Andrew Coburn, Ph.D.

Recently, Andrew Coburn, Ph.D., and colleagues at the University of Southern Maine and St. Louis University completed a study of patterns of individual health insurance coverage. Results from this HCFO-funded project provide important insights into who uses the individual insurance market, the role this market plays in providing longer-term versus bridge coverage, and the patterns of entry into and exit from this market. In a time when increasingly more individuals are uninsured and the employer-based market is becoming less stable, it is critical for policymakers to consider ways to sustain affordable individual insurance coverage.

In his recent Health Affairs paper, co-authored with colleague Erika Ziller, Coburn reported that patterns of individual insurance coverage are complex and vary among subgroups. Key among the findings was the fact that most of those in the individual market are entering from and exiting to employer-based coverage, with spell-length averaging eight months. They also found that healthier and younger individuals are much more likely than their sicker and older counterparts to end up uninsured. Coburn notes that this finding supports the theory that the "young invincibles" find premiums prohibitively high.

According to Coburn, "Previous studies of the individual insurance market were based on cross-sectional data that offered a limited, static picture of who purchases individual coverage, how long they keep it, and why they leave the market. By tracking people's enrollment and disenrollment from individual plans, and observing their coverage over a four-year period, we have been able to examine the role that individual insurance plays in the patterns of health care coverage." He adds, "Policymakers should note that HIPAA provisions are inapplicable to the sizeable minority of the individually insured who enroll after being uninsured or publicly insured."

Coburn is professor of health policy and management, director of the Institute for Health Policy, and associate dean at the Edmund S. Muskie School of Public Service at the University of Southern Maine in Portland. His research focuses on the problems of health care access and financing with particular attention to health insurance coverage, rural health, and Medicaid. Coburn is also very involved in state health policy research and has led the development of the Muskie School's extensive work with Maine's Medicaid program and other health agencies. He says, "The laboratory of state health policy is rich with opportunities for understanding the problems of our nation's health system and for demonstrating and evaluating potential solutions. Our health services research and policy work bridges the worlds of research and policy development."

In addition to teaching and research, Coburn founded and directed for 11 years the Maine Rural Health Research Center, one of eight research centers funded by the federal Office of Rural Health Policy in the Health Resources and Services Administration. The Center's mission is to inform health care policymaking and the delivery of rural health services through high quality, policy relevant research; policy analysis; and technical assistance on rural health issues of regional and national significance. "We reside in a large, rural state and naturally rural health is a core policy concern," says Coburn, "Our rural health research program mirrors our Institute's interests and capacity in the areas of health care access, financing, and delivery. Our current Center has a topical specialization in rural behavioral health but we continue to study the issues of health insurance coverage in rural America. We are also part of the consortium of rural research centers studying the impact of the Medicare Rural Hospital Flexibility Program, which has supported more than 1,000 small rural hospitals to convert to Critical Access Hospital facilities."

Coburn received his Ph.D. from Brandeis University, an Ed.M. from Harvard University, and a B.A. from Brown University.

Articles from HCFO-funded project

Ziller, E.C., A.F. Coburn, T.D. McBride, & C. Andrews,. "Patterns of Individual Health Insurance Coverage: An Analysis of the 1996-2000 Survey of Income and Program Participation." Health Affairs, Vol. 23, No. 6, 2004, p. 210-222. http://content.healthaffairs.org/cgi/content/full/23/6/210