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Monitoring Changes in New Hampshire Health Insurance Coverage

Monitoring Changes in Health Insurance Coverage

The number of New Hampshire residents who lack health insurance is arguably as important as the number who are unemployed. While the state's Department of Employment Security expends considerable effort tracking and publicizing employment statistics on a monthly basis, the state has no regular program or method to monitor how many residents lack health insurance.

Health finance professionals, employers, and the news media have all noted that increasing health care costs are driving up the price of health insurance and that employers are shifting more of the cost of health insurance premiums onto employees directly or are dropping health insurance benefits altogether. A "death spiral" has been hypothesized in which relatively healthy individuals opt out of their costly insurance which, in turn, raises the rates for those remaining in the risk pool, thus driving out even more of the healthy.

Is the "death spiral" real or just theoretical? There has been little change in recent years in the percentage of New Hampshire residents without insurance, but if that number started to change, how would we know? If health insurance coverage of the population begins to decline, New Hampshire's policy makers would need to know about it as soon as possible. Yet the state has no consistent organized method to determine what may be happening.

Data already gathered by New Hampshire's hospitals can and should be used to track changes in insurance coverage. Each year, thousands of people are treated by the state's hospitals and discharged. The hospitals keep digital records on each discharge and whether the patient was covered by insurance, Medicare, Medicaid, or lacked coverage. The hospitals already report this information to the state of New Hampshire. They also report admissions on a quarterly basis to the New Hampshire Hospital Association. With minimal effort both sets of data could be used as prime indicators of changes in the extent of health insurance coverage in New Hampshire.

The hospital admissions and discharge data have one important advantage over surveys of insurance coverage. They are actual counts of the total population receiving hospital care, so they are not subject to the margins of error that accompany all surveys, including those surveys that New Hampshire has relied on for estimates of insurance coverage.