This background report explores the insurance trends for the latter half of the 1990s and examines why the number of uninsured nonelderly Americans fell in 2000 for the second straight year.

Some of the key findings include:

— Between 1999 and 2000, the number of uninsured declined by 570,000; uninsured children actually declined by 700,000 while the number of uninsured adults increased by 130,000. Expansions in Medicaid and the State Children’s Health Insurance Program (SCHIP) led to the reduction in the uninsured rate for children. Employer coverage also increased for adults but public coverage did not and the result was an increase in the number of uninsured adults.

— There was a small increase in the rate of employer sponsored coverage among those living in families with at least one full time worker. However, the main reason for the increase in the rate of employer coverage in the non-elderly population was the huge increase in the number of people living in working families (18.5 million between 1994 and 2000).

— Another reason for the increase in employer sponsored insurance was the increase in employment in larger firms (1,000+ workers) where the likelihood of employer sponsored coverage was higher. Large firms employed 38.4 percent of workers in 1994 but accounted for 63 percent of the job growth between 1994 and 2000.

— Despite the recent gain in coverage for children, the trends in health insurance remain bleak. Between 1994 and 2000, a period of great economic prosperity, the uninsured rate was essentially unchanged from 17.3 percent in 1994 and 17.2 percent in 2000. While employer health coverage grew over this six year period, largely due to the movement of people up the income scale into jobs with health coverage, these gains were offset by declines in Medicaid and private individual coverage.

— Between 1994 and 1998, Medicaid coverage declined due to the loss of coverage following welfare reform and the expanding economy resulting in an increase in the number of uninsured. After 1998, increased enrollment in Medicaid and SCHIP of children combined with an increase in employer coverage contributed to the decline in the uninsured population. For adults, employer coverage increased for adults between 1994 and 2000, but Medicaid and private non-group coverage both fell with an increase in the uninsured rate over the period.

— From 1994 to 2000, the number of uninsured white Americans declined by 900,000 while the number of uninsured blacks increased by 500,000 and uninsured Hispanics by 1.9 million. Each group benefited from the strong growth in employer-sponsored coverage, but blacks and Hispanics were particularly adversely affected by the declines in Medicaid coverage.

• Report

This policy brief describes the current federal staffing requirements and how states separately regulate staffing levels in nursing homes. It also presents data showing actual staffing levels in over half of this country’s nursing homes exceed the levels that states and the federal government require.

This policy brief describes the resources, staffing, and performance of state licensing and certification agencies based on findings from a survey of state survey agency officials.

• Issue Paper

Health News Index July/August, 2002

The Health News Index measures public attention to and knowledge about leading health stories covered in the news in June and July, including discussions in Congress about a Medicare prescription drug benefit; a report from the National Institutes of Health on hormone replacement therapy; and the International AIDS Conference in Barcelona, Spain. The Health News Index is designed to help news media and people in the health field gain a better understanding of which health stories Americans are following and what they understand about those issues.

• HNI July-August 2002
• Topline/Survey

This memorandum provides background on the issue of contraceptive coverage and presents new findings from the soon to be released Kaiser/HRET 2002 Annual Survey of Employer-Sponsored Health Benefits.

• Employer Based Coverage of Contraception

This report summarizes the key findings from the largest ever national survey of South African teenagers on their attitudes towards issues such as sex, gender, and substance abuse, as well as their aspirations for the future. This nationally representative random sample of 2,000 South Africans aged 12-17 years shows that young South Africans are overwhelmingly optimistic about the future of South Africa and filled with the usual aspirations and ambitions of youth. However, most young South Africans fear they might not live to realize their dreams and that South Africa’s future prospects may be overwhelmed by the HIV/AIDS epidemic. The personal risk of HIV/AIDS, as well as it’s impact on friends, families and the country’s future are a major preoccupation for young people.

More than 40% of South Africans are under 15 years of age. These young South Africans are at great risk of HIV infection. At the current rate of infection more than 50% of South Africans under 15 today could die of AIDS-related causes in the next five to ten years. On the one hand, most young South Africans say they are happy with their lives, but at the same time they are also struggling with very serious issues. The AIDS epidemic is a particular source of fear and concern. While almost all young people say they accept responsibility for protecting themselves from the virus, many still do not know important facts about the disease and how it is prevented or treated. Moreover, many sexually active teens are making unsafe choices and hold attitudes that put them at risk for HIV infection.

While young South Africans generally spend large parts of their time doing the things young people do everywhere – watching television, listening to the radio or “hanging out” with friends – poverty is a major factor in the lives of a large proportion of young South Africans. About one third of young South Africans are living in households with less than R1,000 ($130) income per month. Approximately one third of black respondents reported going hungry and many are living in homes that are overcrowded and lack basic amenities such as electricity and sewerage. Most respondents said that if they had money they would spend it on food.

Although the risk of HIV/AIDS looms large in the lives of young South Africans, 65% indicate that they are worried about their personal safety. Crime is the greatest concern (72%), but 62% of respondents cited the fear of sexual or physical abuse as a concern. Many young South Africans are sexually active. About one third of boys and girls aged 12-17 have had sexual intercourse. One in five (18%) of this group reported having their first sexual experience at the age of 12 or younger. Most teenagers say they first learned about sex from their friends and peer pressure and coercion play a significant role in adolescent sexual behaviour. Sex is also often used as a commodity in exchange for money or other forms of payment. Twenty-eight percent of young South Africans indicate they know people their age who have sex for money, and 16% of sexually experienced girls interviewed said they themselves have had sex for money, drinks, food or other gifts.

Although nearly three quarters of respondents say they are positive about the future of South Africa, white and Indian youth in particular are less positive, and 39% of all young South Africans indicate that they will probably leave South Africa someday. Although 8 in 10 respondents say they feel happy mixing with people of all races, 71% said they only have friends of their own race. But the vast majority believe they should participate in determining the country’s future with 88% of respondents saying they think it important to vote in an election.

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This focus group study is of New Yorkers who enrolled in Disaster Relief Medicaid (DRM), a temporary public health insurance program created after the September 11th attacks. It is based on findings from six focus groups conducted with Hispanic, Chinese, and African American New Yorkers.

An issue brief that looks at mandated health insurance benefits and the tradeoffs among benefits, coverage, and costs. It explores the debate over mandated benefits legislation, the evidence about the impact of mandates, the status of mandated benefits in other states and in California.

An issue update that provides preliminary results from a survey of the 50 states and the District of Columbia on their plans to constrain Medicaid cost growth. The full survey will be released in September.

• Issue Update

Updated, July 31, 2002

This document, prepared by Health Policy Alternatives, Inc., provides a side-by-side comparison of five major federal proposals to provide outpatient prescription drug coverage to Medicare beneficiaries, introduced as of July 31, 2002: H.R. 4954, The Medicare Modernization and Prescription Drug Act of 2002 (passed by the House of Representatives on June 28, 2002); H.R. 5019, The Medicare Rx Drug Benefit and Discount Act of 2002 (Rep. Rangel/House Democratic proposal); S. 2625, The Medicare Outpatient Prescription Drug Act of 2002 (Sen. Graham/Senate Democratic Proposal, including modifications in the Graham Amendment to S.812);S. 2729, The 21st Century Medicare Act (known as the Tripartisan Proposal); andS. 2736, The Medicare Rx Drug Discount and Security Act of 2002 (Sen. Hagel). Modeled on earlier side-by-side comparisons prepared for The Kaiser Family Foundation, this document summarizes the key provisions of leading proposals as part of the Foundation’s continuing effort to track the Medicare prescription drug debate. This side-by-side may be updated to include additional proposals.

• Report