The Uninsured: A Primer, Key Facts About Americans Without ...acs.txaheceast.org/Portals/0/Uninsured...

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Over 46 million Americans were without health insurance in 2005. The number of uninsured under age 65 grew by 1.3 million from 2004 to 2005, continuing an upward trend from 2000. While the number of uninsured Americans has been increasing, who they are has remained constant. Two-thirds of the uninsured are low-income, and eight in ten come from working families. Many uninsured work for firms that do not offer insurance, and those who are offered insurance often find their share of the premiums unaffordable. Young adults, racial and ethnic minorities, and those who are non-citizens are more likely to be uninsured; however, most of the uninsured are adults over the age of 30, white, and American citizens.

It is important to understand the reasons why people lack health insurance because health coverage matters to whether people get needed and timely medical care. The uninsured are much more likely than those with insurance to forego or delay seeking care. And, the consequences can be severe. Reduced access to care leads to poorer health, preventable hospitalizations, and even premature death.

It is the Commission’s hope that this updated primer will serve as a valuable resource to understand who is uninsured, the consequences of being uninsured, and why the number of uninsured Americans continues to grow.

James R. Tallon Diane Rowland, Sc.D. Chairman Executive Director


Over 45 million Americans were without health insurance in 2004. Since 2000 the number of uninsured under the age of 65 has grown by six million. Employer-sponsored health insurance has decreased by five full percentage points, covering 66 percent of the nonelderly in 2000, but just61 percent in 2004. Public insurance, both Medicaid and the State Children’s Health Insurance Program, has filled this gap for children but not for adults – who accounted for all of the growth in the number of uninsured since 2000. Two-thirds of this growth in uninsured adults occurred among the poor or near-poor.

It is the Commission’s hope that by updating this primer, the fundamentals of how health insurance is provided in our country will be understood by more, as well as how important insurance is in accessing health services, and why the number of uninsured Americans continues to grow.

The Kaiser Commission on Medicaid and the Uninsured provides information and analysis on health care coverage and access for the low-income population, with a special focus on Medicaid's role and coverage of the uninsured. Begun in 1991 and based in the Kaiser Family Foundation's Washington, DC office, the Commission is the largest operating program of the Foundation. The Commission's work is conducted by Foundation staff under the guidance of a bi-partisan group of national leaders and experts in health care and public policy.


Over 45 million Americans were without health insurance in 2004. Since 2000 the number of uninsured under the age of 65 has grown by six million. Employer-sponsored health insurance has decreased by five full percentage points, covering 66 percent of the nonelderly in 2000, but just61 percent in 2004. Public insurance, both Medicaid and the State Children’s Health Insurance Program, has filled this gap for children but not for adults – who accounted for all of the growth in the number of uninsured since 2000. Two-thirds of this growth in uninsured adults occurred among the poor or near-poor.

It is the Commission’s hope that by updating this primer, the fundamentals of how health insurance is provided in our country will be understood by more, as well as how important insurance is in accessing health services, and why the number of uninsured Americans continues to grow.

The Kaiser Commission on Medicaid and the Uninsured provides information and analysis on health care coverage and access for the low-income population, with a special focus on Medicaid's role and coverage of the uninsured. Begun in 1991 and based in the Kaiser Family Foundation's Washington, DC office, the Commission is the largest operating program of the Foundation. The Commission's work is conducted by Foundation staff under the guidance of a bi-partisan group of national leaders and experts in health care and public policy.

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The Uninsured: A Primer

Key Facts AboutAmericans Without Health Insurance

Over 46 million Americans under the age of 65 lacked health insurance coverage in 2005, an increase of 1.3 million from the year before and an

increase of over seven million since 2000.

Fundamental facts useful to understanding this many-faceted problem are framed in this primer under these nine questions:

How do most Americans obtain health insurance?...........................................................................1 Most under the age of 65 obtain health coverage as an employer benefit. While Medicare covers all of the

elderly, the nonelderly who do not have access to or cannot afford private insurance go without health coverage unless they qualify for the Medicaid program, SCHIP, or other state-subsidized insurance programs.

Who are the uninsured?.............................................................................................................3 While the number of uninsured has been growing, who the uninsured are and the social and economic

factors that place a person at risk of being uninsured have not changed substantially over time. The uninsured are largely low-income adults in working families, for whom coverage is either unavailable or unaffordable.

How does lack of insurance affect access to health care services?...........................................6 Health insurance makes a difference in whether and when people get necessary medical care, where

they get their care, and ultimately, how healthy people are. The consequences of reduced access to care can be serious, particularly when preventable conditions go undetected.

How do the uninsured pay for medical care?.............................................................................8 For many of the uninsured, the costs of health insurance and medical care are weighed against equally

essential needs. Medical bills can mount quickly for the uninsured, even for relatively minor problems like dental care, and the financial impact, particularly on a low-income family, can be severe.

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How is uncompensated care financed?....................................................................................10 Federal and state governments fund the vast majority of uncompensated care. That money is vital to

the public hospitals and clinics that provide the bulk of such care, but funding levels have not kept pace with the rising number of uninsured and increasing medical costs.

How and why has the number of uninsured changed recently?...............................................12Changes in the overall economy and its impact on employment and family incomes, the rapid growth in health care costs and insurance premiums, and the ability of Medicaid and other public safety net programs to cover more of the uninsured, largely explain the trends in health coverage over the past decade.

Why doesn’t employer-sponsored insurance cover more Americans?.....................................15Employer-sponsored health insurance is voluntary for employers and employees. Thirty-seven million people from working families were uninsured in 2005 because not all businesses offer health benefits, not all workers qualify for coverage, and many employees cannot afford their share of the health premium.

What is Medicaid’s role?...........................................................................................................19 Medicaid is this country’s public health insurance program for low-income Americans, providing

coverage based not only on a person’s or family’s income, but also on whether they fit into specific eligibility categories. Medicaid covers some of these basic groups of nonelderly, low-income people: children, their parents, pregnant women, and people with disabilities.

What can be done to decrease the number of uninsured?.......................................................23The majority of the general public believes decreasing the number of uninsured is an important policy priority, but there is little agreement on how to achieve this goal. Building on the nation’s mixed system of public and private insurance, the strategies being discussed vary not only by the means of insuring more Americans, but also by who is to be included in the reform. In the absence of national reform, more governors and state legislators are seeking solutions to help address the problem in their own state.

Tables..…………………………………………………...………………………...………………………..27Data Notes…….….……………………………………………………………………………….………...38

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How Do Most Americans Obtain Health Insurance?

Most Americans under the age of 65 receive health insurance coverage as an employer benefit—61% in 2005. While Medicare covers virtually all those who are 65 years or older, the nonelderly who do not have access to or cannot afford private insurance go without health coverage unless they qualify for the Medicaid program, the State Children’s Health Insurance Program (SCHIP), or other state-subsidized insurance programs. The gaps in our private and public health insurance systems left 46.1 million nonelderly Americans—18% of those under age 65—without health coverage in 2005 (Figure 1).

Figure 1

Health Insurance Coverage of the Nonelderly Population, 2005

* Medicaid/Other Public includes Medicaid, SCHIP, other state programs, Medicare and military-related coverage. SOURCE: KCMU/Urban Institute analysis of March 2006 CPS.

Total = 257.4 million

Employer-Sponsored

61%

Uninsured18%

Medicaid/Other Public* 16%

Private Non Group 5%

Private Health Insurance Coverage

� Many, but not all, employers offer group health insurance policies to their employees as a benefit and also often extend coverage to their employees' families. About half of Americans insured through employer-sponsored health plans are covered by their own employer (51%) and half are covered as an employee’s dependent (49%). Health insurance offer rates vary among businesses, with large firms and those with more high-wage workers more likely to offer coverage.1

� Employer-sponsored health insurance is voluntary; businesses are not legally required to offer health benefits, and employees can choose not to participate. In 2006, 61% of firms offered health benefits to at least some of their employees, down from 69% in 2000.2 Even when businesses offer health benefits, some employees are ineligible because they are part-time employees or recent hires and some do not sign up because of the required employee share of the premium.

� Private policies directly purchased in the non-group market (i.e., outside of employer-sponsored benefits) cover only 5% of nonelderly Americans. Private, non-group insurance premiums are based on individual health risk and are substantially more expensive than group plans purchased by employers, with costs varying by age and health status. The share of the nonelderly with private non-group insurance has changed very little over time. Obtaining coverage in the individual

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market can be difficult—in 2005, nearly three in five adults who sought coverage had difficulty finding a plan they could afford, and one in five were denied coverage, charged a higher price, or had a specific health condition excluded from coverage.3

� Private health insurance coverage is subsidized through the federal tax system in several ways.The most common form of private insurance subsidy is the employee tax exclusion of the health insurance premiums paid by employers. Those who are self-employed are now allowed to deduct all of the costs of their insurance premiums from their taxes. In addition, people with unusually high health care expenses (exceeding 7.5% of their adjusted gross income) can deduct the costs, including premiums, on their tax returns. Tax advantages are also available for health savings accounts (HSAs) and flexible spending accounts.

Public Health Insurance Coverage

� The Medicaid program provides coverage to some, but not all, of the low-income and disabled uninsured. Covering 13% of the nonelderly, Medicaid is larger than any single private health insurer.It provides health coverage based on both income and categories of eligibility, primarily covering four main groups of nonelderly, low-income people: children, their parents, pregnant women, and individuals with disabilities. Although Medicaid covers over 40% of the poor, the categorical nature of the program means that 37% of those below the poverty level remain uninsured (Figure 2).

Figure 2

Health Insurance Coverageby Poverty Level, 2005

45%

71%

26%

11%37% 30%

18%7%

89%

20%

4%

43%

0%

25%

50%

75%

100%

<100% FPL 100-199% FPL 200-299% FPL 300% + FPL

Employer/Other Private Medicaid/Other Public Uninsured

The federal poverty level was $19,971 for a family of four in 2005. Data may not total 100% due to rounding. SOURCE: KCMU/Urban Institute analysis of March 2006 CPS.

� Medicaid and the State Children’s Health Insurance Program (SCHIP) cover one quarter of all children and half of low-income children. Medicaid is the largest source of health insurance for children in the U.S., covering 28 million children. SCHIP supplements Medicaid by covering six million children who are low-income but whose family incomes are too high to qualify for Medicaid.4

� Medicaid covers one in five people with severe disabilities. Medicaid provides health and long-term care coverage for eight million nonelderly people with disabilities, including over one million disabled children. Its role is more prominent for people with certain conditions, such as HIV/AIDS.However, eligibility for Medicaid for people with disabilities in most states is limited to those with incomes below the federal poverty level.

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Who Are the Uninsured?

In 2005, 46.1 million Americans under the age of 65 lacked health insurance. While the number of uninsured Americans has been growing, who the uninsured are and the social and economic factors that place a person at risk of being uninsured, have not changed substantially over time. The uninsured are largely low-income adult workers for whom coverage is either unavailable or unaffordable.

� In 2005, over eight in ten uninsured came from working families—almost 70% from families with one or more full-time workers and 11% from families with part-time workers. Only 19% of the uninsured are from families that have no connection to the workforce (Figure 3). Even at lower income levels, the majority of the uninsured have workers in their family. Fifty-three percent of the uninsured who are poor have at least one worker in the family. (Poor is defined as an income less than 100% of the federal poverty level – $19,971 for a family of four in 2005).

� Because of the high cost of health insurance, the poor and near-poor have the greatest risk of being uninsured. The uninsured rate among the nonelderly poor is twice as high as the national average (36% vs.18%). Were it not for the Medicaid program, many more of the poor would be uninsured. The near-poor (those with incomes between 100% and 199% of poverty) also run a high risk of being uninsured (30%), in part, because they are less likely to be eligible for Medicaid. Two-thirds of the uninsured are either poor or near-poor.

� Adults are more likely to be uninsured than children. Adults make up about 70% of the nonelderly population, but 80% of the uninsured (Figure 3). Most low-income children qualify for Medicaid or SCHIP, but low-income adults under age 65 qualify for Medicaid only if they are disabled, pregnant, or have dependent children. Income eligibility levels are generally much lower for parents than for children.

Figure 3

Characteristics of the Uninsured, 2005

200% FPL and Above

35%

100-199% FPL29%

<100% FPL36%

Family IncomeFamily Work Status

Total = 46.1 million uninsured

The federal poverty level was $19,971 for a family of four in 2005. Data may not total 100% due to rounding.SOURCE: KCMU/Urban Institute analysis of March 2006 CPS.

1 or More Full-Time Workers

69%

No Workers

19%

Part-TimeWorkers

11%

Age

55-649%

35-5432%

19-3440%

0-1820%

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� More than 60% of non-elderly uninsured adults did not attend college, making them less able to get higher-skilled jobs that more typically provide health coverage. Those with less education are also more likely to be uninsured for longer periods of time.

� Minorities are much more likely to be uninsured than white Americans. About one third of Hispanics and Native Americans are uninsured compared to 13% of whites. The uninsured rates among African Americans (21%) and Asian Americans (19%) are also much higher than that of whites.These differences are only partly explained by income disparities—insurance disparities exist at both lower and higher income levels (Figure 4).

Figure 4

Uninsured Rates Among Racial/Ethnic and Income Groups, 2005

16%

44%

11%

37%

21%

44%

12%

29%

8%

29%

White, Non-Hispanic

Black, Non-Hispanic

Hispanic

Asian1

American Indian2

1Asian group includes Pacific Islanders. 2American Indian group includes Aleutian Eskimos. 200% of the poverty level was $39,942 for a family of four in 2005. SOURCE: KCMU/Urban Institute analysis of March 2006 CPS.

< 200% FPL

Poverty Level

200% + FPL

White, Non-Hispanic

Black, Non-Hispanic

Hispanic

Asian1

American Indian2

� The large majority of the uninsured (80%) are native or naturalized U.S. citizens. Non-citizens have high uninsured rates (roughly 40% to 50%) compared to citizens due to their employment in low-wage jobs that are less likely to offer health coverage and restrictions on their eligibility for public coverage (Figure 5). However, studies show that new immigrants are not primarily responsible for the growth in the overall uninsured population, mainly because they comprise a small share of the total U.S. population.5

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Figure 5

Nonelderly Uninsured by Citizenship, 2005

51%

44%

16%Native and

NaturalizedCitizens

Non-Citizens, Residents 5+ Yrs.

Non-Citizens, Residents <5 Yrs. Native and Naturalized

Citizens 80%

Non-Citizens, Residents <5 Yrs.

6%

Total = 46.1 million uninsuredNational Rate = 18%

Uninsured Rates

Non-Citizens, Residents 5+ Yrs.

15%

SOURCE: KCMU/Urban Institute analysis of March 2006 CPS. Data may not total 100% due to rounding.

� The uninsured tend to be in worse health than the privately insured. Ten percent of the uninsured are in fair or poor health, compared to 5% of those with private coverage. Almost half of all uninsured nonelderly adults have a chronic condition.6 Those with such conditions and others who are not in good health may find non-group coverage to be unavailable or unaffordable if they do not have job-based coverage.

� The majority of uninsured adults (59%) have gone without coverage for a period of at least two years.7 Because health insurance is primarily obtained as an employment benefit, health coverage can be disrupted when people change jobs. This, as well as other changes in income and family composition, can cause temporary gaps in health insurance.

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How Does Lack of Insurance Affect Access to Health Care Services?

Health insurance makes a difference in whether and when people get necessary medical care, where they get their care, and ultimately, how healthy people are. Uninsured adults are far more likely than the insured to postpone or forgo health care altogether and less able to afford prescription drugs or follow through with recommended treatments. The consequences of reduced access to care can be severe, particularly when preventable conditions go undetected.

� The uninsured are up to three times more likely than those with insurance to report problems getting needed medical care, even for serious conditions. Part of the reason many of the uninsured postpone or forgo needed care is because over 40% do not have a regular place to go when they are sick or need medical advice, compared to just 9% of those with coverage (Figure 6). About 20% of the uninsured (compared to 3% of those with coverage) say their usual source of care is an emergency room.8

� Anticipating high medical bills, many of the uninsured are not able to follow recommended treatment. Over a third of uninsured adults say they did not fill a drug prescription in the past year and over a third went without a recommended medical test or treatment due to cost.9 Insured nonelderly adults are at least 50% more likely to have had preventive care such as pap smears, mammograms, and prostate exams compared to uninsured adults.10

Figure 6

Barriers to Health Care by Insurance Status, 2003

13%

9%

15%

9%

37%

35%

47%

42%

Did Not Fill a Prescriptionbecause of Cost

Needed Care but Did Not Get It

Postponed Seeking Carebecause of Cost

No Regular Source of Care

UninsuredInsured

* Experienced by the respondent or a member of their family.Insured includes those covered by public or private health insurance. SOURCE: Kaiser Family Foundation, Kaiser 2003 Health Insurance Survey.

Percent experiencing in past 12 months:*

� Problems getting needed care also exist for uninsured children, who are generally healthy and for whom access to care is a solid investment. Uninsured children are much more likely to lack a usual source of care, to delay care, or to have unmet medical needs than children with insurance.Uninsured children with common childhood illnesses and injuries often do not receive the same level of care. As a result, they are at higher risk for preventable hospitalizations and for missed diagnoses of serious health conditions (Figure 7).11

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9

Figure 7

1%

12%

4%2%

4%

17%

11%

36%

2% 2%2%4%3%

8%

14%

21%25%

17%

No UsualPlace of

Care

DelayedCare due to

Cost

UnmetMedical

Need

Last MDVisit >2

Years Ago

UnmetDental Need

Last DentalVisit >2

Years Ago

Private Medicaid/Public Uninsured

Children’s Access to Care, by Health Insurance Status, 2004

* MD or any health care professional, including time spent in a hospital. All estimates are age-adjusted.SOURCE: National Center for Health Statistics, CDC. 2006. Summary of Health Statistics for U.S. Children: National Health Interview Survey, 2004.

*

� Lack of health coverage, even for short periods of time, results in decreased access to care. Those who have been uninsured for less than six months are already less likely than those with continuous health coverage to have a usual source of care and more likely to report having an unmet need for medical care or a prescription drug in the past year. As the period without coverage lengthens, more of the uninsured face these kinds of access problems.12

� Access to health care improves after an uninsured person obtains health insurance; similarly, losing coverage, whether it is private insurance or Medicaid, substantially decreases access to care. For example, people who have lost Medicaid coverage are two to three times more likely than Medicaid beneficiaries to report going without medical care because it is too expensive and they are worried about medical bills.13

� Because the uninsured are less likely than the insured to have regular outpatient care, they are more likely to be hospitalized for avoidable health problems. When they are hospitalized, they are more likely to receive fewer services and to die in the hospital than are insured patients.14

� The uninsured are also less likely to receive timely preventive care. For example, people with insurance are significantly more likely to have had recent mammograms and colon and cervical cancer screenings. Consequently, uninsured cancer patients are diagnosed in later stages of the disease and die earlier than those with insurance.

� Having insurance improves health overall and could reduce mortality rates for the uninsured by 10-15%. It has been estimated that the number of excess deaths among uninsured adults age 25-64 is in the range of 18,000 a year.15

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How Do the Uninsured Pay for Medical Care?

For many of the uninsured, the costs of health insurance and medical care are weighed against equally essential needs. The uninsured are twice as likely as those with health coverage to live in a household that is having difficulty paying monthly expenses as basic as rent, food, and utilities. Medical bills can mount quickly for the uninsured, even for relatively minor problems like dental care, and the financial impact on a family can be serious.

� Among the nonelderly in 2004, the costs of medical care received by those uninsured for the full year were just over half that of those with insurance. Because the uninsured receive less care, their per capita costs were $1,629 compared to $2,975 for the insured. Over a third (35%) of the costs of care received by the full-year uninsured are paid for themselves out-of-pocket.16

� Having health insurance makes a difference in the debt individuals and families face because of medical bills. The uninsured are more than twice as likely to have had problems paying medical bills in the past year as those who have coverage. In addition, the impact of these bills is much greater on uninsured families (Figure 8). Nearly a quarter (23%) of the uninsured reported spending less on other basic needs such as food and heat in order to pay medical bills.17

� Having health insurance makes a difference to a person's credit history. Like any bill, when medical bills are not paid or paid off too slowly, they are turned over to a collection agency, and a person's ability to get further credit is significantly limited. About a quarter (23%) of the uninsured report that they were contacted by a collection agency about unpaid medical bills in just the past year.18

Figure 8

Financial Burden of Medical Bills by Insurance Status, 2003

8%

9%

16%

23%

23%

36%

Contacted by CollectionAgency about Medical Bills

Changed Way of LifeSignificantly to Pay Medical

Bills

Had Problem Paying MedicalBill

UninsuredInsured

Insured includes those with public or private insurance coverage. SOURCE: Kaiser Family Foundation, Kaiser 2003 Health Insurance Survey.

Percent experiencing in past 12 months:

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� The uninsured are increasingly paying "up front" before services will be rendered. When the uninsured are unable to pay the full medical bill in cash at the time of service, they can sometimes negotiate a payment schedule with a provider, pay with credit cards (typically with high interest rates), or can be turned away.19

� Most of the uninsured do not receive health services for free or at reduced charge. Hospitalsfrequently charge uninsured patients two to four times what health insurers and public programs actually pay for hospital services.20 Only about one quarter of low-income uninsured adults (those with incomes under 200% of the poverty line) report they have received care for free or at reduced rates in the past year.21

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How Is Uncompensated Care Financed?

When the uninsured are unable to pay for care they receive, that uncompensated care is paid for through a patchwork of federal, state, and private funds. The bulk of such care is funded by the government and is crucial to the strength of the nation’s public hospitals and clinics, which provide most of the uncompensated care the uninsured receive. Although this funding remains important, it has not kept pace with the rising numbers of uninsured and increasing medical costs.

� The costs of uncompensated care were estimated to be about $41 billion in 2004. Projectedgovernment spending available to pay for the care of the uninsured in 2004 was $34.6 billion—about 85% of the total uncompensated care bill (Figure 9). More than half of all funds for uncompensated care come from the federal government, with the majority of federal dollars flowing through Medicare and Medicaid.

Most government dollars for uncompensated care are paid to hospitals based partly on the share of uncompensated care they provide. Uncompensated care costs in direct service programs, such as community health centers and the Veterans Affairs health system, are funded almost completely by public dollars.22

Figure 9

Payment Sources for Uncompensated Care, 2004

Private Dollars$6 Billion

(15%)

State Dollars$11 Billion

(27%)

Total = $40.7 billion

SOURCE: Derived from Hadley J. and J. Holahan. 2004. The Cost of Care for the Uninsured: What Do We Spend, Who Pays, and What Would Full Coverage Add to Medical Spending? KCMU, Issue Update, May 2004.

Federal Dollars$24 Billion

(58%)

� The federal uncompensated care funding that flows through Medicaid is a major source of financing for health care providers that serve the low-income and uninsured populations.Medicaid is the largest source of third-party payments for community health centers, accounting for over one-third of their operating revenues. Medicaid also provides 37% of public hospital net revenues (Figure 10).

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Figure 10

Medicaid Financing of Safety-Net Providers

Medicare19%

State/Local Subsidies

15%

Self Pay/ Other

6%

Commerical23%

Medicaid37%


SOURCE: National Association of Public Hospitals and Health Systems, 2003, National Association of Public Hospitals and Health Systems, October 2005. Rosenbaum and Shin, Health Centers Reauthorization: An Overview of Achievements and Challenges, Kaiser Commission on Medicaid and the Uninsured, March 2006.

Federal Grants

24%

Self Pay6%

State/ Local13%

Private6%

Medicare6%

Medicaid37%

Other8%


Public Hospital Net Revenues by Payer, 2003

Health Center Revenues by Payer, 2004

� Federal spending on uncompensated care has not kept up with the recent growth in the number of uninsured. Although federal support for community health centers increased by more than 50% between 2001 and 2004 (from $430 million to $670 million), these expenditures account for less than 3% of total federal spending for uncompensated care. As the number of uninsured increased by 11% between 2001 and 2004, total federal spending on the health care safety net increased by only 1%, leading to a decline in federal spending per uninsured person from an average of $546 in 2001 to $498 in 2004 (Figure 11).23

Figure 11

Federal Spending on the Safety Netper Uninsured, 2001-2004

Federal spending includes payments to hospitals through Medicaid and Medicare and funding for direct care programs, such as the Veterans Health Administration, the Indian Health Service and the Ryan White Care Act.SOURCE: Hadley J, M Cravens, T Coughlin, J Holahan. 2005. Federal Spending on the Health Care Safety Net from 2001-2004: Has Spending Kept Pace with the Growth in the Uninsured? Kaiser Commission on Medicaid and the Uninsured (#7425; November).

$546$498

2001 2004

� The cost of uncompensated care provided by physicians (estimated at $5 billion in 2001) is not directly or indirectly reimbursed by public dollars.24 Financial pressures and time constraints, coupled with changing physician practice patterns, have contributed to a decline in charity care provided by physicians. The percent of all doctors who provide charity care fell to 68% in 2004-2005 from 76% in 1996-1997.25

13

Figure 10


Medicare19%


15%

Self Pay/ Other

6%

Commerical23%

Medicaid37%



Federal Grants

24%

Self Pay6%

State/ Local13%

Private6%

Medicare6%

Medicaid37%

Other8%





Figure 11



$546$498

2001 2004


13

Figure 10


Medicare19%


15%

Self Pay/ Other

6%

Commerical23%

Medicaid37%



Federal Grants

24%

Self Pay6%

State/ Local13%

Private6%

Medicare6%

Medicaid37%

Other8%





Figure 11



$546$498

2001 2004


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How and Why Has the Number of Uninsured Changed?

Lack of health insurance coverage is a problem for many more Americans today than it was ten years ago.Even through most of the 1990s, when the economy was rapidly growing and competition for workers was high, the number of uninsured increased by about one million a year—leveling off only at the end of the economic boom. The 2001 recession, brief as it was, triggered a downturn in job-based coverage that continued to affect health insurance coverage even in 2005, as job opportunities shifted and family incomes declined. Between 2000 and 2004 the number of uninsured Americans increased by about 6 million. Most recently, the number of nonelderly uninsured grew by 1.3 million between 2004 and 2005 (Figure 12).

Figure 12

Number of Nonelderly Uninsured Americans,1994 - 2005

40.6 41.7 43.1 43.942.1 40.9

43.344.8 46.145.544.7

40.0 39.6

0

25

50

Previous Method 1999 Revised Method 2004 Revised Method

Uninsured in Millions

* The Census Bureau periodically revises its CPS methods, which means data before and after the revision are not comparable. Comparison across years can be made between 1994 and 1999, 1999 through 2004, and 2004 vs. 2005.SOURCE: KCMU/Urban Institute analysis of March 2006 CPS.

‘94 ‘95 ‘96 ‘97 ‘98 '99* ‘00 ‘01 ‘03‘02 ’04* ‘05

39.8

� In the mid- and late-1990s, employer-sponsored coverage gradually increased—fueled by a robust economy, low unemployment rates, increases in real wages, and slower growth in health premiums. However, until 1999, the increases had not been enough to offset the declines in Medicaid enrollment that began following welfare reforms implemented in the mid-1990s. As families moved into the workforce, they often found low-paying jobs that were not likely to offer health benefits. In addition, as the link between welfare assistance and Medicaid was severed, many eligible families were not enrolled in Medicaid. The number of uninsured grew by four million between 1994 and 1998.

� By 1999, the percentage of people covered by Medicaid stabilized, and modest increases in private coverage helped to decrease the number of uninsured for the first time in over a decade.As more Americans moved into higher income levels, job-based coverage became more affordable. In addition, more people gained coverage as states implemented SCHIP and improved Medicaid enrollment. Expanded public coverage of children in 2000 accounted for another small decline in the number of uninsured that year.26

� The decline in the uninsured did not last long, however, as economic growth stalled in 2001.The share of nonelderly Americans with employer-sponsored health insurance decreased for the first time since 1993, dropping from 66% in 2000 to 61% by 2004.

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As the nonelderly population grew by ten million people between 2000 and 2004, the income distribution shifted so that a greater share of Americans came from poor and near-poor families, where uninsured rates are highest. In addition, employment continued to shift—more workers in 2004 were either self-employed or were working in small firms (< 25 workers) and more were working in the kinds of jobs that are less likely to offer health benefits. The number of nonelderly uninsured grew by six million, two-thirds of whom were poor or near-poor (Figure 13).

Figure 13

Poor(<100% FPL)

46%

Near-Poor(100-199% FPL)

19%

Growth in Nonelderly Uninsured, by Family Income, 2000 - 2004

Growth in Uninsured = 6.0 Million

Middle(200-399% FPL)

22%

High(400%+ FPL)

12%

SOURCE: KCMU/Urban Institute analysis of CPS 2001-2005.

� Enrollment in both Medicaid and SCHIP increased between 2000 and 2004, in response to greater numbers who qualified and also because of improved program outreach efforts and streamlined enrollment systems. Declines in employer-sponsored insurance among children over this period were fully offset by increases in Medicaid and SCHIP enrollment (Figure 14). Children’s uninsured rates actually decreased slightly between 2000 and 2004 and the number of uninsured children did not grow.27

0014 00 15

16

Figure 14

6.3%

17.9%12.3%

20.5%

67.9%61.6%

20.6%

7.8%

63.1%

11.6%

56.3%

26.4%

0%

25%

50%

75%

ESI* Medicaid* Uninsured* ESI* Medicaid* Uninsured*

2000 2004

Changes in ESI, Medicaid and Uninsured RatesChildren vs. Adults, 2000 - 2004

AdultsChildren

Change in Number of Nonelderly Uninsured, 2000 – 2004-400,000 Children +6.3 million Adults*

*Statistically significant change 2000-2004 (p<.05). Medicaid includes SCHIP and other state programs.SOURCE: KCMU/Urban Institute analysis of CPS 2001-2005.

� Public coverage had also increased among adults between 2000 and 2004, but with Medicaid’s limits on adult eligibility, it was not enough to buffer the loss of job-based coverage. Adultsaccounted for all of the growth in the number of uninsured over these years—increasing by 6.3 million.

� By 2005, the number of nonelderly uninsured was still growing significantly, by 1.3 million compared to the year before. Most of the growth in the uninsured between 2004 and 2005 occurred among those with low incomes—1.1 million of the 1.3 million were from families with incomes less than twice the poverty level. Medicaid and other state programs were, in general, no longer expanding and continued decreases in employer-based coverage, particularly among those with low incomes, increased the share of the nonelderly population who were uninsured. By 2005, nearly 18% of all the nonelderly and 33% of those with low incomes were uninsured.

0014 00 15

17

Why Doesn't Employer-Sponsored Insurance Cover More Americans?

Employer-sponsored health insurance covered 156 million Americans (61% of the nonelderly population) in2005. Yet, 37 million people from working families were uninsured in that year because not all businesses offer health benefits, not all workers qualify for coverage, and many employees cannot afford their share of the health premium. The strength of the economy and growth rate of health insurance premiums are the primary factors influencing the proportion of Americans insured through employer-sponsored benefits.

� Employer-sponsored health insurance is sensitive to sharp changes in health insurance premiums. Between 1988 and 1993, health insurance premiums grew by at least 8% annually and the proportion of workers covered by job-based insurance decreased. By 1996, premiums had stabilized, even dropping below the overall rate of inflation as insurers competed to increase their market share. Low premium growth combined with the prospering economy very gradually reversed the trend in employer-sponsored coverage, and the percent of the population covered by employer-sponsored coverage grew slightly.

� The economic downturn which began in early 2001, coupled with the return of double-digit inflation in health insurance premiums, decreased employer-sponsored coverage again. Both factors also adversely affect the type of health benefits offered and the amount employees are required to contribute towards their health benefits. Although the growth rate of health insurance premiums has declined recently, premiums continue to grow more than twice as fast as wage increases, and employer-sponsored coverage continues to erode.

Figure 15

$2,137$3,615

$4,819

$8,508

$2,973$1,619$627$334

2000 2006 2000 2006

Employer Contribution

Worker Contribution

Average Annual Premium Costs for Covered Employees, 2000 and 2006

Family coverage is defined as health coverage for a family of four.SOURCE: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2006.

$2,471

$6,438

$4,242

$11,480

Single Coverage Family Coverage

0016 00 17

18

� In 2006, annual employer-sponsored group premiums cost, on average, $4,242 for individual coverage and $11,480 for family coverage of four. Total family premiums now exceed the annual salary of a full-time, minimum-wage worker. The employee’s share of a family premium in 2006 averaged $2,973, increasing by $1,354 since 2000 (Figure 15).28

� The share of employees who were covered by employer-sponsored insurance (ESI) decreased markedly between 2001 and 2005, with a corresponding increase in the share who were uninsured. Decreases in job-based coverage—and increases in the share who were uninsured—were greatest among low-income workers, those who were already the most likely to be uninsured.The share of poor employees who had employer-sponsored insurance dropped from 37% in 2001 to 30% by 2005 and among the near-poor dropped from 59% to 52%, while among those with the highest incomes, employer-sponsored insurance rates stayed at over 92% (Figure 16).29

Figure 16

82.4%

58.7%

92.9%

36.8%

92.2%

78.5%

51.7%

30.4%

0%

20%

40%

60%

80%

100%

<100% FPL 100-199% FPL 200-399% 400%+

2001 2005

Changes in Employees’ ESI Coverage and Uninsured Rates, by Family Income Levels,

2001-2005

46.7% 54.1%

Uninsured Rates33.9% 39.1% 13.4% 16.0% 3.6% 4.0%

* * *

Percent with ESI

* Statistically significant changes for both ESI and uninsured rates for these groups (p<.05).SOURCE: Urban Institute analysis of the February 2001 and 2005 Contingent Work Supplement of the Current Population Survey (CPS) and the March 2001 and 2005 Annual Social and Economic (ASEC) Supplement of the CPS.

The main reason for this change was that fewer employees worked for employers who sponsored health benefits. Over 70% of the decline in job-based coverage was due to loss of employer sponsorship, changes in employees’ eligibility for health benefits, or loss of job-based coverage as a dependent of another worker. About a quarter of the drop was due to employees not participating in health benefits offered to them (Figure 17). Declines in employer sponsorship between 2001 and 2005 were deepest among poor and near-poor employees.30

0016 00 17

19

Figure 17

Reasons for Decline in ESI among Employees, 2001- 2005

Employer Sponsorship

Decline48%

ESI Dependent Coverage Decline

11%

Employee EligibilityDecline

14%

Employee Take-up Decline

27%

3.8% Decline in ESI among Employees (From 81.2% to 77.4%)

SOURCE: Urban Institute analysis of the February 2001 and 2005 Contingent Work Supplement of the Current Population Survey (CPS) and the March 2001 and 2005 Annual Social and Economic (ASEC) Supplement of the CPS.

� Workers from low-income families have less access to job-based insurance, even when benefits from a spouse’s job are considered. In 2005, 55% of employees from poor families did not have employer-sponsored insurance available to them, either through their own job or a family member's job, compared to only 4% of employees from higher income families (Figure 18).31

Figure 18

55%35%

13%

14%

30%52%

79%92%

8% 4%

15%

<100% 100-199% 200-399% 400% +

Covered by Own or Spouse's EmployerDeclined offer from Own or Spouse's EmployerNot offered through Own or Spouse's Employer

Employee Access to ESI within the Familyby Family Income, 2005

Poverty Level

4%

Data may not total 100% due to rounding. SOURCE: Urban Institute analysis of the February 2005 Contingent Work Supplement of the Current Population Survey (CPS) and the March 2005 Annual Social and Economic (ASEC) Supplement of the CPS.

� The required employee share of premiums makes employer-sponsored coverage unaffordable for some, particularly low-wage workers. Poor employees compared to higher-wage workers are less likely to participate when health benefits are offered (64% participation among poor employees vs. 84% of those with family incomes greater than four times the poverty level).32 Low-wage workers often

0018 00 19

20

work in firms where employees are required to pay a larger share of the premium. Among businesses offering health benefits in 2006, employees in lower-wage firms paid 35% of the premium costs for family coverage compared to 26% paid by employees in higher-wage firms.33

� Employees of small businesses (less than 100 employees) are less likely than those in larger firms to have health benefits offered to them. This gap widened between 2001 and 2005, with employees of the smallest firms (less than 10 employees) experiencing the greatest change. The share of employees in these small firms who were offered health benefits declined from 54% in 2001 to 50% by 2005.34

� Health coverage varies both by industry and by type of occupation. Across industries, uninsured rates range from a high of 35% in agriculture to just 4% in public administration. But even in industries where health benefits are better than average, the gap in health coverage between blue and white collar workers is nearly two-fold or greater. Over 80% of uninsured workers are in blue-collar jobs.

Figure 19

Uninsured Rates Among Selected Industry Groups, White vs. Blue Collar Jobs, 2005

14%

20%

6%

7%

6%

23%

35%

18%

18%

11%Blue CollarWhite Collar

Wholesale/Retail (15%)

Services/ArtsEntertainment (13%)

Mining/Manufacturing (12%)

Health/Soc Services(12%)

Information/Education/Communication (11% of jobs)

Uninsured Rate for All Workers = 19%

White collar workers include all professionals and managers; all other workers classified as blue collar.SOURCE: KCMU/Urban Institute analysis of March 2006 CPS

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21

What is Medicaid's Role?

Medicaid is the nation’s major public health insurance program for low-income Americans, providing health coverage based not only on income levels, but also eligibility categories. As a federal-state program, Medicaid's combination of federal rules and state options for coverage has created different eligibility rules for different groups across the country.

Medicaid covers four main groups of nonelderly, low-income people: children, their parents, pregnant women, and people with disabilities—with the program playing its broadest role among children. Half of all Medicaid beneficiaries are children.

� Federal law requires states to cover children under age 19 who come from poor families. The threshold is higher (133% of the poverty level) for children under age six and pregnant women, and states have the option to expand coverage beyond these federal minimum requirements.

� SCHIP works as a complement to Medicaid by covering low-income children not eligible for Medicaid. The two programs together aim to cover nearly all low-income children. SCHIP gives states the option to cover children through their existing Medicaid program or a separate child health program. Most states cover children up to 200% of the poverty level through Medicaid or SCHIP (Figure 20).

Figure 20

Medicaid/SCHIP Eligibility Levels for Children, July 2005

AZAR

MS

LA

WA

MN

ND

WY

ID

UTCO

OR

NV

CA

MT

IA

WIMI

NE

SD

ME

MOKS

OHIN

NY

IL

KY

TNNC

NH

MA

VT

PA

VAWV

CTNJ

DE

MD

RI

HI

DC

AK

SCNM

OK

GA

SOURCE: Based on a national survey conducted by the Center on Budget and Policy Priorities for KCMU, 2005.

TX

IL

FL

AL

> 200% FPL (13 states)

200% FPL (28 states including DC)

< 200% FPL (10 states)

� Despite broad Medicaid and SCHIP eligibility for low-income children, many eligible children are not enrolled in the programs. As much as 75% of uninsured children are eligible for Medicaid or SCHIP but are not enrolled (Figure 21).35 Some families are not aware of the availability of the programs or may not believe their children are eligible. But, many families face barriers to enrolling and renewing their children in public programs, and new rules require U.S. citizens to document their citizenship and identity when applying for Medicaid or renewing their coverage.

0020 00 21

22

Figure 21

Medicaid and SCHIP Eligibility Status of Uninsured Children, 2004

Not Eligible

25%

SCHIP Eligible

22%

Medicaid Eligible

53%

SOURCE: Georgetown Center for Children and Families analysis of March 2005 Current Population Survey using July 2004 eligibility rules.

Total = 8.1 million uninsured children

� In contrast, the role of Medicaid for nonelderly adults is far more limited. Medicaid covers some parents and low-income disabled individuals, but most adults without dependent children—regardlessof how poor—are ineligible for Medicaid. Parents of dependent children qualify for Medicaid, though income eligibility levels are set much lower than congressionally mandated standards for children and pregnant women. These eligibility restrictions, coupled with barriers to Medicaid enrollment, leave 42% of poor parents under age 65 uninsured (Figure 22).

Figure 22

18%

28%

17%

40%

41%

61%

39%

47%

33%

42%

17%

22%

25%

43%

17%

43%

18%

50%

Employer/Other Private Medicaid/Other Public Uninsured

Poor

Near-Poor

(<100% Poverty)

(100-199% Poverty)

Poor

Near-Poor

(<100% Poverty)

(100-199% Poverty)

Poor

Near-Poor

(<100% Poverty)

(100-199% Poverty)

Children

Parents

Adults without children

Medicaid also includes SCHIP and other state programs, Medicare and military-related coverage. The federal poverty level was $19,971 for a family of four in 2005. Data may not total 100% due to rounding.SOURCE: KCMU/Urban Institute analysis of March 2006 CPS.

Health Insurance Coverage of Low-Income Adults and Children, 2005

0020 00 21

23

� Some states have expanded Medicaid eligibility for low-income parents, but most states continue to tie income eligibility levels for parents to former welfare assistance levels. Over one quarter of states have used the flexibility available to them under federal law to extend Medicaid eligibility for parents to 100% of the poverty level or higher. However, in the remaining states, parents still must have income below the poverty level in order to qualify for health coverage (Figure 23). As a result, millions of poor parents are ineligible for Medicaid. For example, a parent in a family of three working full-time at the minimum wage could not qualify for Medicaid in 25 states in 2005.36

Figure 23

IL

Medicaid Eligibility for Working Parents,by Income, July 2005

AZAR

MS

LA

WA

MN

ND

WY

ID

UTCO

OR

NV

CA

MT

IA

WIMI

NE

SD

ME

MOKS

OHIN

NY

KY

TNNC

NH

MA

VT

PA

VAWV

CTNJ

DE

MD

RI

HI

DC

AK

SCNM

OK

GA

* Federal Poverty Level (FPL) refers here to HHS Poverty Guidelines, $16,090 for a family of three in 2005. SOURCE: Center on Budget and Policy Priorities for KCMU, 2005

TX

FL

AL

50% - 100% FPL (23 states)

> 100% FPL* (14 states including DC)

< 50% FPL (14 states)National Average = 67% FPL

� Growth in Medicaid and SCHIP enrollment from 2000 to 2004 contributed to the decrease in the share of children who were uninsured; however, Medicaid coverage leveled off in 2005. Manystates remain focused on measures to control Medicaid enrollment and spending growth. In 2006, 18 states implemented policies to restrict eligibility. However, improving fiscal conditions are allowing for more program investments than in previous years. In both their 2006 and 2007 budgets, just over half of states implemented or adopted policies that would expand eligibility either by raising eligibility levels or by simplifying application or eligibility processes.37

0022 00 23

24

� Medicaid covers the majority of people who are in fair or poor health. Over 50% of people in fair and poor health are covered by Medicaid, while only 18% are covered by private insurance (Figure 24).Medicaid beneficiaries are also poorer and more likely to have health conditions that limit work compared to the low-income privately insured. Most Medicaid beneficiaries do not have access to private health insurance, and without Medicaid, they would become uninsured.

Figure 24

Health Insurance Coverage of the Low-IncomeNonelderly by Health Status, 2005

Employer/Other Private UninsuredMedicaid

Excellent/Very Good

Good

Fair/Poor

28%

38%

18%

30%

55%

34%

32%

38%

27%

Medicaid also includes SCHIP, other state programs, Medicare, and military-related coverage. Data may not total 100% due to rounding. SOURCE: KCMU/Urban Institute analysis of March 2006 CPS.

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25

What Can Be Done to Decrease the Number of Uninsured?

Public opinion surveys over time show that the majority of Americans believe decreasing the number of uninsured is an important policy priority. However, there is little agreement on how to achieve this goal.Policy options that have been proposed to guarantee universal coverage range from a single public plan that covers all Americans to more targeted strategies that extend employer-based coverage. Some build on public coverage while others require individuals to purchase coverage directly. Most strategies recognize the need to subsidize the cost for the lowest income groups.

Many of the recent proposals, however, have taken approaches that combine strategies in order to expand health insurance coverage incrementally. Building on the nation’s mixed system of public and private insurance, the strategies being discussed vary not only by the means of insuring more Americans, but also by who is targeted for coverage. The uninsured population is diverse; therefore, applying different strategies may be necessary to meet the needs of a growing uninsured population.

Figure 25

The Nonelderly Uninsured,by Age and Income Groups, 2005

Other Children5%

Low-IncomeParents

16%

Low-IncomeAdults without

Children35%

Low-IncomeChildren

14%

Other Parents8%

Total = 46.1 million uninsured

Low-income includes those with family incomes less than 200% of the federal poverty level ($39,942 for a family of four in 2005). SOURCE: KCMU/Urban Institute analysis of March 2006 CPS.

Other Adultswithout Children

22%

Components of proposed strategies include:

� Expanding public coverage for the low-income uninsured by building on Medicaid and SCHIP.With the administrative means to enroll beneficiaries and pay providers already in place, these public programs currently provide comprehensive benefits with no or minimal cost-sharing to all who qualify. These programs are explicitly designed to cover those most at risk of being uninsured—low-income families and the disabled. However, neither program has reached its full enrollment potential.

0024 00 25

26

With the introduction of SCHIP, several states successfully implemented system-wide changes in order to improve enrollment and retention efforts in both Medicaid and SCHIP. However, not all of these efforts could be fully sustained during recent state budget crises. With major budgetary problems now behind many states, more states are again considering ways of expanding coverage to more of the low-income population through their public programs.Increasing federal and state funding to expand public coverage offers the potential (as shown in Figure 25) to reach nearly two-thirds of the uninsured population, if coverage is extended to low-income adults without children, as well as to more parents.

� Expanding private group coverage by bolstering the current employer-sponsored system and/or building new group insurance options. The share of Americans with job-based coverage has been declining, particularly since 2000. While the majority of Americans obtain their health insurance through the workplace, over 80% of the uninsured are working themselves or have a connection to the workforce. Proposals aimed at increasing coverage through the workplace range from encouraging more job-based coverage with financial incentives for employers, including tax incentives, to mandating that businesses provide health coverage. Some federal proposals would set up new group insurance options for individuals or businesses, sometimes modeled after the Federal Employee Health Benefits Program, that would provide a wide range of health plans with a large risk pool. Others would make it easier for small employers and the self-employed to band into larger insurance purchasing pools, potentially giving them large group negotiating power when buying insurance. Both types of strategies could lower premiums and broaden the choice of policies available to the uninsured, but many experts believe the government will need to subsidize the premiums for low-wage workers or some small firms, or at least, provide some form of federal reinsurance for high cost enrollees to reduce employer premiums.

� Subsidizing the purchase of private individual health insurance, making coverage more affordable with tax credits or deductions delivered through the federal income tax system.Some believe job-based coverage is an outdated approach in a country where workers change employers several times during their lives and are unable to maintain their health benefits across jobs.It has also been argued that tax exclusions tied to employer health insurance unfairly benefit only those who have group coverage through a business.

Letting individuals choose their own health plans and helping with costs through tax credits provides an alternative to employment-linked coverage. However, the success of these options depends on whether the individual health insurance market can evolve to meet the needs of people with higher health needs. Most people with health problems or a chronic condition currently are either excluded from nongroup insurance or find policies unaffordable. Private nongroup coverage has not grown over time, still covering just over 5% of the nonelderly population.

Another set of proposals would make it easier for people to take advantage of health savings accounts (HSAs) if they purchase a high deductible health plan. Contributions and withdrawals to HSAs are made tax-free and are to be used for paying out-of-pocket medical expenses. While high deductible plans could potentially make people more cost-conscious, for many, particularly the low-income uninsured, they are not more affordable than other plans and could attract only healthy people, driving

0024 00 25

27

up the cost of coverage for others. HSA-qualified health plans are still relatively rare, with recent estimates of three million individuals covered in either group or nongroup HSA-qualified HDHPs.38

Proposals that offer tax credits or deductions to individuals vary by whom they would assist. Some would target tax provisions to the low-income; others would assist all the uninsured. The cost to the government of tax-based approaches could be high, since those least able to afford insurance would require substantial financial assistance to pay their premiums. Moreover, such tax credits are likely to also be used by many who are already insured, providing greater tax equity, but also increasing the cost of expanding coverage.

Figure 26

Uninsured Rates Among the Nonelderlyby State, 2004-2005

<13% Uninsured (12 states)13 to <18% Uninsured (22 states & DC)>18% Uninsured (17 states)

National Average = 18%

SOURCE: KCMU and Urban Institute analysis of the March Current Population Survey, 2005 and 2006, two-year pooled data.

AZ

WA

WY

ID

UT

OR

NV

CA

MT

HI

AK

AR

MS

LA

MN

ND

CO

IA

WI

NE

SD

MOKS

TN

NMOK

TX

AL

MI

ILOH

IN

KYNC

PA

VAWV

SC

GA

FL

ME

NY

NH

MA

VT

NJ

DE

MD

RI

DC

CT

In the absence of national reform and as more state budgets return to healthy balances, more governors and state legislators are seeking solutions to address their state’s growing number of uninsured—and are proposing a diverse mix of reforms. The problem differs widely across states, with uninsured rates varying nearly three-fold, largely due to differences in state economies and employer coverage, the share of families with low incomes, and the breadth of state Medicaid programs (Figure 26).

Some states are moving toward expanded coverage of children, while others are looking for more comprehensive solutions. Recent landmark legislation in Massachusetts, designed to provide nearly universal coverage for its residents, combines several strategies: a Medicaid expansion, an individual mandate, and required employer participation. Because each state faces different circumstances, the combination that may work for Massachusetts may not be feasible for others. Moreover, the growing size and scope of the problem means few states will be able to move towards universal coverage in the absence of federal assistance and financial support.

00 27

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28

TABLES

Table 1: Characteristics of the Nonelderly Uninsured, 2005

Table 2: Characteristics of Uninsured Children, 2005

Table 3: Characteristics of the Low-Income Nonelderly Uninsured, 2005

Table 4: Health Insurance Coverage of the Nonelderly, 2005

Table 5: Health Insurance Coverage of Children, 2005

Table 6: Health Insurance Coverage of the Low-Income Nonelderly, 2005

Table 7: Health Insurance Coverage of the Nonelderly by State, 2004-2005

Table 8: Health Insurance Coverage of Children by State, 2004-2005

Table 9: Health Insurance Coverage of the Low-Income Nonelderly by State, 2004-2005

0028 00 29

Nonelderly Percent of Uninsured Percent of Uninsured(millions) Nonelderly (millions) Uninsured Rate

Total - Nonelderlya 257.4 100.0% 46.1 100.0% 17.9%

Age

Children - Total 77.9 30.3% 9.0 19.6% 11.6%

Adults - Total 179.5 69.7% 37.1 80.4% 20.7%Adults 19-24 23.9 9.3% 7.8 17.0% 32.8%Adults 25-34 39.1 15.2% 10.4 22.6% 26.6%Adults 35-44 42.8 16.6% 8.1 17.5% 18.9%Adults 45-54 42.7 16.6% 6.5 14.1% 15.3%Adults 55-64 31.0 12.0% 4.2 9.1% 13.6%

Annual Family Income

<$20,000 61.2 23.8% 22.7 49.2% 37.1%$20,000 - $39,999 53.4 20.7% 13.0 28.1% 24.3%

$40,000 + 142.9 55.5% 10.5 22.7% 7.3%

Family Poverty Levelb

<100% 45.9 17.8% 16.7 36.3% 36.5%100-199% 44.8 17.4% 13.3 28.9% 29.8%

...100-149% 22.2 8.6% 7.2 15.7% 32.7%

...150-199% 22.6 8.8% 6.1 13.2% 27.0%200-399% 74.4 28.9% 10.7 23.3% 14.4%

...200-299% 40.5 15.7% 7.2 15.7% 17.8%

...300-399% 33.9 13.2% 3.5 7.7% 10.4%400%+ 92.3 35.9% 5.3 11.4% 5.7%

Household Type

Single Adults Living Alone 19.1 7.4% 3.2 6.9% 16.7%Single Adults Living Together 29.7 11.5% 10.5 22.8% 35.4%

Married Adults 52.8 20.5% 8.9 19.4% 16.9%

1 Parent with childrenc 31.9 12.4% 6.2 13.3% 19.3%2 Parents with childrenc 111.3 43.2% 13.6 29.5% 12.2%

Multigenerational/Other with childrend 12.7 4.9% 3.7 8.1% 29.2%

Family Work Status

2 Full-time 71.5 27.8% 5.9 12.8% 8.3%1 Full-time 137.9 53.6% 26.1 56.5% 18.9%

Only Part-timee 17.7 6.9% 5.2 11.4% 29.6%Non-Workers 30.3 11.8% 8.9 19.3% 29.4%

Race/Ethnicity

White only (non-Hispanic) 166.6 64.7% 22.0 47.6% 13.2%Black only (non-Hispanic) 32.6 12.7% 6.8 14.8% 20.9%

Hispanic 40.8 15.8% 14.0 30.3% 34.3%Asian/S. Pacific Islander only 11.8 4.6% 2.3 5.0% 19.4%

Am. Indian/Alaska Native 1.5 0.6% 0.5 1.1% 32.0%

Two or More Racesf 4.2 1.6% 0.6 1.3% 13.9%

Citizenship

U.S. citizen - native 225.8 87.7% 34.4 74.5% 15.2%U.S. citizen - naturalized 11.0 4.3% 2.4 5.2% 21.8%

Non-U.S. citizen, resident for < 5 years 5.0 1.9% 2.6 5.6% 51.3%Non-U.S. citizen, resident for 5+ years 15.6 6.1% 6.8 14.7% 43.5%

Health Status

Excellent/Very Good 177.8 69.1% 28.1 61.0% 15.8%Good 58.2 22.6% 13.5 29.3% 23.3%

Fair/Poor 21.5 8.3% 4.4 9.6% 20.7%

Characteristics of the Nonelderly Uninsured, 2005Table 1

0028 00 29

Children Percent of Uninsured Percent of Uninsured(millions) Children (millions) Uninsured Rate

Total - Childreng 77.9 100.0% 9.0 100.0% 11.6%

Age

<1 4.1 5.2% 0.6 6.2% 13.9%1-5 20.3 26.1% 2.1 22.8% 10.1%

6-18 53.5 68.7% 6.4 71.0% 12.0%

Family Income

<$20,000 18.6 23.9% 4.1 45.5% 22.1%$20,000 - $39,999 14.9 19.1% 2.5 27.8% 16.9%

$40,000 + 44.4 57.0% 2.4 26.6% 5.4%


<100% 17.7 22.7% 4.0 43.8% 22.3%100-199% 15.5 19.8% 2.6 28.8% 16.8%

...100-149% 7.8 10.1% 1.5 16.7% 19.2%

...150-199% 7.6 9.8% 1.1 12.1% 14.4%200-399% 22.6 29.1% 1.8 19.4% 7.7%

...200-299% 12.8 16.4% 1.3 13.9% 9.8%

...300-399% 9.9 12.7% 0.5 5.5% 5.1%400%+ 22.1 28.4% 0.7 8.0% 3.3%

Household Typeh

1 Parent with childrenc 19.0 24.3% 2.6 28.4% 13.5%2 Parents with childrenc 52.7 67.6% 4.8 53.0% 9.1%


Family Work Status



Race/Ethnicity



Am. Indian/Alaska Native 0.5 0.7% 0.1 1.6% 27.5%Two or More Racesf 2.1 2.7% 0.1 1.7% 7.2%

Citizenship

U.S. Citizen 75.1 96.4% 7.9 87.8% 10.6%Non-U.S. citizen, resident for < 5 years 1.2 1.5% 0.5 5.8% 44.5%Non-U.S. citizen, resident for 5+ years 1.6 2.1% 0.6 6.5% 35.8%

Health Status


Fair/Poor 1.8 2.3% 0.2 2.0% 10.4%

Table 2Characteristics of Uninsured Children, 2005

0030 00 31

Low-Income Percent of Uninsured Percent of UninsuredNonelderly Low-Income (millions) Uninsured Rate(millions) Nonelderly

Total - Low-Income Nonelderlya 90.7 100.0% 30.1 100.0% 33.2%

Age

Children - Total 33.2 36.6% 6.6 21.8% 19.8%

Adults - Total 57.5 63.4% 23.5 78.2% 40.9%Adults 19-24 13.8 15.2% 6.1 20.3% 44.3%Adults 25-34 14.8 16.3% 7.0 23.1% 47.0%Adults 35-44 11.9 13.1% 4.9 16.2% 41.0%Adults 45-54 9.6 10.6% 3.6 11.8% 36.9%Adults 55-64 7.4 8.2% 2.0 6.8% 27.6%


<$20,000 61.2 67.4% 22.7 75.4% 37.1%$20,000 - $39,999 25.6 28.3% 6.8 22.5% 26.4%

$40,000 + 3.9 4.3% 0.6 2.1% 16.2%


<100% 45.9 50.6% 16.7 55.7% 36.5%100-199% 44.8 49.4% 13.3 44.3% 29.8%

...100-149% 22.2 24.4% 7.2 24.1% 32.7%

...150-199% 22.6 25.0% 6.1 20.3% 27.0%

Household Type

Single Adults Living Alone 6.5 7.2% 1.9 6.4% 29.6%Single Adults Living Together 15.4 16.9% 7.5 24.8% 48.6%

Married Adults 9.9 11.0% 4.1 13.6% 41.3%

1 Parent with childrenc 21.2 23.4% 4.9 16.4% 23.3%

2 Parents with childrenc 29.1 32.1% 8.7 28.8% 29.8%


Family Work Status



Race/Ethnicity



Am. Indian/Alaska Native 0.9 1.0% 0.4 1.3% 43.7%

Two or More Racesf 1.7 1.9% 0.4 1.3% 22.3%

Citizenship

U.S. citizen - native 75.6 83.4% 21.8 72.4% 28.8%U.S. citizen - naturalized 3.4 3.7% 1.4 4.5% 40.2%

Non-U.S. citizen, resident for < 5 years 3.1 3.4% 2.0 6.6% 63.5%Non-U.S. citizen, resident for 5+ years 8.6 9.4% 5.0 16.5% 58.1%

Health Status


Fair/Poor 12.3 13.6% 3.4 11.1% 27.3%

(Less than 200% of Poverty), 2005

Table 3Characteristics of the Low-Income Nonelderly Uninsured

0030 00 31

Nonelderly Uninsured

(millions) Employer Individual Medicaid Otheri

Total - Nonelderlya 257.4 60.8% 5.4% 13.5% 2.4% 17.9%

Age

Children - Total 77.9 56.4% 4.4% 26.1% 1.4% 11.6%

Adults - Total 179.5 62.7% 5.8% 8.0% 2.8% 20.7%Adults 19-24 23.9 43.6% 10.6% 11.3% 1.7% 32.8%Adults 25-34 39.1 58.9% 4.2% 8.8% 1.5% 26.6%Adults 35-44 42.8 67.5% 4.6% 7.3% 1.8% 18.9%Adults 45-54 42.7 70.0% 5.3% 6.7% 2.8% 15.3%Adults 55-64 31.0 65.3% 6.6% 7.6% 6.8% 13.6%


<$20,000 61.2 18.4% 6.7% 33.8% 4.0% 37.1%$20,000 - $39,999 53.4 51.4% 5.9% 15.7% 2.8% 24.3%

$40,000 + 142.9 82.4% 4.7% 4.0% 1.6% 7.3%


<100% 45.9 14.2% 6.2% 39.8% 3.3% 36.5%100-199% 44.8 38.6% 6.0% 22.0% 3.6% 29.8%

...100-149% 22.2 30.2% 6.0% 27.3% 3.9% 32.7%

...150-199% 22.6 46.8% 6.1% 16.9% 3.3% 27.0%200-399% 74.4 71.0% 5.6% 6.6% 2.4% 14.4%

...200-299% 40.5 64.9% 6.1% 8.6% 2.6% 17.8%

...300-399% 33.9 78.3% 5.0% 4.1% 2.1% 10.4%400%+ 92.3 86.4% 4.6% 1.9% 1.4% 5.7%

Household Type

Single Adults Living Alone 19.1 60.2% 8.9% 9.5% 4.7% 16.7%Single Adults Living Together 29.7 43.7% 8.5% 9.7% 2.8% 35.4%

Married Adults 52.8 69.1% 5.5% 4.7% 3.8% 16.9%

1 Parent with childrenc 31.9 37.9% 4.9% 36.6% 1.3% 19.3%2 Parents with childrenc 111.3 70.9% 4.2% 11.1% 1.5% 12.2%

Multigenerational/Other with childrend 12.7 35.7% 3.9% 28.6% 2.5% 29.2%

Family Work Status

2 Full-time 71.5 83.1% 3.1% 4.5% 1.1% 8.3%1 Full-time 137.9 63.2% 5.5% 10.8% 1.6% 18.9%

Only Part-timee 17.7 29.9% 12.2% 25.1% 3.2% 29.6%Non-Workers 30.3 15.0% 6.6% 40.4% 8.5% 29.4%

Race/Ethnicity

White only (non-Hispanic) 166.6 68.7% 6.3% 9.3% 2.5% 13.2%Black only (non-Hispanic) 32.6 47.5% 3.2% -0.4% 3.2% 20.9%

Hispanic 40.8 39.5% 3.1% 21.6% 1.6% 34.3%Asian/S. Pacific Islander only 11.8 63.4% 6.9% 8.6% 1.7% 19.4%

Am. Indian/Alaska Native 1.5 42.9% 2.4% 19.7% 3.0% 32.0%

Two or More Racesf 4.2 55.1% 5.1% 22.4% 3.6% 13.9%

Citizenship

U.S. citizen - native 225.8 62.8% 5.5% 14.0% 2.5% 15.2%U.S. citizen - naturalized 11.0 62.3% 6.3% 7.7% 1.9% 21.8%

Non-U.S. citizen, resident for < 5 years 5.0 32.0% 5.5% 10.5% 0.8% 51.3%Non-U.S. citizen, resident for 5+ years 15.6 40.2% 3.8% 11.2% 1.3% 43.5%

Health Status

Excellent/Very Good 177.8 66.0% 5.9% 10.8% 1.4% 15.8%Good 58.2 53.8% 4.5% 16.1% 2.4% 23.3%

Fair/Poor 21.5 36.3% 3.6% 29.3% 10.2% 20.7%

( ) = Estimate has a large 95% confidence interval of +/- 5.0 - 7.9 percentage points. Estimates with larger margins of error are not provided.

Table 4Health Insurance Coverage of the Nonelderly, 2005

PublicPrivatePercent Distribution by Coverage Type

0032 00 33

Children Uninsured


Total - Childreng 77.9 56.4% 4.4% 26.1% 1.4% 11.6%

Age

<1 4.1 48.5% 2.6% 33.5% 1.5% 13.9%1-5 20.3 53.7% 3.3% 31.1% 1.7% 10.1%

6-18 53.5 58.0% 5.0% 23.7% 1.3% 12.0%


<$20,000 18.6 13.9% 3.6% 58.9% 1.5% 22.1%$20,000 - $39,999 14.9 39.4% 4.6% 37.5% 1.5% 16.9%

$40,000 + 44.4 79.9% 4.7% 8.6% 1.4% 5.4%


<100% 17.7 13.3% 3.3% 59.5% 1.5% 22.3%100-199% 15.5 38.2% 4.4% 39.0% 1.6% 16.8%

...100-149% 7.8 29.1% 4.0% 46.1% 1.6% 19.2%

...150-199% 7.6 47.6% 4.9% 31.5% 1.7% 14.4%200-399% 22.6 72.2% 5.2% 13.1% 1.8% 7.7%

...200-299% 12.8 65.6% 5.4% 17.3% 1.8% 9.8%

...300-399% 9.9 80.6% 4.8% 7.7% 1.8% 5.1%400%+ 22.1 87.5% 4.6% 3.7% 0.9% 3.3%

Household Typeh

1 Parent with childrenc 19.0 35.1% 4.4% 46.0% 1.0% 13.5%

2 Parents with childrenc 52.7 68.0% 4.3% 17.0% 1.6% 9.1%


Family Work Status



Race/Ethnicity

White only (non-Hispanic) 45.3 67.7% 5.8% 17.7% 1.4% 7.5%Black only (non-Hispanic) 11.4 39.1% 2.3% 44.1% 1.7% 12.9%


Am. Indian/Alaska Native 0.5 ----- 2.8% ----- 0.4% (27.5%)


Citizenship

U.S. citizen 75.1 57.3% 4.5% 26.2% 1.5% 10.6%Non-U.S. citizen, resident for < 5 years 1.2 28.7% 4.0% 21.8% 1.0% (44.5%)Non-U.S. citizen, resident for 5+ years 1.6 34.5% 2.6% 26.3% 0.8% 35.8%

Health Status


Fair/Poor 1.8 27.7% 2.0% 58.1% 1.8% 10.4%


Table 5Health Insurance Coverage of Children, 2005

Percent Distribution by Coverage Type

Private Public

0032 00 33

Low-Income

Nonelderly Uninsured


Total - Low-Income Nonelderlya 90.7 26.2% 6.1% 31.0% 3.4% 33.2%

Age

Children - Total 33.2 24.9% 3.8% 49.9% 1.6% 19.8%

Adults - Total 57.5 27.0% 7.4% 20.1% 4.5% 40.9%Adults 19-24 13.8 25.5% 12.1% 16.4% 1.6% 44.3%Adults 25-34 14.8 26.7% 4.7% 19.5% 2.1% 47.0%Adults 35-44 11.9 29.6% 5.2% 20.8% 3.4% 41.0%Adults 45-54 9.6 26.7% 6.4% 23.4% 6.6% 36.9%Adults 55-64 7.4 26.8% 8.9% 23.0% 13.7% 27.6%


<$20,000 61.2 18.4% 6.7% 33.8% 4.0% 37.1%$20,000 - $39,999 25.6 40.3% 4.8% 26.2% 2.3% 26.4%

$40,000 + 3.9 56.8% 5.1% 19.9% 2.1% 16.2%


<100% 45.9 14.2% 6.2% 39.8% 3.3% 36.5%100-199% 44.8 38.6% 6.0% 22.0% 3.6% 29.8%

...100-149% 22.2 30.2% 6.0% 27.3% 3.9% 32.7%

...150-199% 22.6 46.8% 6.1% 16.9% 3.3% 27.0%

Household Type

Single Adults Living Alone 6.5 25.3% 11.8% 24.2% 9.3% 29.6%Single Adults Living Together 15.4 19.9% 10.8% 16.6% 4.1% 48.6%

Married Adults 9.9 29.3% 7.9% 14.8% 6.7% 41.3%

1 Parent with childrenc 21.2 21.8% 3.3% 50.0% 1.5% 23.3%

2 Parents with childrenc 29.1 33.7% 4.4% 29.8% 2.2% 29.8%


Family Work Status



Race/Ethnicity

White only (non-Hispanic) 42.8 30.7% 8.9% 27.3% 4.4% 28.7%Black only (non-Hispanic) 17.8 23.0% 3.5% 40.9% 3.7% 28.8%


Am. Indian/Alaska Native 0.9 (19.9%) 1.2% (31.1%) 4.1% (44.5%)


Citizenship

U.S. citizen - native 75.6 27.2% 6.4% 33.9% 3.8% 28.8%U.S. citizen - naturalized 3.4 31.0% 6.8% 19.0% 2.8% 40.2%

Non-U.S. citizen, resident for < 5 years 3.1 16.2% 5.7% 13.6% 1.0% 63.5%Non-U.S. citizen, resident for 5+ years 8.6 20.0% 3.5% 16.9% 1.5% 58.1%

Health Status


Fair/Poor 12.3 14.3% 3.2% 43.8% 11.5% 27.3%

Table 6

Private Public

Health Insurance Coverage of the Low-Income Nonelderly, 2005(Less than 200% of Poverty)



0034 00 35

Nonelderly

(thousands)a Employer Individual Medicaid Otheri

United States 256,260 60.9% 5.5% 13.6% 2.3% 17.7%Alabama 3,962 60.6% 3.6% 15.9% 3.6% 16.3%Alaska 601 55.4% 4.4% 15.9% 5.6% 18.6%Arizona 5,131 53.2% 5.8% 17.4% 2.3% 21.3%Arkansas 2,369 53.4% 6.3% 16.3% 4.1% 19.8%California 31,896 53.5% 7.5% 16.5% 1.5% 21.0%Colorado 4,146 63.7% 7.8% 7.4% 2.7% 18.4%Connecticut 3,030 69.8% 4.5% 11.2% 1.5% 12.9%Delaware 723 67.4% 3.5% 11.2% 2.5% 15.4%District of Columbia 479 55.8% 6.2% 22.2% 1.3% 14.5%Florida 14,773 55.3% 5.6% 11.6% 3.4% 24.1%Georgia 8,050 57.9% 4.5% 14.5% 3.3% 19.9%Hawaii 1,058 69.8% 3.4% 10.9% 5.3% 10.7%Idaho 1,269 60.3% 8.4% 12.7% 1.5% 17.1%Illinois 11,064 66.6% 4.9% 10.9% 1.7% 15.9%Indiana 5,497 64.7% 4.5% 12.8% 2.1% 15.9%Iowa 2,521 68.4% 8.1% 11.8% 1.3% 10.4%Kansas 2,331 67.4% 7.1% 10.6% 2.4% 12.4%Kentucky 3,550 61.4% 4.1% 15.3% 3.8% 15.4%Louisiana 3,687 55.8% 5.4% 16.0% 2.5% 20.2%Maine 1,125 59.1% 4.7% 21.5% 2.8% 12.0%Maryland 4,883 68.0% 4.6% 9.1% 2.4% 15.9%Massachusetts 5,608 67.1% 4.4% 14.9% 1.5% 12.1%Michigan 8,788 67.0% 4.5% 14.1% 1.4% 13.0%Minnesota 4,519 71.4% 8.3% 9.2% 1.4% 9.7%Mississippi 2,500 52.6% 4.4% 20.3% 3.4% 19.3%Missouri 4,937 63.4% 5.9% 14.4% 2.1% 14.1%Montana 787 53.5% 9.0% 12.1% 4.1% 21.4%Nebraska 1,524 65.8% 8.2% 10.9% 2.2% 13.0%Nevada 2,122 65.0% 4.6% 7.0% 3.1% 20.3%New Hampshire 1,134 75.5% 4.6% 6.0% 2.0% 11.9%New Jersey 7,627 71.0% 3.0% 8.0% 1.3% 16.5%New Mexico 1,667 49.6% 5.0% 18.3% 3.4% 23.6%New York 16,539 60.4% 4.4% 19.0% 1.1% 15.1%North Carolina 7,450 59.8% 5.5% 13.2% 3.9% 17.7%North Dakota 538 64.4% 10.7% 8.7% 2.9% 13.3%Ohio 9,891 67.7% 4.1% 12.8% 1.8% 13.5%Oklahoma 2,960 55.7% 4.6% 13.7% 3.8% 22.1%Oregon 3,128 60.4% 6.8% 12.5% 1.5% 18.8%Pennsylvania 10,445 67.6% 6.0% 12.2% 1.4% 12.9%Rhode Island 926 63.4% 4.4% 17.4% 2.0% 12.8%South Carolina 3,613 57.9% 4.5% 15.5% 3.4% 18.6%South Dakota 654 59.5% 10.7% 12.1% 3.7% 14.0%Tennessee 5,062 56.4% 6.0% 17.4% 4.1% 16.1%Texas 20,208 53.4% 4.5% 12.5% 2.5% 27.2%Utah 2,267 63.3% 7.9% 10.6% 1.5% 16.7%Vermont 538 59.4% 4.9% 20.7% 2.1% 12.9%Virginia 6,538 67.5% 4.6% 7.8% 4.6% 15.5%Washington 5,435 63.0% 6.0% 12.4% 3.5% 15.2%West Virginia 1,522 58.3% 2.5% 15.4% 3.8% 20.0%Wisconsin 4,751 67.6% 6.4% 12.8% 1.7% 11.5%Wyoming 439 60.6% 8.1% 11.0% 3.5% 16.8%


Private Public Uninsured

Table 7Health Insurance Coverage of the Nonelderly

by State, 2004-2005


0034 00 35

Children Uninsured

(thousands)g Employer Individual Medicaid Otheri

United States 77,836 56.4% 4.5% 26.3% 1.4% 11.4%Alabama 1,153 56.4% 2.8% 33.4% 1.3% 6.1%Alaska 195 49.3% 3.7% 30.8% 7.1% 9.2%Arizona 1,659 47.7% 4.9% 29.8% 1.3% 16.3%Arkansas 719 45.8% 5.2% 38.6% 1.0% 9.4%California 10,157 49.1% 6.2% 30.1% 1.0% 13.6%Colorado 1,234 62.0% 6.5% 14.8% 2.4% 14.3%Connecticut 880 68.8% 3.2% 19.3% 0.5% 8.2%Delaware 207 63.2% 2.8% 20.1% 2.0% 11.9%District of Columbia 119 (44.1%) 3.1% (45.2%) 0.1% 7.6%Florida 4,250 51.7% 4.7% 24.5% 1.9% 17.2%Georgia 2,467 50.2% 3.4% 32.0% 2.5% 11.9%Hawaii 311 64.0% 2.1% 21.6% 6.7% 5.6%Idaho 413 54.7% 9.3% 24.4% 0.7% 10.9%Illinois 3,442 63.1% 4.5% 20.7% 0.6% 11.2%Indiana 1,680 59.7% 3.4% 26.8% 0.6% 9.6%Iowa 728 64.0% 6.4% 22.7% 0.8% 6.1%Kansas 722 63.0% 6.1% 22.6% 1.4% 6.9%Kentucky 1,041 56.4% 3.3% 30.3% 2.2% 7.9%Louisiana 1,168 50.8% 5.2% 34.7% 0.8% 8.7%Maine 304 54.1% 3.9% 33.1% 1.8% 7.2%Maryland 1,448 64.1% 4.0% 20.7% 1.7% 9.5%Massachusetts 1,588 67.7% 3.8% 22.5% 0.5% 5.5%Michigan 2,686 63.4% 3.5% 26.7% 0.5% 5.9%Minnesota 1,315 70.1% 6.6% 16.3% 0.5% 6.5%Mississippi 810 41.9% 3.9% 39.2% 1.9% 13.1%Missouri 1,476 56.7% 5.8% 28.3% 0.8% 8.4%Montana 228 52.4% 5.9% 24.8% 1.6% 15.4%Nebraska 462 63.0% 5.7% 24.0% 1.2% 6.1%Nevada 662 65.8% 3.3% 13.6% 1.6% 15.8%New Hampshire 320 74.0% 3.8% 15.3% 0.7% 6.3%New Jersey 2,296 70.1% 2.5% 16.2% 0.2% 10.9%New Mexico 524 40.7% 2.0% 37.9% 1.5% 17.9%New York 4,831 56.4% 3.3% 31.9% 0.5% 8.0%North Carolina 2,299 55.5% 4.8% 24.6% 3.5% 11.6%North Dakota 154 60.6% 8.4% 18.2% 3.1% 9.6%Ohio 2,927 63.6% 3.5% 23.9% 0.7% 8.3%Oklahoma 899 47.2% 4.1% 31.5% 2.6% 14.5%Oregon 918 57.0% 7.5% 24.5% 0.1% 10.9%Pennsylvania 3,002 62.3% 4.7% 23.0% 0.7% 9.4%Rhode Island 268 57.4% 4.1% 29.5% 1.5% 7.6%South Carolina 1,072 52.2% 3.7% 32.7% 2.0% 9.5%South Dakota 200 53.1% 8.9% 25.9% 3.0% 9.0%Tennessee 1,490 54.7% 4.2% 29.4% 2.0% 9.7%Texas 6,706 47.3% 3.5% 27.2% 1.7% 20.4%Utah 806 61.4% 6.5% 19.3% 0.9% 11.9%Vermont 144 50.5% 3.5% 39.0% 1.1% 5.9%Virginia 1,935 65.8% 3.5% 17.1% 4.7% 8.8%Washington 1,602 57.3% 4.5% 26.6% 3.6% 8.0%West Virginia 410 54.5% 2.4% 32.8% 1.7% 8.7%Wisconsin 1,383 63.6% 4.4% 24.6% 0.8% 6.7%Wyoming 125 57.0% 5.1% 24.4% 2.6% 10.9%


Table 8Health Insurance Coverage of Children

by State, 2004-2005

Private PublicPercent Distribution by Coverage Type

0036 00 37

Low-Income % of

Nonelderly Nonelderly with Uninsured

(thousands)a Low Incomesb Employer Individual Medicaid Otheri

United States 90,251 35.2% 26.4% 6.1% 31.3% 3.4% 32.7%Alabama 1,582 39.9% 25.3% 5.2% 35.1% 6.4% 28.1%Alaska 181 30.2% 19.4% 4.2% 38.6% 6.1% 31.7%Arizona 2,100 40.9% 23.1% 6.3% 32.8% 2.7% 35.2%Arkansas 1,000 42.2% 25.2% 6.8% 30.4% 5.7% 31.9%California 12,673 39.7% 21.7% 6.7% 33.9% 2.0% 35.7%Colorado 1,229 29.7% 28.3% 8.9% 19.7% 3.6% 39.5%Connecticut 771 25.4% 27.6% 5.8% 34.9% 3.5% 28.3%Delaware 221 30.6% 30.7% 4.6% 30.1% 4.8% 29.8%District of Columbia 196 -0.4% 22.0% 6.2% 47.5% 2.1% 22.2%Florida 5,285 35.8% 26.0% 4.9% 24.0% 3.8% 41.3%Georgia 3,020 37.5% 25.9% 5.0% 31.0% 4.5% 33.6%Hawaii 333 31.5% 40.5% 4.1% 28.7% 6.0% 20.6%Idaho 452 35.6% 29.8% 7.8% 30.8% 2.1% 29.5%Illinois 3,495 31.6% 28.5% 6.2% 29.2% 3.3% 32.9%Indiana 1,815 33.0% 30.5% 4.3% 32.8% 3.8% 28.6%Iowa 738 29.3% 28.7% 11.9% 32.2% 2.6% 24.6%Kansas 785 33.7% 34.6% 9.3% 26.6% 3.6% 25.9%Kentucky 1,387 39.1% 28.4% 5.2% 33.1% 5.9% 27.3%Louisiana 1,636 44.4% 25.4% 5.6% 31.2% 3.7% 34.1%Maine 364 32.4% 20.2% 5.6% 50.9% 3.3% 19.9%Maryland 1,348 27.6% 29.3% 5.9% 26.1% 4.3% 34.4%Massachusetts 1,551 27.7% 25.0% 6.4% 41.3% 2.8% 24.5%Michigan 2,887 32.8% 31.4% 5.1% 35.6% 2.6% 25.3%Minnesota 1,029 22.8% 29.4% 13.9% 30.3% 2.3% 24.2%Mississippi 1,155 46.2% 22.8% 5.0% 38.2% 4.5% 29.5%Missouri 1,637 33.2% 26.4% 6.9% 35.5% 3.8% 27.4%Montana 320 40.6% 26.9% 9.2% 25.2% 4.6% 34.0%Nebraska 456 29.9% 30.9% 9.6% 29.6% 2.7% 27.2%Nevada 751 35.4% 37.3% 4.6% 16.3% 4.8% 37.0%New Hampshire 231 20.4% 35.4% 8.8% 19.8% 5.1% 30.9%New Jersey 1,917 25.1% 31.0% 4.5% 24.9% 2.9% 36.6%New Mexico 736 44.2% 19.7% 4.6% 33.9% 3.9% 38.0%New York 6,050 36.6% 26.0% 5.4% 40.7% 1.6% 26.3%North Carolina 2,726 36.6% 25.3% 6.3% 30.5% 5.1% 32.8%North Dakota 163 30.2% 31.7% 15.9% 21.9% 4.6% 25.8%Ohio 3,176 32.1% 30.2% 5.6% 33.9% 3.1% 27.2%Oklahoma 1,165 39.4% 26.5% 4.6% 28.1% 4.8% 36.0%Oregon 1,159 37.1% 26.2% 8.1% 29.1% 2.3% 34.3%Pennsylvania 3,361 32.2% 31.4% 9.2% 29.8% 3.2% 26.4%Rhode Island 294 31.7% 26.4% 5.6% 40.9% 3.4% 23.7%South Carolina 1,403 38.8% 24.7% 5.0% 33.6% 5.0% 31.7%South Dakota 212 32.4% 25.6% 12.1% 31.4% 4.8% 26.1%Tennessee 1,956 38.6% 22.5% 6.4% 37.7% 5.8% 27.6%Texas 8,628 42.7% 23.1% 4.2% 24.6% 3.2% 44.9%Utah 781 34.4% 33.5% 11.7% 24.1% 1.8% 29.0%Vermont 141 26.3% 19.7% 7.2% 48.2% 4.2% 20.8%Virginia 1,891 28.9% 33.9% 5.6% 22.2% 6.1% 32.2%Washington 1,664 30.6% 25.0% 8.3% 32.2% 4.6% 29.9%West Virginia 616 40.5% 26.4% 2.6% 32.6% 5.9% 32.6%Wisconsin 1,450 30.5% 33.0% 8.5% 32.3% 3.4% 23.0%Wyoming 130 29.6% 25.5% 8.8% 30.6% 4.4% 30.8%


Table 9Health Insurance Coverage of the Low-Income Nonelderly

(Less than 200% of Poverty) by State, 2004-2005

Private PublicPercent Distribution by Coverage Type

0036 00 37

Table Endnotes

The term family as used in family income, family poverty levels, and family work status, isdefined as a health insurance unit (those who are eligible as a group for "family" coveragein a health plan) throughout this report.

a Nonelderly includes all individuals under age 65.

b The 2005 federal poverty level for a family of four was $19,971.

c Parent includes any person with a dependent child.

d Multigenerational/other families with children include families with at least three generationsin a household, plus families in which adults are caring for children other than their own(e.g., a niece living with her aunt).

e Part-time workers were defined as working < 35 hours per week.

f For the first time in 2003, respondents could identify themselves in more than one racial group. Since there is no way of knowing how people who reported more than one race in 2003 previously reported their race, comparisons in health insurance coverage by race/ethnicitycannot be made with earlier years.

g Children includes all individuals under age 19.

h Approximately 1% of children live in households with no adult, three-quarters of whom are 17-18 years old.

i Other includes other public insurance (mostly Medicare and military-related).SCHIP is included in Medicaid.

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Data Notes

Much of the health insurance coverage information in this primer (including data in the tables) is based on a collaborative analysis of the Census Bureau’s March Current Population Survey (CPS; Annual Social and Economic Supplement) by analysts at the Kaiser Commission on Medicaid and the Uninsured and the Urban Institute. The CPS supplement is the primary source of annual health insurance coverage information in the United States.

While other ongoing national surveys may be able to more precisely determine health coverage over a specific time period, the CPS remains the most frequently cited national survey on health insurance coverage. Since the CPS began asking questions about health insurance in 1980, its design has been changed a number of times so that better estimates of the number of people with health coverage could be obtained. Despite these changes, the CPS remains the best survey for trending changes in health insurance from year to year.

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Endnotes 1 Kaiser Family Foundation and Health Research and Educational Trust. 2006. Employer Health Benefits 2006 Annual Survey. (#7527; September).

2 Kaiser Family Foundation and Health Research and Educational Trust. 2006.

3 Collins S, et al. 2006. Squeezed: Why Rising Exposure to Health Care Costs Threatens the Health and Financial Well-being of American Families. The Commonwealth Fund. (September).

4 Georgetown Center for Children and Families analysis of FY 2003 Medicaid Statistical Information System (MSIS) and SCHIP enrollment data.

5 Holahan J and A Cook. 2005. Are Immigrants Responsible for Most of the Growth of the Uninsured?Kaiser Commission on Medicaid and the Uninsured paper (#7411; October).

6 Davidoff AJ and G Kenney. 2005. Uninsured Americans with Chronic Health Conditions: Key Findings from the National Health Interview Survey. Available at: http://www.urban.org/publications/411161.html.

7 Kaiser Family Foundation. 2004. Kaiser 2003 Health Insurance Survey. (#7204; October).

8 Kaiser Commission on Medicaid and the Uninsured. 2003. Access to Care for the Uninsured: An Update.(# 4142; September).

9 Kaiser Commission on Medicaid and the Uninsured. 2003.

10 NewsHour with Jim Lehrer/Kaiser Family Foundation National Survey on the Uninsured. March 2003.

11 Institute of Medicine. 2002. Health Insurance is a Family Matter. Washington, DC.

12 Haley J and S Zuckerman. 2003. Is Lack of Coverage a Short-Term or Chronic Condition? Kaiser Commission on Medicaid and the Uninsured report (#4120; June).

13 Kasper J, T Giovannini, C Hoffman. 2000. “Gaining and Losing Health Insurance: Strengthening the Evidence for Efforts on Access to Care and Health Outcomes.” MCRR. 57(3): 298-318.

14 Hadley J. 2003. “Sicker and Poorer – The Consequences of Being Uninsured.” MCRR. 60(2): 3-76.

15 Institute of Medicine. 2002. Care Without Coverage, Too Little, Too Late. Washington, DC. P. 161-65.

16 Hadley J and J Holahan. 2004. The Cost of Care for the Uninsured: What Do We Spend, Who Pays, and What Would Full Coverage Add to Medical Spending? Kaiser Commission on Medicaid and the Uninsured.Issue Update (# 7084; May). Hadley J and J Holahan. 2003. Who Pays and How Much? The Cost of Caring for the Uninsured. Kaiser Commission on Medicaid and the Uninsured (# 4088; February).



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19 Asplin B, et al. 2005. “Insurance Status and Access to Urgent Ambulatory Care Follow-up Appointments”. JAMA 294(10):1248-54.

20 Anderson G. “Price Discrimination in Hospitals.” Forthcoming paper submitted for publication, July 2006.

21 Kaiser Commission on Medicaid and the Uninsured, 2005 Low-Income Coverage and Access Survey. Unpublished Data.

22 Hadley J and J Holahan, 2004.

23 Hadley J, M Cravens, T Coughlin, J Holahan. 2005. Federal Spending on the Health Care Safety Net from 2001-2004: Has Spending Kept Pace with the Growth in the Uninsured? Kaiser Commission on Medicaid and the Uninsured (#7425; November).

24 Hadley J and J Holahan. 2003.

25 Cunningham PJ and JH May. 2006. “A Growing Hole in the Safety Net: Physician Charity Care Declines Again.” Center for Studying Health Systems Change Tracking Report.

26 Holahan J and MB Pohl. 2002. “Changes in Insurance Coverage: 1994-2000 and Beyond.” HealthAffairs. Web Exclusive: April 2002.

27 Holahan J and A Cook. 2005. “Changes in Economic Conditions and Health Insurance Coverage, 2000-2004.” Health Affairs. W5-498-508.

28 Kaiser Family Foundation and Health Research and Educational Trust. 2006.

29 Clemans-Cope L and B Garrett. Changes in Employer-Sponsored Health Insurance Sponsorship, Eligibility, and Participation: 2001 – 2005. Kaiser Commission on Medicaid and the Uninsured, Forthcoming October, 2006. (#7570)

30 Clemans-Cope L and B Garrett. 2006.



33 Kaiser Family Foundation and Health Research and Educational Trust, 2006.


35 Georgetown Center for Children and Families analysis of March 2005 Current Population Survey using July 2004 eligibility rules, unpublished data.

36 Cohen Ross D and L Cox. 2005. In a Time of Growing Need: State Choices Influence Health Coverage Access for Children and Families. Kaiser Commission on Medicaid and the Uninsured report (# 7393; October).

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37 Smith V, K Gifford, E Ellis, A Wiles, R Rudowitz, M O’Malley, and C Marks. 2006. Low Spending Growth Amid Rebounding State Revenues: Results from a 50-State Medicaid Budget Survey, State Fiscal Years 2006 and 2007. Kaiser Commission on Medicaid and the Uninsured report (October).

38 America’s Health Insurance Plans. 2006. “Over 3 Million Enrolled in High-Deductible/HSA Plans.” Press Release, January 26, 2006. Obtained on Feb. 14, 2006 from http://www.ahip.org/content/pressrelease.

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Select Publications from the Kaiser Commission on Medicaid and the Uninsured

Available at www.kff.orgReports/Data Books

Why Did the Number of Uninsured Continue to Increase in 2005?, October 2006 (#7571)

Who are the Uninsured? A Consistent Profile Across National Surveys, August 2006 (#7553)

Changes in Employees’ Health Insurance Coverage, 2001-2005, October 2006 (#7570)

Health Savings Accounts and High Deductible Health Plans: Are They An Option for Low-Income Families?, October 2006 (#7568)

Health Coverage for Low-Income Americans: An Evidence-Based Approach to Public Policy, November 2006

Opening Doorways to Health Care for Children: 10 Steps to Ensure Eligible but Uninsured Children Get Health Insurance, May 2006 (#7506)

Federal Spending on the Health Care Safety Net: 2001-2004: Has Spending Kept Pace with the Growth in the Uninsured? November 2005 (#7425)

Are Immigrants Responsible for Most of the Growth of the Uninsured? October 2005 (#7411)

In a Time of Growing Need: State Choices Influence Health Coverage Access for Children and Families, October 2005 (#7393)

Low Medicaid Spending Growth Amid Rebounding State Revenues: Results from a 50-State Medicaid Budget Survey State Fiscal Years 2006 and 2007, October 2006 (#7569)

What is the Current Population Survey Telling Us About the Number of Uninsured? August 2005 (#7384)

The Economic Downturn and Changes in Health Insurance Coverage, 2000-2003, September 2004 (#7174)

At the Edge: Near-Elderly Americans Talk About Health Insurance, July 2004 (#7127)

Health Insurance Coverage of the Near Elderly, July 2004 (#7114)

The Cost of Care for the Uninsured: What Do We Spend, Who Pays, and What Would Full Coverage Add to Medical Spending, May 2004 (#7084)

Challenges and Tradeoffs in Low-Income Family Budgets: Implications for Health Coverage, April 2004 (#4147)

Fact Sheets

The Uninsured and Their Access to Health Care, October 2006 (#1420-08)

The Medicaid Program at a Glance, May 2006 (#7235)

Health Coverage for Low-Income Children, September 2004 (#2144-04)

Uninsured Workers in America, July 2004 (#7117)

Kaiser Family Foundation Publication

Employer Health Benefits 2006 Annual Survey, September 2006 (#7527)

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A d d i t i o n a l c o p i e s o f t h i s r e p o r t ( # 7451-02) a r e a v a i l a b l e o n t h e K a i s e r F a m i l y F o u n d a t i o n ' s w e b s i t e a t w w w . k f f . o r g .Additional copies of this report (#7451-02) are availableon the Kaiser Family Foundation’s website at www.kff.org.

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