Received 16 February 2007; received in revised form 13 July 2007; accepted 3 October 2007.
Background
In the fragmented US health insurance system, women’s health insurance coverage is an outcome both of changes in the availability of private and public health insurance and of changing patterns of labor force participation and household formation. Over the past 2 decades, women’s socioeconomic circumstances have changed and public policy around health insurance coverage for low-income women has also undergone substantial modification.
Methods
This study examines the roles of these changes in circumstances and policy on the level and composition of women’s health insurance. Using the Census Bureau’s March Current Population Survey 1980–2005, the government’s principal source of nationally representative labor market and health insurance data, we examine how changes in marriage, full-time and part-time labor force participation, and public policy around coverage affected the level and source of women’s health insurance coverage over 3 periods: 1980–1987, 1988–1994, and 1995–2005.
Results
Health insurance coverage rates have fallen for both women and men since 1980. What makes women different is that, in addition to the decline in coverage, the composition of health insurance coverage for women has also changed markedly. More women now obtain health insurance on their own, rather than as dependents, than did in 1980. A larger fraction of insured women are now enrolled in Medicaid than were in 1980. Women’s routes to coverage have changed as their social and economic circumstances have changed and as policy, especially Medicaid policy, has evolved.
Conclusions
Women’s channels for obtaining health insurance coverage are more fragmented than those of men. The availability of multiple sources of coverage, and the possibility of moving amongst them, have not, however, insulated women from the overall declines in health insurance coverage caused by the rising cost of private health insurance.
Mailman School of Public Health, Columbia University, New York, New York
Correspondence to: Sherry Glied, PhD, Department of Health Policy and Management, Mailman School of Public Health, Columbia University, 600 West 168th Street, 6th Floor New York, NY 10032; Phone: 212-305-4031; Fax: 212-305-3405.
Supported by a grant from the Commonwealth Fund.
7 Sherry Glied, PhD, is Professor and Chair in the Department of Health Policy and Management at Columbia University’s Mailman School of Public Health. She is an economist whose research focuses on health insurance coverage and mental health policy.
8 Kathrine Jack, JD, is a recent graduate of Indiana University School of Law. She is currently employed as a special project attorney at the National Advocates for Pregnant Women. She wrote this paper while working as a research assistant at Columbia University.
9 Jason Rachlin, BA, MS, is currently working at the Bank of Montreal specializing in the risk management of their trading operations. When he wrote this paper, he was a research assistant at Columbia University.
ABSTRACT