Introduction
From 1999 to 2011, the proportion of individuals covered by ESI decreased by approximately 15 percent nationwide.1 In Michigan during that time, the percentage of people with ESI fell by 20 percent, the second greatest reduction among all states, exceeded only by South Carolina.2 In spite of these declines, in 2011 the proportion of people covered by employer-sponsored plans in Michigan remained 4.5 percentage points higher than the national average, in part because a larger percentage of employers in Michigan have historically offered health insurance.
This issue brief describes trends in private health insurance coverage in Michigan and the U.S., and focuses on coverage both by industry type and by income level. Key findings include:
- The percentage of people with private coverage declined by more than 4 percentage points in both Michigan and the nation from 2008 to 2011. Reductions in the proportion of people with employer-based plans drove the overall decline in private coverage nationally and in Michigan, while the proportion of people with individually purchased coverage fell more slowly.
- The percentage of employers offering health benefits fell by approximately 5 percentage points from 2008 to 2011 in Michigan and the U.S. However, a larger proportion of employers in several industries in Michigan offered benefits in 2011, compared to the national average, including manufacturing, agriculture, and construction.
- In Michigan from 2010 to 2011, approximately 55,000 low-income people aged 18 to 25 years gained or retained private insurance as a result of the Affordable Care Act (ACA).
Trends in Private Insurance Coverage
The economic recession from 2007 to 2009 contributed to the decline, as did the rising cost of health insurance premiums.3 4The most rapid decline in coverage was from 2008 to 2009, with a drop of 3.1 percentage points in Michigan and 2.2 percentage points nationally. In the following two years, private coverage declined more slowly.5
FIGURE 1: Proportion of the Population with Private Insurance, U.S. and Michigan, 2008–2011
Source: CHRT, using American Community Survey (SHADAC) data, 2013
Private insurance can be directly purchased by individuals or can be provided through an employer-sponsored plan. From 2008 to 2011, most people with private insurance received coverage as a benefit of employment. Reductions in the proportion of people covered by ESI during those years drove the overall declines in private coverage. The decline of ESI is due in part to reductions in the number of employers who offer health benefits, as well as increasing numbers of part-time workers, who may not be eligible for benefits. Affordability may also be a factor, as fewer workers enroll in employer-sponsored plans due to cost sharing, and more people are unemployed.6 Although the proportion of people with ESI declined faster in Michigan (5.1 percentage points) than in the nation overall (3.9 percentage points), the proportion of people enrolled in employer-sponsored plans remained higher in Michigan in 2011 than in the U.S.
The proportion of people with individually purchased coverage did not change as much as did employer-sponsored coverage between 2008 and 2011. Individual coverage fell by only 1.9 percentage points in the nation and by 0.7 percentage points in Michigan. In 2008, 14.1 percent of the population bought insurance individually in the U.S. and 12.9 percent did so in Michigan. In 2011, 12.2 percent of people nationally and in Michigan purchased coverage in the individual market.
FIGURE 2: Proportion of the Population with Private Insurance, ESI and Individual Plans, U.S. and Michigan, 2008–2011
Overall Private Health Coverage | Employer-Sponsored Insurance | Individual Coverage | ||||
---|---|---|---|---|---|---|
Year | U.S. | Michigan | U.S. | Michigan | U.S. | Michigan |
2008 | 69.8% | 73.2% | 60.6% | 65.1% | 14.1% | 12.9% |
2009 | 67.6% | 70.1% | 58.5% | 61.7% | 13.1% | 12.6% |
2010 | 66.0% | 68.9% | 56.9% | 60.5% | 12.7% | 12.5% |
2011 | 65.4% | 68.5% | 56.7% | 60.0% | 12.2% | 12.2% |
Source: CHRT, using American Community Survey (SHADAC) data, 2013
Employer-Sponsored Insurance by Industry
FIGURE 3: Percent of Employers that Offer ESI, U.S. and Michigan, 2008–2011
Source: CHRT, using Medical Expenditure Panel Survey data, 2013
In 2011, a larger proportion of Michigan employers in several industries offered ESI than employers in these industries nationally. The largest differential between Michigan and national employers was in the agriculture, fishing, forestry, and construction industries: 40.2 percent of Michigan employers in these industries offered health benefits in 2011, compared to 35.2 percent of such employers nationally. A similar differential existed in the mining and manufacturing industry, which includes the auto-manufacturers. A larger percentage of employers in the retail and service industries in Michigan also offered benefits in 2011, compared to such employers nationwide. However, the proportion of Michigan employers in professional services and all other industries offering benefits was lower than the national average in those industries.
FIGURE 4: Percentage of Private Sector Businesses Offering Health Insurance by Industry Type, U.S. and Michigan, 2011
Source: CHRT, using Medical Expenditure Panel Survey data, 2013
Private Health Insurance by Federal Poverty Guideline
People in Michigan whose income was below 138 percent of the FPG experienced a significant8 increase in private coverage (1.3 percentage points) between 2008 and 2011. This low-income group experienced both gains and losses in private coverage in recent years, but the overall gain in 2011 is attributable to the ACA provision that allowed young adults up to age of 26 to be covered by their parents’ insurance plans beginning in 2010. In Michigan, nearly 97 percent of those who gained private coverage in this income bracket were aged 18 to 25 years (approximately 55,000 people). Prior to this policy change, a large proportion of young adults were uninsured, particularly those who were low income.9
FIGURE 5: Private Health Coverage in Michigan, by Federal Poverty Guideline, 2008–2011
Number Privately Insured (in thousands) | Percentage Privately Insured | ||||||||
---|---|---|---|---|---|---|---|---|---|
Year | 0–138% FPG | 139%–200% FPG | 201%–400% FPG | 401+ FPG | Total | 0–138% FPG | 139%–200% FPG | 201%–400% FPG | 401+ FPG |
2008 | 935 | 682 | 2,479 | 3,056 | 7,153 | 13.1% | 9.5% | 34.7% | 42.7% |
2009 | 954 | 751 | 2,430 | 2,690 | 6,826 | 14.0% | 11.0% | 36.0% | 39.0% |
2010 | 925 | 675 | 2,392 | 2,666 | 6,658 | 14.0% | 10.0% | 36.0% | 40.0% |
2011 | 951 | 657 | 2,293 | 2,712 | 6,613 | 14.4% | 9.9% | 34.7% | 41.0% |
Source: CHRT, using American Community Survey (SHADAC) data, 2013
FIGURE 6: Distribution of Individuals Who Lost Private Health Insurance 2008–2011, by Federal Poverty Guideline, Michigan
Source: CHRT, using American Community Survey (SHADAC) data, 2013
Conclusion
Appendix
FIGURE A-1: State Comparisons: Percent Privately Insured, All Ages 2008–2011
Rankings (1=high, 51=low)2011 Rank | 2008 Rank | State | % Privately Insured 2011 |
---|---|---|---|
1 | 2 | North Dakota | 79.1 |
2 | 1 | Hawaii | 77.7 |
3 | 6 | New Hampshire | 76.6 |
4 | 4 | Minnesota | 76.0 |
5 | 5 | Iowa | 75.8 |
6 | 3 | Massachusetts | 74.9 |
7 | 9 | Virginia | 74.7 |
8 | 10 | Maryland | 74.5 |
9 | 7 | Nebraska | 73.9 |
10 | 7 | Connecticut | 73.4 |
11 | 14 | Utah | 73.0 |
12 | 12 | Kansas | 72.8 |
13 | 16 | South Dakota | 72.6 |
14 | 13 | Pennsylvania | 72.1 |
15 | 11 | Wisconsin | 71.6 |
16 | 15 | Rhode Island | 71.3 |
16 | 19 | Wyoming | 71.3 |
18 | 17 | New Jersey | 71.2 |
19 | 18 | Delaware | 70.2 |
20 | 27 | Vermont | 69.7 |
21 | 24 | Colorado | 69.6 |
22 | 30 | District of Columbia | 69.5 |
23 | 20 | Washington | 69.3 |
24 | 21 | Ohio | 69.0 |
25 | 22 | Michigan | 68.5 |
26 | 25 | Missouri | 68.3 |
27 | 29 | Idaho | 68.1 |
28 | 23 | Indiana | 67.9 |
29 | 26 | Illinois | 67.1 |
30 | 31 | Maine | 66.0 |
31 | 34 | Montana | 65.8 |
32 | 27 | Oregon | 65.7 |
33 | 33 | Alabama | 65.3 |
34 | 32 | New York | 65.0 |
35 | 38 | Alaska | 64.9 |
36 | 37 | North Carolina | 64.0 |
37 | 38 | Kentucky | 63.7 |
38 | 35 | Tennessee | 63.5 |
39 | 36 | Nevada | 63.0 |
40 | 40 | South Carolina | 62.5 |
41 | 42 | Georgia | 62.0 |
42 | 41 | West Virginia | 61.8 |
43 | 44 | Oklahoma | 61.5 |
44 | 43 | California | 60.3 |
45 | 46 | Arizona | 59.2 |
46 | 48 | Arkansas | 58.9 |
46 | 47 | Louisiana | 58.9 |
48 | 45 | Florida | 57.7 |
49 | 50 | Texas | 57.6 |
50 | 48 | Mississippi | 56.2 |
51 | 51 | New Mexico | 53.7 |
United States | 65.4 |
Source: CHRT, using American Community Survey (SHADAC) data, 2013
FIGURE A-2: State Comparisons: Percent Privately Insured, Employer-Based Only, All Ages, 2008–2011
Rankings (1=high, 51=low)2011 Rank | 2008 Rank | State | % Employer Based 2011 |
---|---|---|---|
1 | 1 | Hawaii | 71.5 |
2 | 4 | New Hampshire | 68.6 |
3 | 3 | Maryland | 66.8 |
4 | 5 | Virginia | 66.6 |
5 | 2 | Massachusetts | 65.9 |
6 | 6 | Connecticut | 64.8 |
7 | 7 | Delaware | 64.1 |
7 | 9 | New Jersey | 64.1 |
9 | 11 | Utah | 64.0 |
10 | 10 | Minnesota | 63.8 |
11 | 14 | Iowa | 63.0 |
12 | 25 | District of Columbia | 62.5 |
13 | 12 | Rhode Island | 62.3 |
14 | 7 | Wisconsin | 62.2 |
15 | 17 | North Dakota | 61.5 |
16 | 20 | Alaska | 61.4 |
16 | 15 | Kansas | 61.4 |
16 | 13 | Ohio | 61.4 |
16 | 24 | Wyoming | 61.4 |
20 | 17 | Pennsylvania | 61.2 |
21 | 30 | Vermont | 60.7 |
22 | 16 | Michigan | 60.0 |
23 | 19 | Nebraska | 59.9 |
24 | 20 | Indiana | 59.7 |
25 | 22 | Washington | 59.6 |
26 | 28 | Colorado | 58.8 |
27 | 23 | Illinois | 58.7 |
28 | 27 | Missouri | 58.6 |
29 | 36 | South Dakota | 58.1 |
30 | 29 | New York | 57.6 |
31 | 33 | Maine | 56.8 |
31 | 26 | Nevada | 56.8 |
33 | 31 | Alabama | 56.4 |
34 | 31 | West Virginia | 56.1 |
35 | 34 | Kentucky | 55.6 |
36 | 41 | Idaho | 55.1 |
37 | 40 | Georgia | 54.8 |
38 | 38 | North Carolina | 54.6 |
39 | 39 | South Carolina | 54.4 |
39 | 36 | Tennessee | 54.4 |
41 | 35 | Oregon | 54.0 |
42 | 43 | Oklahoma | 53.5 |
43 | 42 | Montana | 52.7 |
44 | 44 | California | 51.4 |
45 | 45 | Texas | 51.2 |
46 | 45 | Arizona | 50.4 |
46 | 48 | Louisiana | 50.4 |
48 | 50 | Arkansas | 49.7 |
49 | 47 | Florida | 48.0 |
50 | 49 | Mississippi | 47.4 |
51 | 51 | New Mexico | 46.7 |
United States | 56.7 |
Source: CHRT, using American Community Survey (SHADAC) data, 2013
Suggested Citation: Hammoud, Abdullah; Dreyer, Theresa; Baum, Nancy; and Udow-Phillips, Marianne. Private Health Insurance in Michigan, 2008 to 2011. Cover Michigan 2013. September 2013. Center for Healthcare Research & Transformation. Ann Arbor, MI.