...depend on the insurance system to behave in ways that are responsive to public health in prevention and crisis management.

Karen Pollitz

Seventy-five percent of the American population, excluding the elderly, has coverage through the private health insurance system. Ninety percent of this group receives their insurance through employer-sponsored programs, and the remaining ten percent buy their own coverage. Approximately ten percent of the non-elderly population has insurance through a government program, and fifteen percent of the non-elderly population, almost forty-one million Americans, is uninsured.

The increase in the uninsured is due to a decline in employer-sponsored coverage. Almost ninety-nine percent of extremely large companies offer health benefits to their workers, though only two-thirds of small employers offer coverage, and that number is declining. The Medicaid program has expanded, particularly with the creation of the Children's Health Insurance Program in the late 1990s. However, states are experiencing record fiscal crises, and many Medicaid programs are seeing reductions in funding at the state level.

Trends in the content of coverage also are disturbing. In recent years there has been an aggressive shifting of costs to employees and...

NOTE: All illustrations and photos have been removed from this article.



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