The economic downturn has strained family finances and prompted some Americans to cut back on medications and forgo preventive care and visits to the doctor. At the same time, the downturn has triggered declines in tax revenue that inhibit states’ ability to meet rising Medicaid program costs as enrollment spikes during economic hard times. In response, the National Governors Association has asked Congress to temporarily increase federal Medicaid funding to help bridge the gap.

The Foundation has created a number of resources that shed light on how Americans and states are faring and provide background on the uninsured, employer-sponsored health insurance costs, trends in states’ Medicaid enrollment and spending and prior efforts to shore up the Medicaid program during a slumping economy.

Public Opinion: Kaiser Tracking Polls

• The final Kaiser Health Tracking Poll: Election 2008 finds more people are reporting problems with health care bills, and paying for health care retains a solid hold on the public’s list of their top economic concerns.

Health Coverage and Unemployment

• Impact of Unemployment: A one percent rise in the nation's unemployment rate is projected to increase the number of uninsured by 1.1 million people.  See the chart.
  
  
• Coverage Options During Rising Unemployment
  Maintaining insurance coverage can be tough for those who lose a job.
  
  
• Families Turn to Medicaid and SCHIP
  This brief, based on focus group discussions, examines the experiences of families who have lost jobs and health coverage.

Implications for States and People on Medicaid and SCHIP

• Fact Sheet: State Fiscal Conditions and Medicaid
  Demand for Medicaid increases when the economy is weak, driving up enrollment and costs just as state budgets tighten.
  
  
• Strengthening Medicaid
  Short-term options for bolstering the program in a recession

• Financing Health Coverage: The Fiscal Relief Experience
  This 2005 paper discusses the context which prompted federal fiscal relief to the states in 2003 and examines the implications of this experiment in federal intervention for financing Medicaid.

• The Role of Medicaid in State Economies A 2004 analysis of more than a dozen studies examines the economic stimulus derived from Medicaid spending, and the adverse effects of Medicaid spending cuts.

• Headed for a Crunch: An Update on Medicaid Spending, Coverage and Policy Heading into an Economic Downturn
  This annual 50-state survey by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured (KCMU) finds enrollment in Medicaid began to rise in fiscal year 2008 as states confronted a weakening economy, leading to more rapid increases in spending and raising the potential for program cutbacks.

• Medicaid in a Declining Economy: Limited Approaches for States to Control Spending
  Analysis of KCMU’s annual 50-state budget surveys from 2003 to 2007 describes how states adopted a variety of Medicaid cost containment strategies during the last downturn and received federal help to avoid deeper Medicaid cuts.

Employer-Sponsored Health Insurance Costs

• 2008 Kaiser/HRET Employer Health Benefits Survey
   This annual survey of employers provides a detailed look at trends in employer-sponsored health coverage, including changes in premiums, employee contributions, cost-sharing provisions, and other relevant information.

State Data

Statehealthfacts.org has extensive state-specific data illustrating the effects of a downturn.

• State budget shortfalls 
  
  
  
• Current unemployment rate
  
  
  
• Foreclosures, unemployment, food stamps

The Uninsured

• The Uninsured: A Primer
   This primer reviews the basic profile of the uninsured population, how they receive care, the latest trends in health insurance coverage, and what the options are for increasing coverage.
  
  
  
• The Decline in the Uninsured in 2007: Why Did It Happen and Can It Last?
  This policy brief examines the 1.5 million decrease in the number of uninsured people under age 65 in 2007 and explains why those gains are expected to be erased by the current economic downturn.