This article first appeared in the St. Louis Beacon, June 27, 2011 - Moderate-income Missourians are among the biggest losers in the nationwide decline of employer-sponsored health coverage.
The portion of Missourians with health insurance through employer-sponsored plans dipped nearly 12 percent between 1999 and 2009, according to a report by the University of Minnesota and released by the Robert Wood Johnson Foundation.
Missouri is one of a dozen states that experienced declines of 10 percentage points or more in employer-sponsored health insurance during that decade, the study said. The other states were Arizona, Arkansas, Indiana, Michigan, Minnesota, Mississippi, North Carolina, Ohio, Rhode Island, Tennessee and Texas.
In spite of the nationwide decline, employer-sponsored coverage remains the predominant source of health insurance for non-elderly Americans. While the erosion occurred at all income levels, the report said more than half of those losing this insurance had moderate incomes. These are individuals or families earning between 200 percent and 399 percent of the federal poverty level -- or between $44,000 and $88,000 for a family of four.
In Missouri, the report said, employer-sponsored insurance dipped 11.7 percent for families in that income range, compared to a national drop of 6.3 percent for such families between 1999 and 2009, the most recent data available.
The decline was lowest, both nationally and in Missouri, among families earning more than 400 percent of the poverty level. For a family of four, that's an income higher than $88,000 a year. Missouri families in that category fared slightly better than the national picture, with only 2 percent losing employer health coverage, compared to 2.2 percent of such families nationally.
The report noted that nearly all companies that offer health insurance make dependent coverage available. Usually, the report said, if any family member is covered, the entire family is covered.
But whole-family coverage declined to 82 from 86 percent, the report said, adding that Missouri, Iowa and Mississippi were four states where the decline was twice as large as the national average.
According to the report, the decline in whole family coverage means that it's dependents rather than employees who are losing insurance. Of the 7.3 million Americans who lost employer-sponsored insurance between 1999 and 2009, the study said 4.1 million or roughly 57 percent were dependents, such as spouses and children.
Economic conditions and job losses have affected the employer insurance picture, the study reported. Some decline in employer coverage may be related to premium costs, noting that employee contributions are typically much higher for family coverage. The study found that a typical employee's share of a premium in Missouri was nearly 23 percent in 2009, compared to about 16 percent in 1999 -- a difference of 6.7 percent.
Nationally, the number of policyholders with employer insurance fell by 3.1 million between 1999 and 2009, with Missouri being among the states experiencing the largest declines in these policies, the report said.
Bruce Gosser of Gosser Group, a health care consulting firm in St. Louis, said he isn't surprised by the Missouri numbers. The rising cost of health insurance, the economy and perhaps the number of small businesses in Missouri could all affect the availability of employer-sponsored health insurance
"The high level of unemployment, which has been over 9 percent, certainly has caused lots of Missouri workers to lose their jobs and their health benefits," he said. "Beyond that is the cost of health care. It's a hidden cost for employers for every worker hired. We shouldn't rule out that factor, particularly for small businesses. This rising cost has forced some of them to drop health insurance. I would also suggest that the numbers in Missouri could be higher because Missouri has a fairly high percentage of small employers relative to some other states."
A separate report by the Urban Institute pointed to hope for the uninsured in the form of the Affordable Care Act. Noting that small businesses tend to have the most difficulty providing health insurance, the institute notes that ACA will offer some relief. The law is expected to help small firms save on health insurance through insurance exchanges and subsidies. Some workers will benefit from the expansion of Medicaid under ACA. The expansion is expected to offer insurance to some whose incomes otherwise would be too high to qualify for Medicaid, the health insurance program for the needy.
In spite of the promise of the new health law, there is no guarantee that it will survive in its current form. Many states have sued to block the law. Some portions of the legislation are already in effect, and full implementation of the law is scheduled for 2014.
Funding for the Beacon's health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization that aims to improve the health of the people in the communities it serves.