Three-year decline in Medicaid coverage ended. As efforts to increase awareness of continued eligibility for Medicaid in the wake of welfare reform have begun to take effect, the recent declines in enrollment appear to have ended. Employer-based coverage increased in all firms, even small firms. The percent of workers covered through their employers increased in general from 53.3 to 55.5 percent between 1998 and 1999. However, while small businesses with fewer than 25 employees increased employee coverage generally, they were still half as likely to have employer-based coverage as firms with 100 or more employees.
Problems persist for middle-income people.
Over the last five years, the gains in coverage among the lowest income individuals has been offset by increases in the uninsured among higher income people. Certain vulnerable populations such as legal immigrants and young adults continue to face barriers to health coverage. Approximately 42 percent of foreign-born residents, who are immigrants but not yet citizens, continue to be without insurance and the proportion rises to 60 percent among the poor. Millions of Americans lack health insurance. Although there are many causes of this problem, it generally results from lack of affordability or access to coverage.