Since the defeat of the Clinton national health care plan, incremental change has replaced sweeping reform as the most promising method for addressing major problems in the area of health insurance. The problems fall into two major categories: first, lack of coverage, which keeps many Americans from getting the health care they need, and second, threats to the quality of care, especially given the incentives to cut costs within the burgeoning managed care industry.
The number of uninsured Americans has risen steadily since the mid-1970s, after falling dramatically with the enactment of Medicare and Medicaid in 1965. The major force behind the more recent trend is the erosion of employer-sponsored coverage. Between 1990 and 1995, the percentage of non-elderly Americans who got health insurance through their employers (or the employers of family members) dropped from 67 percent to 64 percent.The changing nature of jobs within and across industries—especially the growth of service sector jobs without health benefits and the increase in part-time and contract workers—and the unaffordably high cost of the employee share of premiums account for most of this decline. Recent figures indicate that 42 million Americans, or about 16 percent of the total population, are uninsured throughout the year.
