7 percent to 58.6 percent. Despite this trend, the percentage of children without any form of health insurance coverage barely increased. In 1987, 13.1 percent were uninsured, compared with 13.8 percent in 1995. Medicaid program expansions helped to alleviate the effects of the decline in employment-based health insurance coverage among children and the potential increase in the number of uninsured children. Between 1987 and 1995, the percentage of children enrolled in the Medicaid program increased from 15.5 percent to 23.2 percent. Some questions to consider in assessing approaches to improving children's health insurance coverage include the following: If the government intervenes, should it do so through a compulsory mechanism or a voluntary system? Is the employment-based system "worth saving" for children? In other words, are the market interventions necessary to keep this system functioning for children too regulatory, too intrusive, and too cumbersome to be practical? In addition to reforming the employment-based system, what reforms are necessary in order to reach those families who have no coverage through the work place? Which approaches are both efficient and politically acceptable? Employment-based coverage of children will likely continue. The challenge for lawmakers is to find a way to cover more uninsured children without eroding employment-based coverage. Several current legislative proposals attempt to avoid this problem by excluding children who have access to employment-based coverage. Without such a requirement, the opportunity to purchase coverage at a discount would create incentives for some low-income employees to drop dependent/family coverage, which in turn could lead some employers to drop their health plans.
本问题简报探讨了未参保儿童的问题。目前国会正在审议的预算协调立法拨款160亿美元用于新举措，以便在未来五年为1000万未参保儿童中的约500万提供医疗保险。扩大儿童医保覆盖范围的提议包括使用税收抵免、补贴、代金券、扩大医疗补助计划以及扩大州计划。然而，这些提议并未解决基于就业的医疗保险覆盖范围下降的问题——这是缺乏医保覆盖的根本原因，只要能确定原因的话。更糟糕的是，一些扩大儿童医疗保险的提议可能会阻碍雇主提供医保。1987年至1995年期间，参加基于就业的医疗保险的儿童比例从66.7%降至58.6%。尽管有这一趋势，但没有任何形式医疗保险覆盖的儿童比例几乎没有增加。1987年，13.1%的儿童未参保，1995年这一比例为13.8%。医疗补助计划的扩大有助于缓解儿童基于就业的医疗保险覆盖范围下降以及未参保儿童数量可能增加的影响。1987年至1995年期间，参加医疗补助计划的儿童比例从15.5%增至23.2%。在评估改善儿童医疗保险覆盖范围的方法时需要考虑的一些问题如下：如果政府进行干预，应该通过强制机制还是自愿系统？基于就业的系统对儿童来说“值得挽救”吗？换句话说，为使该系统继续为儿童发挥作用而进行的市场干预是否过于监管、过于侵扰且过于繁琐而不切实际？除了改革基于就业的系统之外，为了惠及那些无法通过工作单位获得医保的家庭，还需要进行哪些改革？哪些方法既有效又在政治上可行？基于就业的儿童医保覆盖可能会继续。立法者面临的挑战是找到一种方法，在不侵蚀基于就业的医保覆盖范围的情况下覆盖更多未参保儿童。目前的几项立法提案试图通过排除有机会获得基于就业的医保覆盖的儿童来避免这个问题。如果没有这样的要求，以折扣价购买医保的机会可能会促使一些低收入员工放弃受抚养人/家庭医保，这反过来可能导致一些雇主放弃他们的医保计划。
