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3 Insurance Transitions Over the Family Life Cycle
Pages 46-63

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From page 46...
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From page 47...
... Some of the transitions indicate where families bump up against the rules of coverage set by private insurers and public programs. In this chapter, three kinds of transitions are particularly relevant: Age: As individuals within families age, their health insurance status may change because of rules in public programs and private plans.
From page 48...
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From page 49...
... Comparing "uninsured" with "insured" at a given point in time overlooks the fact that many families may have members uninsured for short or long periods that cannot be detected simply by knowing their current insurance status.) A lack of continuity in health insurance coverage can adversely affect access and health outcomes (IOM, 2001; 2002a)
From page 50...
... Marital status is for persons age 16 and over. SOURCE: Monheit et al., 2001b.
From page 51...
... AGE ISSUES AFFECTING INSURANCE PATTERNS WITHIN FAMILIES Finding: The structure of public health insurance programs and the cutoff age for dependents eligibility in private insurance plans make it more likely that children will become uninsured as they grow up. The probability that a person will be without health insurance varies with age and the type of family in which he or she lives.
From page 52...
... in private coverage, too. For Medicaid, eligibility based solely on family income usually ends at age 19, although states have the option to cover youth through age 21.
From page 53...
... The large increase in young people losing coverage beginning at age 19 is a result of how both private insurers and public programs define eligible family members. The rules for private insurance vary somewhat.
From page 54...
... Alternatively, a job that increases family income but that does not offer affordable or any health insurance coverage can have a negative effect on coverage by precluding a family s eligibility for public coverage. It is important to remember that most of those without insurance are in working families, but many jobs do not offer coverage.
From page 55...
... Families with spouses who both work may avoid job lock if both have access to employment-based coverage with similarly generous benefits and affordable premiums. One study found that the job mobility of husbands is 25 to 32 percent lower when their wives do not have employment-based health insurance and the mobility of wives is 49 percent lower when their husbands do not have health insurance compared to their counterparts with insured spouses (Buchmueller and Valletta, 1996~.
From page 56...
... It does not limit preexisting condition exclusions for those who have not had health insurance, nor does it limit the premium charged for the insurance (Health Care Financing Administration, 2002~. Work and Public Insurance Programs Single-parent families have only one opportunity to obtain employmentbased coverage through the employment of an adult family member Some working parents who do not have employment-based insurance are covered by public programs and may lose their own and their children s coverage if their earnings exceed the state-set level.
From page 57...
... It attempted to expand an existing program, the Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA) and proposed alternative approaches to protect former workers and their families, but did not reach political agreement on the best approach.4 3Welfare reform legislation, the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA)
From page 58...
... Under COBRA, workers who leave their jobs, or experience a reduction in hours worked below the level that would quali6r them for health benefits, may continue in their employer s plan. Those who lose coverage for family-related reasons are guaranteed access for 36 months, for example, if a spouse becomes entitled to Medicare or following divorce.
From page 59...
... Marriage Marriage brings the opportunity to obtain health insurance coverage through one s spouse s employer, if it is offered. If both spouses work, they might obtain health insurance coverage from either employer.
From page 60...
... Cohabiting couples make up one-fourth of all stepfamilies (Bumpass et al., 1995~. Children in these stepfarnilies are unlikely to have health insurance coverage through their parent s partner s employer, although they may retain coverage through their absent parent.
From page 61...
... Health insurance for children through a noncustodial parent was most common where a child support award or agreement was in place and the award or agreement included health insurance. In these 4.6 million cases with agreements to provide health insurance, custodial parents reported that the absent parent provided health insurance 44 percent of the time.
From page 62...
... Coverage from outside the household for children with nevermarried parents increased from 4 percent to 12 percent and to 21 percent for children of ever-married parents. However, the absolute level of private coverage remained the same, which suggests some combination of custodial parents being less likely to have jobs that bring coverage for dependent children, and custodial parents moving children to the absent parent s coverage.
From page 63...
... Not all workers have a choice of a job with affordable employee and dependent coverage. Not all lower-income families are fortunate enough to live in a state with expansive public programs.


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