Why does the number of uninsured Americans continue to grow?

Declining employer-sponsored coverage from the 1970s to the mid-1990s has been attributed to a variety of factors: the shift from manufacturing to servicesector jobs, increased temporary and parttime employment, decreasing unionization, a decline in real wages, and growth in health care costs. During the late 1980s and early 1990s this decline was partially offset by large increases in Medicaid coverage, which served to slow increases in the uninsurance rate. In this paper we use data from the Current Population Survey (CPS) to compare changes in insurance coverage over a more recent period, 1994–1998, with those in the period 1989–1993. During the latter years some of the conditions that caused the earlier reduction in employer-sponsored coverage and increases in the uninsurance rate reversed. The economy emerged from the 1990–1992 recession and had a sustained period of rapid economic growth. Real incomes rose, and the growth in health care costs slowed. In addition, the expansions of Medicaid coverage to children and pregnant women had been largely phased in and were no longer a source of significant growth, and state welfare reform efforts began to adversely affect Medicaid enrollment. We examine the 1994–1998 period in greater depth to show changes in insurance coverage for various subgroups. Reasons For Two Study Periods