HEALTH INSURANCE COVERAGE AMONG WORKERS AND THEIR DEPENDENTS IN NEW YORK,

Transcription

1 HEALTH INSURANCE COVERAGE AMONG WORKERS AND THEIR DEPENDENTS IN NEW YORK, UNITED HOSPITAL FUND Danielle Holahan Elise Hubert URBAN INSTITUTE John Holahan Linda Blumberg

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3 HEALTH INSURANCE COVERAGE AMONG WORKERS AND THEIR DEPENDENTS IN NEW YORK,

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5 HEALTH INSURANCE COVERAGE AMONG WORKERS AND THEIR DEPENDENTS IN NEW YORK, UNITED HOSPITAL FUND Danielle Holahan Elise Hubert URBAN INSTITUTE John Holahan Linda Blumberg

6 Copyright 2004 by the Urban Institute and the United Hospital Fund of New York. All rights reserved. No part of this publication may be reproduced in any form or used in any form by any means, electronic or mechanical, including photocopying, recording, or by information storage or retrieval system, without the prior written permission of the copyright holders. The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders. Printed in the United States of America

7 Contents Introduction Section 1. Demographics of the Non-elderly, Workers, and Their Dependents Section 2. Distribution of Coverage among the Non-elderly, Workers, and Their Dependents Section 3. Employer Offer Rates, Employee Eligibility, and Take-Up Rates for Employer-Sponsored Insurance Section 4. Tables

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9 INTRODUCTION Highlights from the Report Nearly 80 percent of the uninsured in New York are workers and dependents of workers; half of uninsured workers and their dependents are low-income (below 200 percent of the federal poverty level). Most uninsured workers are not offered coverage by their employers, and many are not eligible for public coverage. Some of the uninsured are eligible for employer-sponsored coverage but find it to be too expensive. Some uninsured are eligible for public programs but have been deterred by the complexity of the enrollment and renewal procedures. Solutions to the problem of New York s 3 million uninsured must include low-income workers and their dependents. Before developing specific proposals, it is important to understand the characteristics and coverage patterns of the uninsured. Highlights from this report follow: 18 percent of all non-elderly New Yorkers are uninsured (3.0 million people); 26 percent of all non-elderly New York City residents are uninsured (1.8 million people). 19 percent of New York workers are uninsured (1.7 million people); 28 percent of New York City workers are uninsured (1.0 million people). 16 percent of New York workers and their dependents are uninsured (2.3 million people); 24 percent of New York City workers and their dependents are uninsured (1.3 million people). Uninsured workers 52 percent of uninsured workers are low-income (below 200 percent of the federal poverty level). 52 percent of uninsured workers work in small firms (fewer than 25 employees). 84 percent of uninsured workers are neither offered nor eligible for coverage through their employer. Health Insurance Coverage among Workers and Their Dependents in New York,

10 Low-income workers and their dependents There are 6 million low-income New Yorkers, including 4 million workers and their dependents. 1 Dependents are far more likely to have public coverage and are less likely to be uninsured than are workers alone. Among the 4 million low-income workers and their dependents, 37 percent have employersponsored insurance, 27 percent have public coverage, 6 percent have other coverage, and 31 percent are uninsured. 2 Among the 2.2 million low-income workers alone, 38 percent have employer-sponsored insurance, 13 percent have public coverage, 7 percent have other coverage, 3 and 42 percent are uninsured. Income is the principal determinant of insurance status. More than half of uninsured workers and their dependents in New York are low-income. Firm size is another important factor. Workers in small firms (fewer than 25 employees) are far more likely to be uninsured than those in larger firms. Low-income workers are most likely to be uninsured regardless of firm size. For example, 44 percent of low-income workers in medium-sized firms (25 99 employees) and 29 percent of low-income workers in large firms (100 or more employees) are uninsured. Uninsured workers in medium and large firms account for a quarter of all uninsured workers. Most workers firms offer health insurance coverage, and most workers take up (accept) this coverage. However, there are important gaps in employer-sponsored coverage. While 82 percent of workers work for employers that sponsor a health insurance plan, not all workers are eligible for the coverage. For example, some employers do not offer coverage to parttime or temporary workers and some require newly hired workers to satisfy a waiting period before their coverage begins. In fact, only 76 percent of all workers are offered and eligible for their employers coverage. Low-income workers and workers in small firms are least likely to be eligible for their employers coverage. Only 49 percent of low-income workers are eligible for a coverage offer, compared with 82 percent of higher income workers. Similarly, 48 percent of workers in small firms are offered and eligible for employer coverage compared with 84 percent of workers in medium and large firms. Furthermore, only 16 percent of uninsured workers are offered and eligible for employer-sponsored coverage. When offered and eligible, the vast majority of workers take up the coverage. Overall, 88 percent of workers take up their employers coverage offers. Thus, to affect coverage rates through employers, it is important to increase employer offer rates and worker eligibility rates. Interestingly, low-income workers and workers in small firms have slightly higher take-up rates than higher income workers and workers in larger firms (90 percent compared with 87 percent in both cases). These differences, while modest, are unexpected and beg explanation. Higher income workers are more likely than low-income workers to be in a two-earner couple with two employer coverage offers. In most cases, one person will decline coverage from his/her employer and the couple will be covered under one policy. Even though higher income persons have higher overall coverage rates, they have slightly lower take-up rates of coverage through their own employers because they are eligible for more than one policy. Take-up rates 2 Health Insurance Coverage among Workers and Their Dependents in New York,

11 are higher for workers in small firms than for workers in larger firms because small firms frequently pay the full premium to meet insurers demands of high participation rates. Despite these differences, overall take-up rates are quite high. This report provides data from which to structure coverage strategies for New York s uninsured workers. Strategies that simplify public program enrollment and renewal processes would help the portion of low-income workers and their dependents that are eligible for existing programs. Strategies that make the cost of coverage more affordable for employers to offer and workers to take up would help workers who are not eligible for public programs and do not have an affordable coverage option. Policymakers are debating a range of specific proposals to expand coverage to uninsured workers and their dependents in New York and across the country. These proposals include mandates on employers to offer coverage, tax credits to subsidize the cost of coverage, and a variety of strategies that blend public and private funds to extend coverage more broadly. The public-private initiatives include using multiple funding sources to purchase Medicaid or State Child Health Insurance Program coverage for eligible persons, and premium assistance, which uses public funds to cover individuals through cost-effective employer-sponsored coverage. By providing an empirical foundation and context, this report should help shape coverage solutions for uninsured workers and their dependents in New York. Organization of the Report Health Insurance Coverage among Workers and Their Dependents in New York, provides detailed information about the demographics of and health insurance coverage of workers and their dependents in New York. The source for this information is the U.S. Census Bureau s Current Population Survey, the 2002 and 2003 Annual Social and Economic Supplement, and a merged file of the February 2001 CPS Contingent Worker Survey and the March 2001 CPS. Tabulations of these data were prepared for the United Hospital Fund by the Urban Institute. The report is organized into four sections. Section 1 includes demographic information and section 2 provides information about health insurance coverage. Sections 1 and 2 include tabulations from the Census Bureau s CPS, the 2002 and 2003 Annual Social and Economic Supplement. Data are shown as and reflect a two-year average. Section 3 offers information about employer offer rates, employee eligibility, and take-up rates of employer-sponsored coverage. Section 3 includes data from the merged February 2001 CPS Contingent Worker Survey and the March 2001 CPS; thus, the data in this section differ modestly from the rest of the report. Section 4 features corresponding tables. Data are shown for all non-elderly persons, workers, and workers and their dependents for New York State. When available, information is also shown for New York City and Rest of State (New York State excluding New York City). Data are shown by the following characteristics: Income Race/ethnicity Citizenship status Health Insurance Coverage among Workers and Their Dependents in New York,

12 Parent status Firm size Industry Work status Job tenure The report provides detailed information about the characteristics and coverage patterns of workers in New York to help shape coverage policies for this group. Because health insurance coverage is usually offered to individuals and/or families, the data in this report are shown for workers independently as well as with their dependents. Including dependents broadens the scope of a coverage offer, so it is important to understand the numbers in each group. Dependents are more likely to have public coverage because children s eligibility levels for public programs in New York are higher than adults levels. As a result, a smaller share of dependents than of workers is uninsured. So, while there are 5.2 million dependents of workers in New York, only 600,000 of them are uninsured. Because most of the uninsured are low-income, much of the report focuses on this subgroup of workers and their dependents. The report includes additional variables that are correlated with uninsurance, such as firm size and industry type. Data about employer contributions toward coverage are also included, but only for workers who have taken up the coverage. Because the CPS relies on respondent recall, information about the cost of coverage that was not taken up (declined) is unreliable, so it was not collected in this survey. However, other research suggests that affordability is a problem for certain workers and explains why some do not take up an employer s coverage offer. Notes about the Data The Current Population Survey is a monthly survey of approximately 50,000 households conducted by the U.S. Census Bureau for the Bureau of Labor Statistics. For several states, including New York, the CPS has a sufficient sample to produce state-based estimates. The March supplement, the Annual Social and Economic Supplement, includes questions regarding health insurance coverage, employment, earnings, and a variety of additional demographic and economic questions. The February supplement, the Contingent Worker Survey, records the number of workers as well as their health insurance status during the two weeks prior to the survey date. The survey also records whether the employer has a health insurance plan, whether the worker is eligible, and whether the worker participates in the plan. In March 2001, the Census Bureau permanently added verification questions to the CPS. Respondents who did not report any health insurance coverage were asked if they were uninsured throughout the entire year, and if not, the type of coverage they had had. Previously, respondents who did not report any coverage were categorized as uninsured. The addition of the verification questions resulted in a decrease in the reported number of uninsured. Because of this methodology change, data from the 2001 CPS (2000 data) cannot be 4 Health Insurance Coverage among Workers and Their Dependents in New York,

13 compared with earlier years. Tabulations for 2001 and 2002 included in this report are based upon the Census Bureau s revised methodology. Data are shown for New York City, New York State, and Rest of State. New York State data include New York City while Rest of State data exclude New York City. Notes 1. The remaining 2 million low-income New Yorkers are nonworkers and their dependents. 2. Numbers do not add to 100 percent due to rounding. 3. Other coverage includes private non-group and CHAMPUS/Medicare coverage. Health Insurance Coverage among Workers and Their Dependents in New York,

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15 SECTION1 Demographics of the Non-elderly, Workers, and Their Dependents New York State, New York City, and Rest of State

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17 Working adults and their dependents account for the vast majority of New York State s non-elderly population. FIGURE 1 Distribution of the New York State Population, million 16.6 million 2.6m 2.3m 4.9m 9.1m 5.2m 9.1m Working adults Children Nonworking adults Working adults Dependents of working adults Nonworkers and their dependents Source: Urban Institute, Tabulations of the Current Population Survey, 2002 and 2003 Annual Economic Supplements. Notes: Data include all persons age Workers include adults age who work full- or part-time and self-employed workers. Dependents include nonworking spouses, children age 0 18, and students age More than one-third of workers and their dependents in New York City and more than one-fifth in the rest of the state have incomes below 200 percent of the federal poverty level (FPL). FIGURE 2 Workers and Their Dependents in New York by Income, Percentage % 16% 15% 52% 17% 19% 9% 12% NY State 9.1m Workers NY City 3.6m 65% 15% 13% 56% 17% 17% 7% 11% Rest of State 5.5m NY State 14.3m Workers and Dependents 46% 18% 22% 15% NY City 5.6m 62% 16% 14% 8% Rest of State 8.7m Below 100% FPL % FPL % FPL 300% FPL and above Source: Urban Institute, Tabulations of the Current Population Survey, 2002 and 2003 Annual Economic Supplements. Notes: Workers include persons age who work full- or part-time and self-employed workers. Dependents include nonworking spouses, children age 0 18, and students age In 2002, 200% FPL was $17,720 for an individual, $23,880 for a family of two, and $30,040 for a family of three. Numbers may not add to 100% due to rounding. Demographics of the Non-elderly, Workers, and Their Dependents 9

18 The workforce in New York City is more racially and ethnically diverse than the workforce in the rest of the state. FIGURE 3 Workers and Their Dependents in New York by Race/Ethnicity, Workers Workers and Dependents % 14% 14% 12% 25% 6% 7% 3% 7% 14% 15% 13% 27% 3% 6% 8% Percentage % 25% 83% 64% 25% 83% % 36% 0 NY State 9.1m NY City 3.6m Rest of State 5.5m NY State 14.3m NY City 5.6m Rest of State 8.7m White, non-hispanic Black, non-hispanic Hispanic Other Source: Urban Institute, Tabulations of the Current Population Survey, 2002 and 2003 Annual Economic Supplements. Notes: Workers include persons age who work full- or part-time and self-employed workers. Dependents include nonworking spouses, children age 0 18, and students age As defined by CPS methodology, other includes workers and dependents who are not Hispanic and selected multiple races; Native Americans; Asians; and other races. Numbers may not add to 100% due to rounding. More than three-quarters of workers and their dependents in New York are U.S. citizens. The proportion is significantly lower in New York City than in the rest of the state. FIGURE 4 Workers and Their Dependents in New York by Citizenship Status, Workers Workers and Dependents Percentage % 11% 74% 4% 20% 7% 21% 52% 4% 6% 89% 1% 9% 9% 79% 4% 17% 7% 15% 61% 3% 4% 91% 1% 10 0 NY State 9.1m NY City 3.6m Rest of State 5.5m NY State 14.3m NY City 5.6m Rest of State 8.7m U.S. citizen, native U.S. citizen, naturalized Noncitizen, 0 5 years Noncitizen, 6 years Source: Urban Institute, Tabulations of the Current Population Survey, 2002 and 2003 Annual Economic Supplements. Notes: Workers include persons age who work full- or part-time and self-employed workers. Dependents include nonworking spouses, children age 0 18, and students age Numbers may not add to 100% due to rounding. 10 Health Insurance Coverage among Workers and Their Dependents in New York,

19 Approximately one-third of workers in New York are employed by small firms (< 25 workers), and more than half of workers are employed by large firms ( 100 workers). FIGURE 5 Distribution of Workers in New York by Firm Size, Percentage % 34% 20% 13% Workers 30% 33% NY State 9.1m 37% 18% 22% 20% 21% 15% 23% 12% 14% 11% 10% NY City 3.6m 29% Rest of State 5.5m 44% 23% NY State 14.3m Workers and Dependents 39% 28% NY City 5.6m 48% 20% Rest of State 8.7m < 25 workers workers workers 1,000 workers Source: Urban Institute, Tabulations of the Current Population Survey, 2002 and 2003 Annual Economic Supplements. Notes: Workers include persons age who work full- or part-time and self-employed workers. Dependents include nonworking spouses, children age 0 18, and students age Small firms are defined as those with fewer than 25 workers, medium-sized firms are those with workers, and large firms are those with 100 or more workers. Numbers may not add to 100% due to rounding. Demographics of the Non-elderly, Workers, and Their Dependents 11

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21 SECTION2 Distribution of Coverage among the Non-elderly, Workers, and Their Dependents New York State, New York City, and Rest of State

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23 Workers and their dependents in New York City are less likely to have employer-sponsored insurance (ESI) and more than twice as likely to be uninsured than those in the rest of the state. FIGURE 6 Workers and Their Dependents in New York by Health Insurance Coverage, Workers Workers and Dependents Percentage % 5% 73% 4% 28% 6% 62% 4% 13% 16% 5% 79% 3% 5% 9% 71% 24% 14% 58% 4% 11% 5% 6% 78% 10 0 NY State 9.1m NY City 3.6m Rest of State 5.5m NY State 14.3m NY City 5.6m Rest of State 8.7m ESI Medicaid or SCHIP Other Uninsured Source: Urban Institute, Tabulations of the Current Population Survey, 2002 and 2003 Annual Economic Supplements. Notes: Workers include persons age who work full- or part-time and self-employed workers. Dependents include nonworking spouses, children age 0 18, and students age Numbers may not add to 100% due to rounding. SCHIP = State Children s Health Insurance Program. Distribution of Coverage among the Non-elderly, Workers, and Their Dependents 15

24 Because public coverage is more extensive for children than for adults in New York, the share of low-income workers and dependents in public programs is greater than the share of workers alone. FIGURE 7 Low-Income Workers and Their Dependents in New York State by Health Insurance Coverage, Workers Workers and Dependents % 31% Percentage % 13% 6% 27% 20 38% 37% million 4.0 million ESI Medicaid or SCHIP Other Uninsured Source: Urban Institute, Tabulations of the Current Population Survey, 2002 and 2003 Annual Economic Supplements. Notes: Workers include persons age who work full- or part-time and self-employed workers. Dependents include nonworking spouses, children age 0 18, and students age Low income is defined here as below 200% of the federal poverty level (FPL). In 2002, 200% FPL was $17,720 for an individual, $23,880 for a family of two, and $30,040 for a family of three. Numbers may not add to 100% due to rounding. ESI = employer-sponsored insurance; SCHIP = State Children s Health Insurance Program. Seventy-eight percent of the uninsured are workers or dependents of a worker. FIGURE 8 Uninsured in New York State by Work Status, million uninsured 22% 78% Workers and their dependents Nonworkers and their dependents Source: Urban Institute, Tabulations of the Current Population Survey, 2002 and 2003 Annual Economic Supplements. Notes: Data include uninsured persons age Workers include persons age who work full- or part-time and self-employed workers. Dependents include nonworking spouses, children age 0 18, and students age Nonworkers include retired persons under age Health Insurance Coverage among Workers and Their Dependents in New York,

25 Nonworkers and self-employed workers are most likely to be uninsured... FIGURE 9 Uninsurance Rates in New York State by Work Status, million uninsured 30 28% 30% 25% Percentage 20 19% 20% 10 10% 0 Full-time/part-time workers Dependents of self-employed Self-employed Retired (< 65y) Dependents of full-time/part-time workers Other nonworkers and their dependents Source: Urban Institute, Tabulations of the Current Population Survey, 2002 and 2003 Annual Economic Supplements. Notes: Data include uninsured persons age Full-time worker is defined as a person who worked 35 hours or more per week and part-time worker as a person who worked fewer than 35 hours per week in the majority of weeks worked in the preceding calendar year. Self-employed is defined as a person who worked for profit or fees in his or her own business, profession, or trade or operated a farm. Dependents include nonworking spouses, children age 0 18, and students age Distribution of Coverage among the Non-elderly, Workers, and Their Dependents 17

26 ...however, nonworkers and self-employed workers represent less than one-third of all uninsured New Yorkers. FIGURE 10 Uninsured in New York State by Work Status, % 3.0 million uninsured 2% 2% 53% 16% Full-time/part-time workers Dependents of self-employed 7% Self-employed Retired (< 65y) Dependents of full-time/part-time workers Other nonworkers and their dependents Source: Urban Institute, Tabulations of the Current Population Survey, 2002 and 2003 Annual Economic Supplements. Notes: Data include uninsured persons age Full-time worker is defined as a person who worked 35 hours or more per week and part-time worker as a person who worked fewer than 35 hours per week in the majority of weeks worked in the preceding calendar year. Self-employed is defined as a person who worked for profit or fees in his or her own business, profession, or trade or operated a farm. Dependents include nonworking spouses, children age 0 18, and students age Among workers, those in small firms (< 25 workers) are most likely to be uninsured and represent over half of all uninsured workers. However, while workers in large firms ( 100 workers) are less likely to be uninsured, they represent one-third of all uninsured workers. FIGURE 11 Uninsured Workers in New York State by Firm Size, % Uninsured Rates Share of Uninsured Workers 15% 20 21% 14% 10 13% 11% 52% 0 20% < 25 workers workers workers 1,000 workers Source: Urban Institute, Tabulations of the Current Population Survey, 2002 and 2003 Annual Economic Supplements. Notes: Workers include persons age who work full- or part-time and self-employed workers. Small firms are defined as those with fewer than 25 workers, medium-sized firms are those with workers, and large firms are those with 100 or more workers. Numbers may not add to 100% due to rounding. 18 Health Insurance Coverage among Workers and Their Dependents in New York,

27 Low-income workers and workers in small firms (< 25 workers) are less likely to have employer-sponsored insurance than those with higher incomes and those in large firms ( 100 workers). FIGURE 12 Rates of Employer-Sponsored Insurance in New York State by Firm Size and Income, Percentage % Low Income Middle Income High Income 37% 53% 51% 53% 75% 81% < 25 workers workers workers 1,000 workers 85% 81% 87% 93% 95% Source: Urban Institute, Tabulations of the Current Population Survey, 2002 and 2003 Annual Economic Supplements. Notes: Workers include persons age who work full- or part-time and self-employed workers. Small firms are defined as those with fewer than 25 workers, medium-sized firms are those with workers, and large firms are those with 100 or more workers. Low income is defined here as below 200% of the federal poverty level (FPL), middle income as between 200% and 400% FPL, and high income as 400% FPL and above. In 2002, 200% FPL was $17,720 for an individual, $23,880 for a family of two, and $30,040 for a family of three. Distribution of Coverage among the Non-elderly, Workers, and Their Dependents 19

28 Low-income workers and workers in small firms (< 25 workers) are more likely to be uninsured than workers with middle or high incomes and those in large firms ( 100 workers). However, low-income workers in large firms also have relatively high rates of uninsurance. FIGURE 13 Uninsurance Rates in New York State by Firm Size and Income, % Low Income Middle Income High Income 44% Percentage % 30% 35% 19% 14% 12% 12% 9% 5% 3% 0 < 25 workers workers workers 1,000 workers Source: Urban Institute, Tabulations of the Current Population Survey, 2002 and 2003 Annual Economic Supplements. Notes: Workers include persons age who work full- or part-time and self-employed workers. Small firms are defined as those with fewer than 25 workers, medium-sized firms are those with workers, and large firms are those with 100 or more workers. Low income is defined here as below 200% of the federal poverty level (FPL), middle income as between 200% and 400% FPL, and high income as 400% FPL and above. In 2002, 200% FPL was $17,720 for an individual, $23,880 for a family of two, and $30,040 for a family of three. 20 Health Insurance Coverage among Workers and Their Dependents in New York,

29 Nearly 60 percent of workers are in industries with high rates of employer-sponsored insurance (ESI). FIGURE 14 Workers in New York State by Industry, Workers % 16% 15% 58% High-ESI industries Public administration/former military Mining/manufacturing/utilities/ transportation Health/social services Percentage % 14% 13% 14% 42% Finance/insurance/real estate Education/information/ communications Low-ESI industries Wholesale/retail trade Services/arts/entertainment % 7% Professional Agriculture/construction Source: Urban Institute tabulations of a merged file of the February 2001 and March 2001 Current Population Surveys. Notes: Workers include persons age who work full- or part-time and self-employed workers. Dependents include nonworking spouses, children age 0 18, and students age High-ESI industries are defined as those in which 75% or more of employees have employer-sponsored coverage; low-esi industries are those in which less than 75% of employees have employer-sponsored coverage. Numbers do not sum to totals due to rounding. Distribution of Coverage among the Non-elderly, Workers, and Their Dependents 21

30 Low-income workers are more likely to be uninsured than higher-income workers, regardless of whether they are employed in an industry with high or low rates of employer-sponsored insurance. FIGURE 15 Worker Uninsurance Rates in New York State by Income and Industry, % Percentage % 34% 10 9% 0 Low-ESI industry Income < 200% FPL High-ESI industry Income 200% FPL Source: Urban Institute, Tabulations of the Current Population Survey, 2002 and 2003 Annual Economic Supplements. Notes: Workers include persons age who work full- or part-time and self-employed workers. High-ESI industries are defined as those in which 75% or more of employees have employer-sponsored coverage; low-esi industries are those in which less than 75% of employees have employer-sponsored coverage. High-ESI industries include mining, manufacturing, utilities, and transportation. Low-ESI industries include agriculture, construction, services, arts, entertainment, and wholesale and retail trades. Low-income is defined here as below 200% of the federal poverty level (FPL). In 2002, 200% FPL was $17,720 for an individual, $23,880 for a family of two, and $30,040 for a family of three. Low-income workers and higher-income workers both account for approximately half of the total uninsured workers in New York State. FIGURE 16 Uninsured Workers in New York State by Income and Industry, Higher-income workers { 26% 22% 18% 34% } Low-income workers Income 200% FPL, low-esi industry Income 200% FPL, high-esi industry Income < 200% FPL, low-esi industry Income < 200% FPL, high-esi industry Source: Urban Institute, Tabulations of the Current Population Survey, 2002 and 2003 Annual Economic Supplements. Notes: Workers include persons age who work full- or part-time and self-employed workers. High-ESI industries are defined as those in which 75% or more of employees have employer-sponsored coverage; low-esi industries are those in which less than 75% of employees have employer-sponsored coverage. High-ESI industries include mining, manufacturing, utilities, and transportation. Low-ESI industries include agriculture, construction, services, arts, entertainment, and wholesale and retail trades. Low-income is defined here as below 200% of the federal poverty level (FPL). In 2002, 200% FPL was $17,720 for an individual, $23,880 for a family of two, and $30,040 for a family of three. 22 Health Insurance Coverage among Workers and Their Dependents in New York,

31 SECTION3 Employer Offer Rates, Employee Eligibility, and Take-Up Rates for Employer-Sponsored Insurance New York State, New York City, and Rest of State

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33 More than 80 percent of uninsured workers do not have access to employer-sponsored coverage through their own employer. FIGURE 17 Eligibility for an Employer-Sponsored Coverage Offer among Uninsured Workers, New York State, 2001 Yes 16% 84% No Source: Urban Institute tabulations of a merged file of the February 2001 and March 2001 Current Population Surveys. Notes: Workers include persons age who work full- or part-time. Eligibility for coverage indicates that the worker s firm offers health insurance coverage and that the worker is eligible for the offer. Three-quarters of workers in New York are employed by firms where health insurance coverage is offered and where these workers are eligible for the offer. FIGURE 18 Rate of Offer and Eligibility, Workers in New York State, % No 24% No Yes 82% Yes 76% Worker s firm sponsors insurance plan Worker has and is eligible for an offer Source: Urban Institute tabulations of a merged file of the February 2001 and March 2001 Current Population Surveys. Notes: Workers include persons age who work full- or part-time. Firm sponsors insurance plan indicates that the worker s firm offers health insurance coverage. Worker eligible indicates that the worker s firm offers health insurance coverage and that the worker is eligible for the offer. Workers who are ineligible for their firms coverage include part-time or temporary workers and newly hired employees who must satisfy a waiting period before their coverage begins. Employer Offer Rates, Employee Eligibility, and Take-Up Rates for Employer-Sponsored Insurance 25

34 More than 80 percent of higher-income workers had a coverage offer for which they were eligible, compared with half of low-income workers. FIGURE 19 Eligibility for an Offer, Subgroups of Workers in New York State, % No No 18% No 49% 51% Yes 76% Yes Yes 82% All workers Low-income workers Higher-income workers Source: Urban Institute tabulations of a merged file of the February 2001 and March 2001 Current Population Surveys. Notes: Workers include persons age who work full- or part-time. Eligibility for an offer indicates that the worker s firm offers health insurance coverage and that the worker is eligible for the offer. Low-income category includes workers at or below 200% of the federal poverty level (FPL); higher-income category includes all other workers. In 2002, 200% FPL was $17,720 for an individual, $23,880 for a family of two, and $30,040 for a family of three. Nine out of ten workers who are eligible for health insurance coverage through their employer accept this offer. Take-up rates are high across all income levels. FIGURE 20 Take-Up Rates by New York Workers Eligible for an Offer, 2001 No No No 12% 10% 13% Yes 88% Yes 90% Yes 87% All eligible workers Low-income workers Higher-income workers Source: Urban Institute tabulations of a merged file of the February 2001 and March 2001 Current Population Surveys. Notes: Eligible workers include persons age who work full- or part-time and are eligible for their employers offer of health insurance coverage. Takeup indicates that the worker is eligible for and accepts an employer s offer of coverage. Low-income category includes workers at or below 200% of the federal poverty level (FPL); higher-income category includes all other workers. In 2002, 200% FPL was $17,720 for an individual, $23,880 for a family of two, and $30,040 for a family of three. 26 Health Insurance Coverage among Workers and Their Dependents in New York,

35 Workers in small firms (< 25 workers) are far less likely to be offered and eligible for coverage by their employer than workers in larger firms ( 25 workers). FIGURE 21 Workers Eligibility for an Offer by Firm Size, New York State, 2001 No No No 24% 16% 76% 48% 52% 84% Yes Yes Yes All workers Workers in small firms Workers in medium/large firms Source: Urban Institute tabulations of a merged file of the February 2001 and March 2001 Current Population Surveys. Notes: Workers include persons age who work full- or part-time. Small firms are defined as those with fewer than 25 workers; larger firms are defined here as those with 25 or more workers. Compared with workers in larger firms ( 25 workers), workers in small firms (< 25 workers) are slightly more likely to take up coverage when offered. FIGURE 22 Take-Up of Coverage (Conditional on Offer) by Firm Size, Workers in New York State, 2001 No No No 12% 10% 13% 88% 90% 87% Yes Yes Yes Eligible workers in all firms Eligible workers in small firms Eligible workers in medium/large firms Source: Urban Institute tabulations of a merged file of the February 2001 and March 2001 Current Population Surveys. Notes: Workers include persons age who work full- or part-time. Eligible for an offer indicates that the worker s firm offers health insurance coverage and that the worker is eligible for the firm s coverage offer. Take-up indicates that the worker is eligible for and accepts an employer s offer of coverage. Small firms are defined as those with fewer than 25 workers; larger firms are defined here as those with 25 or more workers. Employer Offer Rates, Employee Eligibility, and Take-Up Rates for Employer-Sponsored Insurance 27

36 The vast majority of employers contribute toward the cost of health insurance coverage taken up by workers. Compared with medium and large employers ( 25 workers), a greater percentage of small employers (< 25 workers) contribute all of the cost of coverage taken up. FIGURE 23 Employer Contribution toward Health Insurance When Taken Up by Workers, by Firm Size, New York State, 2001 None 3% All None 3% All None 3% All 65% 33% 54% 43% 66% 31% Some Some Some All firms Small firms Medium/large firms Source: Urban Institute tabulations of a merged file of the February 2001 and March 2001 Current Population Surveys. Notes: Workers include persons age who work full- or part-time. Small firms are those with fewer than 25 workers; larger firms are defined here as those with 25 workers or more. Data above refer to employer contributions toward health insurance coverage that is taken up by workers; information about employer contributions toward coverage that is not taken up is not available from this survey. Numbers may not add to 100% due to rounding. The gap in offer rates between high-esi and low-esi industries is large. Less than 60 percent of workers in low-esi industries are eligible for an offer of health insurance coverage, compared with 86 percent of workers in high-esi industries. FIGURE 24 Share of Workers in New York State Eligible for an Offer by Industry, 2001 No No No 24% 41% 14% 76% 59% 86% Yes Yes Yes Workers in all industries Workers in low-esi industries Workers in high-esi industries Source: Urban Institute tabulations of a merged file of the February 2001 and March 2001 Current Population Surveys. Notes: Workers include persons age who work full- or part-time. Low-ESI industries are defined as those in which less than 75% of employees have employer-sponsored coverage; high-esi industries are those in which 75% or more of employees have employer-sponsored coverage. Low-ESI industries include agriculture, construction, services, arts, entertainment, and wholesale and retail trades. High-ESI industries include mining, manufacturing, utilities, and transportation. Eligible for an offer indicates that the worker s firm provides health insurance coverage and that the worker is eligible for the firm s coverage offer. 28 Health Insurance Coverage among Workers and Their Dependents in New York,

37 Take-up of employer-sponsored insurance among workers eligible for coverage is high across all industries. FIGURE 25 Share of Eligible Workers in New York State Who Take Up by Industry, 2001 No No No 12% 15% 12% Yes 88% Yes 85% Yes 89% Eligible workers in all industries Eligible workers in low-esi industries Eligible workers in high-esi industries Source: Urban Institute tabulations of a merged file of the February 2001 and March 2001 Current Population Surveys. Notes: Workers include persons age who work full- or part-time. Take up indicates that the worker is eligible for and accepts an employer s offer of coverage. Low-ESI industries are defined as those in which less than 75% of employees have employer-sponsored coverage; high-esi industries are those in which 75% or more of employees have employer-sponsored coverage. Low-ESI industries include agriculture, construction, services, arts, entertainment, and wholesale and retail trades. High-ESI industries include mining, manufacturing, utilities, and transportation. Numbers may not add to 100% due to rounding. Employer contributions toward health insurance coverage that is taken up by workers are similar across all industries. FIGURE 26 Employer Contribution toward Health Insurance When Taken Up by Workers, by Industry, New York State, 2001 None 3% All None 3% All None 3% All 33% 36% 32% 65% 61% 66% Some Some Some All industries Low-ESI industries High-ESI industries Source: Urban Institute tabulations of a merged file of the February 2001 and March 2001 Current Population Surveys. Notes: Workers include persons age who work full- or part-time. Low-ESI industries are defined as those in which less than 75% of employees have employer-sponsored coverage; high-esi industries are those in which 75% or more of employees have employer-sponsored coverage. Data above refer to employer contributions toward health insurance coverage that is taken up by workers; information about employer contributions toward coverage that is not taken up is not available from this survey. Numbers may not add to 100% due to rounding. Employer Offer Rates, Employee Eligibility, and Take-Up Rates for Employer-Sponsored Insurance 29

38 Workers who have been in their current jobs for less than one year represent one-sixth of all workers but more than one-quarter of uninsured workers. FIGURE 27 Worker Tenure in New York State, 2001 < 1 year < 1 year 16% 27% 84% 73% 1 year 1 year All workers Uninsured workers Source: Urban Institute tabulations of a merged file of the February 2001 and March 2001 Current Population Surveys. Note: Workers include persons age who work full- or part-time. Compared with high-esi industries, low-esi industries have a greater share of workers who have been in their current jobs less than one year. FIGURE 28 Worker Tenure by Industry, New York State, 2001 < 1 year < 1 year < 1 year 16% 22% 12% 84% 78% 88% 1 year 1 year 1 year Workers in all industries Workers in low-esi industries Workers in high-esi industries Source: Urban Institute tabulations of a merged file of the February 2001 and March 2001 Current Population Surveys. Notes: Workers include persons age who work full- or part-time. Low-ESI industries are defined as those in which less than 75% of employees have employer-sponsored coverage; high-esi industries are those in which 75% or more of employees have employer-sponsored coverage. 30 Health Insurance Coverage among Workers and Their Dependents in New York,

39 Tables SECTION4

40

41 TABLE 1 The Non-elderly, Workers, and Their Dependents, by Income New York State, New York City, and Rest of State, Children Adults All non-elderly Workers Workers and (0 18) (19 64) (0 64) (19 64) dependents n (millions) % n (millions) % N (millions) % n (millions) % n (millions) % New York State Below 100% FPL % FPL % FPL % FPL and above New York City Below 100% FPL % FPL % FPL % FPL and above Rest of State Below 100% FPL % FPL % FPL % FPL and above Source: Urban Institute, Tabulations of the Current Population Survey, 2002 and 2003 Annual Social and Economic Supplements. Notes: Estimates (n) reflect a two-year average. Income reflects income of the health insurance unit. Workers are defined as adults age who work part-time or full-time. Dependents are nonworking spouses, children age 0 18, and full-time students age Numbers may not sum to totals due to rounding. FPL = federal poverty level. TABLE 2 The Non-elderly, Workers, and Their Dependents, by Race/Ethnicity New York State, New York City, and Rest of State, Children Adults All non-elderly Workers Workers and (0 18) (19 64) (0 64) (19 64) dependents n (millions) % n (millions) % N (millions) % n (millions) % n (millions) % New York State Hispanic White, non-hispanic Black, non-hispanic Other New York City Hispanic White, non-hispanic Black, non-hispanic Other Rest of State Hispanic White, non-hispanic Black, non-hispanic Other Source: Urban Institute, Tabulations of the Current Population Survey, 2002 and 2003 Annual Social and Economic Supplements. Notes: Estimates (n) reflect a two-year average was the first year in which CPS respondents were allowed to report more than one race. Non-Hispanics who reported black and white were categorized as Black ; all other non-hispanics who reported more than one race were categorized as Other. Only 1.3 percent of the non-elderly population in New York reported more than one race in Workers are defined as adults age who work part-time or full-time. Dependents are nonworking spouses, children age 0 18, and full-time students age Numbers may not sum to totals due to rounding. Tables 33

42 TABLE 3 The Non-elderly, Workers, and Their Dependents, by Citizenship Status New York State, New York City, and Rest of State, Children Adults All non-elderly Workers Workers and (0 18) (19 64) (0 64) (19 64) dependents n (millions) % n (millions) % N (millions) % n (millions) % n (millions) % New York State U.S. citizen, native U.S. citizen, naturalized Noncitizen, 0 5 years Noncitizen, 6+ years New York City U.S. citizen, native U.S. citizen, naturalized Noncitizen, 0 5 years Noncitizen, 6+ years Rest of State U.S. citizen, native U.S. citizen, naturalized Noncitizen, 0 5 years Noncitizen, 6+ years Source: Urban Institute, Tabulations of the Current Population Survey, 2002 and 2003 Annual Social and Economic Supplements. Notes: Estimates (n) reflect a two-year average. Workers are defined as adults age who work part-time or full-time. Dependents are nonworking spouses, children age 0 18, and full-time students age Numbers may not sum to totals due to rounding. 34 Health Insurance Coverage among Workers and Their Dependents in New York,

43 TABLE 4 Workers, Nonworkers, and All Adults, by Parent Status and Income Level New York State, New York City, and Rest of State, Workers (19 64) Nonworkers (19 64) All adults (19 64) n (millions) % n (millions) % N (millions) % New York State Non-parents Below 100% FPL % FPL % FPL % FPL and above Parents Below 150% FPL % FPL % FPL % FPL and above New York City Non-parents Below 100% FPL % FPL % FPL % FPL and above Parents Below 150% FPL % FPL % FPL % FPL and above Rest of State Non-parents Below 100% FPL % FPL % FPL % FPL and above Parents Below 150% FPL % FPL % FPL % FPL and above Source: Urban Institute, Tabulations of the Current Population Survey, 2002 and 2003 Annual Social and Economic Supplements. Notes: Estimates (n) reflect a two-year average. Income reflects income of the health insurance unit. Workers are defined as adults age who work part-time or full-time. Note that income levels were chosen to reflect eligibility levels for New York s public health insurance programs: Parents are eligible up to 150% FPL and non-parents (childless adults) up to 100% FPL. Numbers may not sum to totals due to rounding. FPL = federal poverty level. Tables 35

44 TABLE 5 Workers and Their Dependents, by Firm Size New York State, New York City, and Rest of State, Workers (19 64) Workers and dependents Number of employees n (millions) % n (millions) % New York State Below ,000 and above New York City Below ,000 and above Rest of State Below ,000 and above Source: Urban Institute, Tabulations of the Current Population Survey, 2002 and 2003 Annual Social and Economic Supplements. Notes: Estimates (n) reflect a two-year average. Workers are defined as adults age who work part-time or full-time. Numbers may not sum to totals due to rounding. 36 Health Insurance Coverage among Workers and Their Dependents in New York,