1. Trends in Health Insurance Coverage in the U.S. Sherry Glied, Ph.D. Assistant Secretary for Planning and Evaluation

2. Declining Coverage – What are the Sources of the Problems? Costs are rising relative to family incomes Costs of obtaining coverage are very high for small firms and for individuals The small firm and individual insurance markets are subject to risk selection (by insurers) and averse selection (by insureds) Limited capacity to smooth economic downturns

3. 33 Decreased Employer-Sponsored Coverage Is Closely Linked to Decreased Affordability SOURCE: T Gilmer and R Kronick. “Hard times and health insurance: how many Americans will be uninsured by 2010?” Health Affairs, May 18,2009. Reprinted with permission.

4. 4 44 Decline in Private Firms Offering Coverage Is Concentrated Among Small Employers SOURCE: ASPE Analysis of MEPS-IC Note: Significant change from 1999-2009 at p<0.05 level for small firms

5. 5 5 The Share of Americans Who Purchase in the Individual Market Is Declining SOURCE: ASPE analysis of 1997 - 2007 MEPS-HC. Percentages reflect non-elderly persons with at least one-month of individual coverage during the year.

6. Trends in the Purchase of Individual Coverage Vary by Age Source: AHRQ analysis of MEPS-HC

7. 7 7 Many People Hold Individual Insurance Coverage Only for Short Periods SOURCE: AHRQ analysis of MEPS-HC

8. 8 8 Denial Rates in the Individual Market Are High for All Groups But Particularly for Those Over 55 SOURCE: America’s Health Insurance Plans, Individual Health Insurance 2009: A Comprehensive Study of Premiums, Availability, and Benefits (October 2009)

9. Annual Unemployment Rate, 1997-2009

10. Unemployment Rate, By Age January 2000 – October 2010

11. Share of Children, Parents and Other Adults Enrolled in Medicaid

12. Affordable Care Act Provisions Affecting Coverage Immediate –Coverage of adult children to 26 –PCIPs –Small firm tax credits 2014 –Exchanges –Premium tax credits and cost sharing reductions –Medicaid Expansions

13. Research Agenda Developing capacity to routinely track key indicators of Affordable Care Act outcomes Developing baseline data and structure for external and internal evaluation of Affordable Care Act and its components

14. Sherry Glied, Ph.D. Assistant Secretary for Planning and Evaluation U.S. Department of Health and Human Services sherry.glied@hhs.gov 202-690-7858 www.aspe.hhs.gov