Issue Brief. Sources of Health Insurance and Characteristics of the Uninsured: Analysis of the March 1997 Current Population Survey

December 1997 Jan. Sources of Health Insurance and Characteristics of the Uninsured: Analysis of the March 1997 Current Population Survey by Paul Fronstin, EBRI Feb. Mar. Apr. May Jun. Jul. Aug. EBRI EMPLOYEE BENEFIT RESEARCH INSTITUTE Issue Brief This Issue Brief provides summary data on the insured and uninsured populations in the nation and in each state. It discusses the characteristics most closely related to individuals health insurance status. Based on EBRI analysis of the March 1997 Current Population Survey, it represents 1996 data the most recent data available. In 1996, 82.3 percent of nonelderly (under age 65) Americans had private or public health insurance. Seventy-one percent had private insurance, 64 percent through an employment-based plan. Sixteen percent had public health insurance. The percentage of uninsured Americans has been increasing since at least 1987. In 1987, 14.8 percent of the nonelderly population was uninsured, compared with 17.7 percent in 1996. However, the erosion of employment-based health benefits cannot fully explain this increase since 1993. Instead, the decline in public sources of health insurance would partly explain it. It may be that, while the percentage of individuals with employment-based coverage is rising, individuals previously covered by Medicaid and CHAMPUS/CHAMPVA are not being fully absorbed into the employment-based health insurance market. Between 1995 and 1996, the percentage of nonelderly Americans without health insurance coverage increased from 17.4 percent to 17.7 percent. Further examination indicates that children completely accounted for this increase. In 1995, 13.8 percent of children and 19 percent of persons ages 18 64 were uninsured, compared with 14.8 percent of children and 18.9 percent of persons ages 18 64 in 1996. With the recent passage of legislation designed to reduce the number of uninsured children, the next focal point for health care reform could be early retirees and unemployed persons. President Clinton and some members of Congress have expressed an interest in improving access to and affordability of coverage for these groups. Currently, health care cost inflation is at its lowest point in years, but there are signals indicating that it is about to rise above current levels. The federal government s recent announcement that health insurance premiums will rise for federal employees an average of 8.5 percent in 1998 may portend higher future health care costs. Similarly, disappointing earnings announcements from several large insurers because of higher medical costs and lower-than-expected revenues may indicate that health insurance plans will increase premiums. Employment and income play a dominant role in determining an individual s likelihood of having health insurance. Age, gender, firm size, work hours, and industry are also important determinants; however, these variables are also closely linked to employment status and income. Some of the widest variations involve factors that are not always looked at in traditional demographic assessments, such as citizenship. However, variations by race, ethnicity, and citizenship are also closely linked to employment status and income. Sep. Oct. Nov. Dec. 1997 EBRI Issue Brief Number 192 December 1997 1997. EBRI December 1997 EBRI Issue Brief 1

Table of Contents Introduction... 3 (table 1, table 2) Determinants of Coverage... 6 (table 3, table 4, table 5, table 6, table 7) The Uninsured... 9 Location... 10 (table 8, chart 1, table 9) Citizenship... 15 (table 10) Employment... 15 (chart 2) Industry... 15 (chart 3) Firm Size... 18 (chart 4, chart 5) Income... 19 (chart 6, chart 7) Race and Origin... 20 Family Type... 21 (chart 8) Age... 21 (table 11, table 12) Children... 21 (table 13, chart 9, chart 10) Policy Implications... 21 Conclusion... 29 References... 30 Glossary of Terms... 31 Reading the Tables... 33 Tables Table 1, Nonelderly Americans with Selected Sources of Health Insurance Coverage, 1987 1996... 3 Table 2, Percentage of Uninsured Children, by Poverty Level and Age, 1995 and 1996... 4 Table 3, Nonelderly Population with Selected Sources of Health Insurance, by Own Work Status and Work Status of Family Head, 1996... 6 Table 4, Workers Ages 18 64 with Selected Sources of Health Insurance, by Industry of Primary Employment, 1996... 8 Table 5, Workers Ages 18 64 with Selected Sources of Health Insurance, by Firm Size, 1996... 9 Table 6, Nonelderly Population with Selected Sources of Health Insurance, by Family Income, 1996... 10 Table 7, Nonelderly Population with Selected Sources of Health Insurance, by Race and Poverty Status, 1996... 11 Table 8, Nonelderly Population with Selected Sources of Health Insurance, by Region and State, 1996... 13 Table 9, Nonelderly Population Living in Consolidated Metropolitan Statistical Areas (CMSAs), with Selected Sources of Health Insurance, by CMSA, 1996... 16 Table 10, Nonelderly Population with and without Health Insurance, by Region, State, and Citizenship, 1996... 17 Table 11, Persons Ages 18 64 with Selected Sources of Health Insurance, by Gender and Age, 1996... 22 Table 12, Persons Ages 18 64 with Selected Sources of Health Insurance, by Age and Activity, 1996... 23 Table 13, Children with Selected Sources of Health Insurance, by Poverty Level and Age, 1996... 25 Charts Chart 1, Percentage of Uninsured, by State, 1996... 15 Chart 2, Nonelderly Population without Health Insurance, by Work Status of Family Head, 1996... 18 Chart 3, Percentage of Uninsured Among Workers Ages 18 64, by Industry Group, 1996... 18 Chart 4, Workers Ages 18 64 without Health Insurance, by Firm Size, 1996... 19 Chart 5, Percentage Uninsured Among Workers Ages 18 64, by Firm Size, 1996... 19 Chart 6, Percentage Uninsured Among Nonelderly Population, by Family Income as a Percentage of the Federal Poverty Level, 1996... 20 Chart 7, Percentage Uninsured Among Workers Ages 18 64, by Total Earnings, 1996... 20 Chart 8, Percentage Uninsured Among the Nonelderly Population, by Family Type, 1996... 21 Chart 9, Percentage Uninsured Among Children Under Age 18, by Work Status of the Family Head, 1996... 27 Chart 10, Children Under Age 18 without Health Insurance, by Work Status of the Family Head, 1996... 27 2 December 1997 EBRI Issue Brief

Paul Fronstin of EBRI wrote this Issue Brief with assistance from the Institute s research and editorial staffs. Any views expressed in this article are those of the author and should not be ascribed to the officers, trustees, members, or other sponsors of EBRI, EBRI-ERF, or their staffs. Neither EBRI nor EBRI-ERF lobbies or takes positions on specific policy proposals. EBRI invites comment on this research. In 1996, there were 234 million civilian, Introduction noninstitutionalized Americans under age 65 in the population. Private or public health insurance, or both, covered 82.3 percent of Americans (192.6 million) at some point in 1996 (calculated from table 1). Seventy-one percent of the nonelderly had private insurance, 64 percent through an employmentbased plan. Sixteen percent of the nonelderly had public health insurance. The percentage of uninsured Americans has been increasing since at least 1987. In 1987, 14.8 percent of the nonelderly population was uninsured, compared with 17.7 percent in 1996. However, the erosion of employment-based health benefits cannot fully explain the increase in the uninsured since 1993. While the increase in the uninsured between 1987 and 1993 can be attributed to the erosion of employment-based health benefits, 1 since 1993 the percentage of Americans 1 See Fronstin and Snider (1996/97) for an analysis of the decline in employment-based health insurance between 1988 and 1993. Table 1 Nonelderly Americans with Selected Sources of Health Insurance Coverage, 1987-1996 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 (millions) Total Population 214.4 216.6 218.5 220.6 222.9 225.5 228.0 229.9 231.9 234.0 Total Private 162.8 162.9 164.3 162.1 161.3 160.5 161.5 162.8 163.9 165.8 Employer coverage 148.5 149.4 149.8 147.7 147.7 145.9 144.9 146.3 147.9 149.8 own name 72.5 73.5 74.0 73.1 73.1 71.7 74.9 75.2 75.9 76.9 dependent coverage 75.9 75.9 75.8 74.7 74.6 74.3 69.9 71.1 72.1 72.9 Other private coverage 14.3 13.5 14.5 14.3 13.6 14.6 16.6 16.4 16.0 16.0 Total Public 28.5 28.8 28.7 31.9 34.4 36.0 38.1 38.9 38.4 37.4 Medicare 3.1 3.2 3.2 3.4 3.5 3.9 3.7 3.7 4.1 4.6 Medicaid 18.4 18.9 19.2 22.4 24.8 26.5 29.0 28.7 29.0 28.2 CHAMPUS/CHAMPVA a 8.5 8.2 7.9 7.9 7.9 7.5 7.4 8.7 7.4 6.8 No Health Insurance 31.8 33.6 34.3 35.6 36.3 38.3 39.3 39.4 40.3 41.4 (percentage) Total Population 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Total Private 75.9 75.2 75.2 73.5 72.4 71.2 70.8 70.8 70.7 70.9 Employer coverage 69.2 69.0 68.6 67.0 66.3 64.7 63.5 63.6 63.8 64.0 own name 33.8 33.9 33.9 33.1 32.8 31.8 32.9 32.7 32.7 32.9 dependent coverage 35.4 35.0 34.7 33.8 33.5 32.9 30.7 30.9 31.1 31.2 Other private coverage 6.7 6.3 6.6 6.5 6.1 6.5 7.3 7.1 6.9 6.8 Total Public 13.3 13.3 13.2 14.5 15.5 16.0 16.7 16.9 16.6 16.0 Medicare 1.4 1.5 1.5 1.6 1.6 1.7 1.6 1.6 1.8 2.0 Medicaid 8.6 8.7 8.8 10.2 11.1 11.8 12.7 12.5 12.5 12.1 CHAMPUS/CHAMPVA a 4.0 3.8 3.6 3.6 3.5 3.3 3.3 3.8 3.2 2.9 No Health Insurance 14.8 15.5 15.7 16.1 16.3 17.0 17.3 17.1 17.4 17.7 Source: Employee Benefit Research Institute estimates of the March 1988 1997 Current Population Surveys. Note: Details may not add to totals because individuals may receive coverage from more than one source. a Civilian Health and Medical Program for the Uniformed Services and the Civilian Health and Medical Program for the Department of Veterans Affairs. December 1997 EBRI Issue Brief 3

Table 2 Percentage of Uninsured Children, by Poverty Level and Age, 1995 and 1996 Medicaid Uninsured Poverty Level Difference Between Difference Between and Age 1995 1996 1995 and 1996 1995 1996 1995 and 1996 Total 23.2% 21.8% 1.5% 13.8% 14.8% 1.1% Infants 32.6 30.5 2.1 16.7 17.5 0.8 1 5 29.0 27.2 1.8 12.7 13.0 0.3 6 12 22.1 20.7 1.4 13.7 14.5 0.9 13 17 16.8 15.9 0.9 14.4 16.5 2.1 0 99% of Poverty 64.1 61.6 2.5 21.8 24.0 2.2 Infants 75.5 68.8 6.7 16.7 22.0 5.3 1 5 71.5 70.2 1.3 17.2 18.3 1.1 6 12 62.9 60.7 2.2 22.2 24.5 2.3 13 17 51.9 49.6 2.4 29.6 31.6 2.0 100% 149% of Poverty 34.4 31.8 2.6 24.2 25.6 1.3 Infants 47.4 44.3 3.1 28.2 24.2 4.0 1 5 43.0 36.3 6.7 21.4 21.7 0.3 6 12 31.0 29.9 1.2 25.7 25.9 0.2 13 17 27.4 26.3 1.0 24.4 30.3 5.9 150% 199% of Poverty 19.2 17.7 1.5 20.5 21.1 0.6 Infants 31.1 27.8 3.3 24.7 21.7 3.0 1 5 24.2 21.1 3.1 18.8 18.2 0.6 6 12 16.6 16.2 0.4 20.4 20.4 0.0 13 17 15.0 14.1 0.9 21.8 25.5 3.7 200% 399% of Poverty 8.0 7.6 0.4 9.1 10.1 1.0 Infants 12.6 14.7 2.1 13.2 14.1 0.8 1 5 9.4 9.6 0.2 9.3 9.0 0.3 6 12 7.2 6.3 0.9 8.4 9.5 1.1 13 17 6.9 6.2 0.7 9.2 11.3 2.2 400% or More of Poverty 3.4 2.8 0.6 4.5 4.8 0.3 Infants 5.6 5.3 0.3 11.7 11.7 0.1 1 5 3.5 3.3 0.2 4.4 5.4 1.0 6 12 3.5 2.6 0.9 3.7 3.6 0.1 13 17 3.0 2.3 0.6 4.3 4.4 0.1 Source: Employee Benefit Research Institute estimates of the March 1996 and March 1997 Current Population Surveys. covered by employment-based health insurance has increased, reaching 64 percent in 1996. 2 Instead, the decline in public sources of health insurance would partly explain the recent increase in the uninsured. For example, between 1994 and 1996 the percentage of nonelderly Americans covered by CHAMPUS/CHAMPVA declined from 3.8 percent to 2.9 percent, in large part due to downsizing in the military. Similarly, between 1995 and 1996, the percentage of nonelderly Americans covered by Medicaid declined from 12.5 percent to 12.1 percent as people left welfare for the private sector. It may be that while the percentage of individuals covered by employment-based coverage is rising, individuals previously covered by Medicaid and CHAMPUS/ CHAMPVA 3 are not being fully absorbed into the employment-based market for health insurance. Between 1995 and 1996, the percentage of nonelderly Americans without health insurance coverage increased from 17.4 percent to 17.7 percent. Further examination indicates that children completely accounted for this increase. In 1995, 13.8 percent of children were uninsured and 19 percent of persons ages 18 64 were uninsured, compared with 14.8 percent for children and 18.9 percent of persons ages 18 64 in 1996 (table 2). Within the population of children, the erosion of employment-based health insurance was a factor until 1994, but since 1994, the percentage of children covered by an employment-based health insurance plan has increased. Hence, the percentage of children without health insurance coverage increased between 1995 and 1996 because of a decline in the percentage of children 2 While the year-to-year changes may not be statistically significant, the fouryear trend is clearly upward. 3 CHAMPUS is the Civilian Health and Medical Program of the Uniformed Services, which covers dependents of active duty and retired members of the armed forces, and CHAMPVA is the Civilian Health and Medical Program of the Veterans Administration, which covers dependents of totally disabled veterans. 4 December 1997 EBRI Issue Brief

covered by Medicaid. Recent changes in welfare that de-link eligibility for Aid to Families with Dependent Children (AFDC) from eligibility for Medicaid may explain the decline in Medicaid coverage rates for children who are eligible for Medicaid but are not participating in the program. In fact, Medicaid enrollment among AFDCeligible children declined 7 percent between 1995 and 1996, while Medicaid enrollment increased slightly for the non-afdc Medicaid eligible children. 4 If families are not enrolling in Medicaid because they are not enrolling in AFDC, then we would expect to see Medicaid coverage decline. 5 Starting with the March 1995 Current Population Survey (CPS), the U.S. Bureau of the Census utilized a more detailed set of health insurance questions designed to take advantage of computer-assisted survey interviewing collection (CASIC) technology. The new questions appear to have had an effect on responses regarding the total number of respondents covered by individual types of private coverage, CHAMPUS/ CHAMPVA, and the uninsured. Questions on Medicare and Medicaid were not revised, making these the only data for which comparable statistics are valid over time. Overall, the data on the uninsured were not statistically affected by the change in the questionnaire. In order to compare the March 1995 CPS, the March 1996 CPS, and the March 1997 CPS with earlier The percentage of children without health insurance coverage increased between 1995 and 1996 because of a decline in the percentage of children covered by Medicaid. years, data from 1987 through 1993 have been revised to reflect what appears to be a reallocation of private coverage. A comparison of the raw estimates of insurance coverage from the March 1994 CPS and the March 1995 CPS indicates that while the percentage of individuals reporting coverage from a private source did not significantly change, the distribution of types of private health insurance coverage did significantly change, with individuals more likely to report having employment-based coverage and less likely to report having private coverage purchased directly from an insurance company (other private coverage). As a result, the data presented in table 1 are not consistent with previously published data on sources of health insurance coverage, including previous Employee Benefit Research Institute (EBRI) publications. 6 Data from the March CPS do not allow researchers to determine the length of time that an individual is insured or uninsured. The Survey of Income and Program Participation (SIPP), another survey conducted by the U.S. Bureau of the Census, allows longitudinal analysis of the uninsured. Tabulations of the SIPP indicate that 19.4 million individuals were uninsured during all of calendar year 1993, the most recent year published (Bennefield, 1996). The survey also found that 53.6 million individuals lacked insurance for at least one month during calendar year 1993. A previous survey found that approximately 43 percent of individuals who 4 Personal communication from Leighton Ku, The Urban Institute. 5 Alternatively, Census Bureau imputations for Medicaid coverage in the Current Population Survey (CPS), which still account for AFDC income, may result in an increase in the degree of underreporting of Medicaid for children who are in fact enrolled in the program. A comparison of CPS data with data from the Health Care Financing Administration (HCFA) indicates that Medicaid underreporting increased between 1995 and 1996. In 1995, there were 19.3 million Medicaid eligible children ages 0 14 according to HCFA, and 14.7 Medicaid enrollees, not including those in the District of Columbia and Hawaii, according to the CPS. In comparison, in 1996, there were 19.1 million Medicaid eligible children ages 0 14, according to HCFA, and 13.7 Medicaid enrollees, according to the CPS. Hence, the undercount increased from 24 percent of Medicaid eligibles to 28.2 percent. 6 Data in this publication are not consistent with data presented in previous EBRI publications because of a change in EBRI s methodology concerning children s health insurance. In the March 1988 CPS through the March 1994 CPS, inconsistencies were found in the way children s health insurance was reported. In the past, EBRI allocated private coverage to children with conflicting responses if they met certain conditions. This correction resulted in EBRI reporting approximately 1.5 million additional uninsured children than the Census Bureau reported. Starting with the March 1995 CPS, the children s health insurance fields do not contain inconsistent responses. The removal of the inconsistency necessitated a change in EBRI s methodology concerning the health insurance coverage of children. As a result, the trend line presented in this Issue Brief has been revised to account for the change in EBRIs methodology accounting for the health insurance coverage of children. Note, however, that some researchers believe that the number of uninsured children is higher when taking into account past inconsistencies in the answers for children. December 1997 EBRI Issue Brief 5

Table 3 Nonelderly Population with Selected Sources of Health Insurance, by Own Work Status and Work Status of Family Head, 1996 Own Work Status Employer Coverage and Work Status Total Other Total of Family Head Total Private Total Own name Dependent Private Public Medicaid Uninsured (millions) Total 234.0 165.8 149.8 76.9 72.9 16.0 37.4 28.2 41.4 Own work status child 71.2 47.2 41.9 0.4 41.6 5.3 17.7 15.5 10.6 family head worker 82.3 64.1 58.6 53.9 4.8 5.4 6.1 4.0 14.6 other worker 50.7 40.5 37.6 19.6 18.0 2.9 3.2 1.5 8.7 nonworker 29.8 14.1 11.6 3.1 8.5 2.4 10.4 7.1 7.5 Work status of family head full-year, full-time worker 173.1 141.0 131.4 65.9 65.5 9.6 14.3 8.7 24.6 other worker 36.2 17.9 13.8 7.7 6.1 4.1 10.0 8.5 10.6 nonworker 24.7 6.9 4.6 3.3 1.3 2.3 13.1 11.0 6.2 (percentage within coverage category) Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Own work status child 30.4 28.5 28.0 0.5 57.0 33.0 47.4 54.9 25.5 family head worker 35.2 38.6 39.1 70.0 6.6 34.0 16.4 14.3 35.3 other worker 21.7 24.4 25.1 25.5 24.7 17.9 8.5 5.5 21.0 nonworker 12.7 8.5 7.8 4.0 11.7 15.1 27.7 25.3 18.2 Work status of family head full-year, full-time worker 74.0 85.0 87.7 85.7 89.8 60.1 38.3 30.9 59.5 other worker 15.5 10.8 9.2 10.1 8.4 25.5 26.7 30.1 25.5 nonworker 10.6 4.2 3.1 4.3 1.8 14.4 35.0 39.0 15.0 (percentage within work status categories) Total 100.0% 70.9% 64.0% 32.9% 31.2% 6.8% 16.0% 12.1% 17.7% Own work status child 100.0 66.3 58.9 0.5 58.4 7.4 24.9 21.8 14.8 family head worker 100.0 77.9 71.3 65.5 5.8 6.6 7.5 4.9 17.7 other worker 100.0 79.7 74.1 38.6 35.5 5.7 6.3 3.1 17.1 nonworker 100.0 47.2 39.1 10.4 28.7 8.1 34.7 24.0 25.3 Work status of family head full-year, full-time worker 100.0 81.4 75.9 38.1 37.8 5.6 8.3 5.0 14.2 other worker 100.0 49.5 38.2 21.4 16.9 11.3 27.6 23.5 29.2 nonworker 100.0 27.9 18.6 13.2 5.4 9.3 53.0 44.5 25.1 Note: Details may not add to totals because individuals may receive coverage from more than one source. were uninsured for a short period of time were uninsured between one and four months (Bennfield, 1995). Approximately 15 percent were uninsured 5 to 8 months, and 8 percent were uninsured 9 to 12 months. The median spell without health insurance coverage was 6 months. These data would seem to indicate that even though many individuals may lose health insurance during any given month, the majority is uninsured for a short period of time. The remainder of this Issue Brief is based on the March 1997 CPS. The report focuses primarily on the nonelderly population (under age 65) because this group receives health insurance coverage from a number of different sources, depending, for example, on income, employment status, and location. Medicare covers 96 percent of the elderly population, which is the least likely population to be employed. The next section discusses the determinants of having employment-based health insurance coverage and other sources of coverage. The third section discusses the uninsured population and the factors associated with being uninsured. The fourth section examines policy implications, and the final section presents conclusions. Determinants of Coverage Stable, full-time workers; publicsector employees; workers employed in 6 December 1997 EBRI Issue Brief

mining, finance, insurance, and real estate industries; and individuals living in families with high income levels are most likely to be covered by private health insurance. Persons in families with income below the poverty level, especially children and single-parent families, are most likely to be covered by public health insurance such as Medicaid. Employment status is the most important determinant of health insurance coverage. Almost twothirds of the nonelderly population have employment-based coverage. This coverage can be obtained either directly through one s employer/union or a previous employer or indirectly through an employed person in one s family. In this report, individuals who receive coverage directly from their employer/union or through a previous employer are categorized as having coverage in their own name. Individuals who receive employment-based coverage indirectly are categorized as having dependent coverage. Employers that provide access to group health insurance are often able to obtain relatively lower premiums than individuals because adverse selection is lower and average administrative costs and marketing costs are lower. However, examination of premium levels across firms usually shows that premiums in larger firms are higher than premiums in smaller firms. Large firms tend to have higher premiums because they typically offer enhanced health benefit packages relative to small firms. The nature of employment, the industry, and the size of the firm often determine the cost and extent of coverage. Workers in large firms are more likely to be covered by health insurance than those in small firms. Full-year, full-time workers are more likely to be covered than seasonal or part-time workers. In 1996, 64 percent of the nonelderly were covered by employment-based health insurance (table 1). Workers were much more likely to be covered by employment-based health insurance than nonworkers (table 3). Seventy-two percent of workers were covered by an employment-based plan, compared with 39.1 percent of In 1996, 19.6 percent of individuals in families with income below $5,000 were covered by private health insurance, compared with 90.9 percent of those in families with income of $50,000 or more. nonworkers. In addition, 75.9 percent of individuals in families headed by a full-year, full-time worker were covered by employment-based health insurance, compared with 38.2 percent of those in families headed by other workers and 18.6 percent of individuals in families headed by a nonworker. With respect to industry, workers employed in mining; manufacturing; the public sector; and transportation, communications, and utilities were more likely to have employment-based coverage in their own name than other workers (table 4). Workers were also more likely to have employment-based coverage in their own name the larger the firm they were employed in. Twentysix percent of self-employed workers and 26.4 percent of private-sector workers in firms with fewer than 10 employees were covered through a group health plan sponsored by their own employer/union or former employer in 1996, compared with 67.8 percent of privatesector workers in firms with 1,000 or more employees (table 5). Health insurance coverage is also related to income. In general, individuals with higher levels of income are more likely to be covered by private health insurance, while those with lower levels of income are more likely to be covered by a publicly sponsored plan. In 1996, 19.6 percent of individuals in families with income below $5,000 were covered by private health insurance, compared with 90.9 percent of those in families with income of $50,000 or more (table 6). In addition, 10.2 percent of individuals in families with income less than $5,000 had employment-based coverage, compared with 85.8 percent of individuals in families with income of $50,000 or more. Although many individuals in poor families are covered by public health plans, that coverage is far from universal. In 1996, 50.1 percent of the nonelderly with family income below the poverty line were covered by a public plan 47.0 percent by Medicaid (table 7), although many low-income individuals may be eligible for Medic- December 1997 EBRI Issue Brief 7

Table 4 Workers Ages 18-64 with Selected Sources of Health Insurance, by Industry of Primary Employment, 1996 Employer Coverage Total Other Total Industry Total Private Total Own name Dependent Private Public Medicaid Uninsured (millions) Total 133.0 104.6 96.2 73.5 22.8 8.3 9.3 5.6 23.3 Self-Employed 12.8 9.2 6.5 3.2 3.3 2.7 0.7 0.4 3.1 Total Wage and Salary Workers 120.3 95.3 89.7 70.2 19.5 5.6 8.6 5.2 20.2 Government 18.8 17.1 16.4 13.8 2.7 0.6 1.4 0.6 1.2 Agriculture 2.4 1.3 1.1 0.7 0.4 0.3 0.2 0.1 0.9 Mining 0.6 0.5 0.5 0.5 0.1 a a a 0.1 Construction 6.5 4.2 4.0 3.1 0.8 0.3 0.3 0.2 2.0 Manufacturing 21.2 18.0 17.6 15.5 2.1 0.4 1.0 0.6 2.7 Transportation, communications, and utilities 7.1 6.0 5.8 5.2 0.6 0.2 0.3 0.2 1.0 Wholesale 4.3 3.6 3.4 2.8 0.6 0.2 0.2 0.1 0.6 Retail 20.6 13.8 12.2 7.6 4.6 1.5 2.1 1.5 5.4 Finance, insurance, and real estate 7.2 6.4 6.1 4.9 1.2 0.3 0.3 0.2 0.6 Business and repair services 7.2 4.9 4.5 3.3 1.1 0.4 0.7 0.5 1.8 Personal services 3.6 2.1 1.8 1.1 0.8 0.2 0.4 0.3 1.2 Entertainment and recreation services 2.0 1.4 1.2 0.7 0.5 0.2 0.2 0.1 0.5 Professional services 18.9 16.0 15.0 11.0 4.0 1.0 1.3 0.8 2.2 (percentage within coverage categories) Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Self-Employed 9.6 8.8 6.8 4.4 14.4 32.3 8.0 6.3 13.3 Total Wage and Salary Workers 90.4 91.2 93.2 95.6 85.6 67.7 92.0 93.7 86.7 Government 14.2 16.3 17.1 18.8 11.7 7.5 15.5 11.2 5.1 Agriculture 1.8 1.3 1.1 0.9 1.7 3.1 2.0 2.5 4.0 Mining 0.5 0.5 0.5 0.6 0.3 0.2 0.2 0.2 0.3 Construction 4.9 4.1 4.1 4.2 3.7 3.5 3.6 4.0 8.7 Manufacturing 15.9 17.2 18.3 21.1 9.2 5.0 11.0 11.5 11.6 Transportation, communications, and utilities 5.3 5.8 6.0 7.0 2.8 2.7 3.4 3.3 4.1 Wholesale 3.2 3.4 3.5 3.9 2.5 2.1 1.8 1.8 2.7 Retail 15.5 13.2 12.7 10.4 20.2 18.3 22.6 26.1 23.3 Finance, insurance, and real estate 5.4 6.1 6.4 6.7 5.4 3.3 3.6 2.9 2.7 Business and repair services 5.4 4.7 4.7 4.5 5.0 5.0 8.0 8.3 7.7 Personal services 2.7 2.0 1.9 1.5 3.3 3.0 4.4 5.9 5.1 Entertainment and recreation services 1.5 1.3 1.3 1.0 2.1 2.4 2.0 2.3 2.0 Professional services 14.2 15.3 15.6 15.0 17.7 11.6 13.8 13.8 9.5 (percentage within industry categories) Total 100.0% 78.6% 72.3% 55.2% 17.1% 6.2% 7.0% 4.2% 17.5% Self-Employed 100.0 72.2 51.1 25.5 25.6 21.1 5.8 2.7 24.2 Total Wage and Salary Workers 100.0 79.3 74.6 58.4 16.2 4.7 7.1 4.4 16.8 Government 100.0 90.7 87.4 73.2 14.2 3.3 7.7 3.3 6.3 Agriculture 100.0 55.1 44.5 28.3 16.2 10.6 8.0 5.9 39.0 Mining 100.0 88.9 85.9 76.1 9.8 3.1 2.8 1.6 10.2 Construction 100.0 65.2 60.7 47.7 13.0 4.5 5.1 3.4 31.3 Manufacturing 100.0 85.2 83.2 73.3 9.9 2.0 4.9 3.0 12.8 Transportation, communications, and utilities 100.0 84.7 81.6 72.5 9.0 3.1 4.5 2.6 13.4 Wholesale 100.0 83.3 79.3 65.9 13.4 4.0 3.9 2.4 14.7 Retail 100.0 66.9 59.6 37.2 22.4 7.4 10.2 7.1 26.3 Finance, insurance, and real estate 100.0 89.0 85.1 68.0 17.1 3.9 4.7 2.3 8.7 Business and repair services 100.0 68.4 62.6 46.7 15.9 5.8 10.4 6.4 25.0 Personal services 100.0 58.2 51.3 30.2 21.0 6.9 11.6 9.1 33.1 Entertainment and recreation services 100.0 71.8 61.5 37.4 24.1 10.3 9.4 6.5 23.3 Professional services 100.0 84.6 79.5 58.2 21.3 5.1 6.8 4.1 11.8 Note: Details may not add to totals because individuals may receive coverage from more than one source. a Fewer than 50,000 respondents (weighted) in this category. 8 December 1997 EBRI Issue Brief

Table 5 Workers Ages 18-64 with Selected Sources of Health Insurance, by Firm Size, 1996 Employer Coverage Total Other Total Firm Size Total Private Total Own name Dependent Private Public Medicaid Uninsured (millions) Total 133.0 104.6 96.2 73.5 22.8 8.3 9.3 5.6 23.3 Self-Employed 12.8 9.2 6.5 3.2 3.3 2.7 0.7 0.4 3.1 Total Wage and Salary Workers 120.3 95.3 89.7 70.2 19.5 5.6 8.6 5.2 20.2 Public sector 18.8 17.1 16.4 13.8 2.7 0.6 1.4 0.6 1.2 Private sector 101.4 78.3 73.3 56.4 16.8 5.0 7.1 4.6 19.0 fewer than 10 employees 14.9 9.0 7.6 3.9 3.7 1.4 1.4 1.0 4.9 10 24 employees 11.2 7.5 6.7 4.4 2.3 0.8 0.9 0.6 3.2 25 99 employees 15.6 11.7 11.0 8.5 2.5 0.8 1.0 0.7 3.2 100 499 employees 16.2 13.1 12.5 10.3 2.3 0.5 1.0 0.6 2.6 500 999 employees 6.4 5.5 5.2 4.3 1.0 0.2 0.5 0.3 0.7 1,000 or more employees 37.1 31.5 30.3 25.1 5.2 1.2 2.4 1.4 4.4 (percentage within coverage categories) Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Self-Employed 9.6 8.8 6.8 4.4 14.4 32.3 8.0 6.3 13.3 Total Wage and Salary Workers 90.4 91.2 93.2 95.6 85.6 67.7 92.0 93.7 86.7 Public sector 14.2 16.3 17.1 18.8 11.7 7.5 15.5 11.2 5.1 Private sector 76.3 74.9 76.1 76.8 73.9 60.2 76.5 82.5 81.7 fewer than 10 employees 11.2 8.7 7.9 5.4 16.1 17.4 14.6 18.0 21.0 10 24 employees 8.5 7.1 6.9 6.0 10.0 9.8 9.7 11.2 13.6 25 99 employees 11.7 11.2 11.4 11.5 10.9 9.2 11.1 12.5 13.9 100 499 employees 12.2 12.5 13.0 14.0 10.0 6.5 10.6 10.9 11.2 500 999 employees 4.8 5.2 5.4 5.8 4.3 2.7 5.0 4.7 3.0 1,000 or more employees 27.9 30.1 31.5 34.2 22.6 14.6 25.6 25.3 18.9 (percentage within firm size categories) Total 100.0% 78.6% 72.3% 55.2% 17.1% 6.2% 7.0% 4.2% 17.5% Self-Employed 100.0 72.2 51.1 25.5 25.6 21.1 5.8 2.7 24.2 Total Wage and Salary Workers 100.0 79.3 74.6 58.4 16.2 4.7 7.1 4.4 16.8 Public sector 100.0 90.7 87.4 73.2 14.2 3.3 7.7 3.3 6.3 Private sector 100.0 77.2 72.2 55.6 16.6 4.9 7.0 4.5 18.7 fewer than 10 employees 100.0 60.7 51.0 26.4 24.5 9.7 9.2 6.7 32.8 10 24 employees 100.0 66.4 59.2 38.9 20.3 7.3 8.0 5.6 28.2 25 99 employees 100.0 75.2 70.3 54.3 16.0 4.9 6.6 4.5 20.8 100 499 employees 100.0 80.5 77.2 63.2 14.0 3.3 6.1 3.7 16.1 500 999 employees 100.0 85.7 82.2 66.7 15.5 3.5 7.3 4.1 10.9 1,000 or more employees 100.0 84.9 81.7 67.8 13.9 3.3 6.4 3.8 11.9 Note: Details may not add to totals because individuals may receive coverage from more than one source. aid coverage even though they do not report coverage. Other sources of public health insurance include Medicare (which primarily covers the elderly but also covers some nonelderly disabled), CHAMPUS, CHAMPVA, Veterans Administration (VA) health insurance, and the Indian Health Service. The Uninsured The cost of uncompensated care (care for which no payment is received) is borne by all payers in the health care delivery system. However, there is evidence that it is becoming more difficult for health care providers to shift costs (Morrisey, 1996). Estimates of uncompensated care are uncertain. The American Hospital Association estimated that hospitals provided over $13 billion in uncompensated care in 1991 (American Hospital Association, 1992). Another study estimated that the cost of all services used by the uninsured amounted to $35 billion in 1991 (Congressional Budget Office, 1993b). 7 Another study estimated 7 Only $25 billion was for uncompensated care (Personal communication based on assumptions in Congressional Budget Office, 1993a). This does not include uncompensated charges for services to insured groups. For example, some insured individuals do not pay their cost-sharing amounts. December 1997 EBRI Issue Brief 9

Table 6 Nonelderly Population with Selected Sources of Health Insurance, by Family Income, 1996 Employer Coverage Total Other Total Family Income Total Private Total Own name Dependent Private Public Medicaid Uninsured (millions) Total 234.0 165.8 149.8 76.9 72.9 16.0 37.4 28.2 41.4 Under $5,000 11.7 2.3 1.2 0.5 0.7 1.1 5.1 4.7 4.7 $5,000 $9,999 14.2 3.0 1.8 1.1 0.7 1.2 7.8 7.2 4.1 $10,000 $14,999 15.3 5.3 3.7 2.5 1.2 1.6 5.7 5.0 5.2 $15,000 $19,999 14.6 6.9 5.6 3.6 2.0 1.3 3.7 3.1 4.8 $20,000 $29,999 30.7 19.7 17.1 10.0 7.2 2.5 5.1 3.6 7.7 $30,000 $39,999 28.6 22.4 20.5 10.7 9.7 2.0 3.0 1.8 4.7 $40,000 $49,999 25.4 21.2 19.7 9.9 9.8 1.5 2.1 1.0 3.2 $50,000 and over 93.5 85.0 80.2 38.6 41.6 4.8 4.9 1.7 6.9 (percentage within coverage categories) Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Under $5,000 5.0 1.4 0.8 0.7 0.9 6.9 13.6 16.7 11.4 $5,000 $9,999 6.1 1.8 1.2 1.4 1.0 7.8 20.8 25.5 10.0 $10,000 $14,999 6.5 3.2 2.5 3.2 1.7 9.8 15.1 17.8 12.6 $15,000 $19,999 6.3 4.2 3.8 4.7 2.8 8.0 10.0 11.0 11.6 $20,000 $29,999 13.1 11.9 11.4 13.0 9.8 15.7 13.6 12.8 18.7 $30,000 $39,999 12.2 13.5 13.7 13.9 13.3 12.5 8.1 6.5 11.3 $40,000 $49,999 10.9 12.8 13.1 12.8 13.5 9.6 5.7 3.7 7.7 $50,000 and over 39.9 51.2 53.5 50.2 57.0 29.7 13.1 6.1 16.6 (percentage within family income categories) Total 100.0% 70.9% 64.0% 32.9% 31.2% 6.8% 16.0% 12.1% 17.7% Under $5,000 100.0 19.6 10.2 4.4 5.8 9.4 43.6 40.4 40.5 $5,000 $9,999 100.0 21.3 12.5 7.6 4.9 8.7 54.7 50.4 29.1 $10,000 $14,999 100.0 34.6 24.3 16.1 8.1 10.3 37.1 32.9 34.2 $15,000 $19,999 100.0 47.3 38.6 24.8 13.8 8.8 25.5 21.3 32.9 $20,000 $29,999 100.0 64.0 55.8 32.5 23.3 8.2 16.6 11.7 25.1 $30,000 $39,999 100.0 78.5 71.5 37.5 34.0 7.0 10.6 6.4 16.3 $40,000 $49,999 100.0 83.5 77.4 38.8 38.6 6.1 8.3 4.1 12.6 $50,000 and over 100.0 90.9 85.8 41.3 44.5 5.1 5.2 1.8 7.4 Note: Details may not add to totals because individuals may receive coverage from more than one source. the cost of care provided to uninsured individuals for all services at $40.6 billion in 1993 (Long and Marquis, 1994). The uninsured may be forced to seek care in more expensive settings, such as emergency rooms, for ailments that could have been prevented or at least treated earlier in a lower-cost setting. Location The proportion of the nonelderly population with and without health insurance varies by location. In eight states, 20 percent or more of the population was uninsured in 1996 (table 8). These states are in large part concentrated in the southcentral and southwestern parts of the United States (chart 1). In many of these states a smaller proportion of the population was eligible for private insurance and/or a larger proportion was eligible for publicly financed health programs than the national average. Lower average income and higher unemployment rates may all be factors contributing to this difference. In addition, many of these states have a higher concentration of racial and ethnic groups that are less likely to be covered by health insurance. In contrast, states with a low percentage of uninsured individuals include Wisconsin, Hawaii, Michigan, New Hampshire, Pennsylvania, and South Dakota. The percentage of the population without any form of health insurance coverage also varies by metropolitan region. In fact, 16.9 percent of the population residing in Consolidated Metropolitan Statistical Areas (CMSAs) were uninsured in 1996, compared with 17.7 percent overall (table 9). The Houston-Galveston- 10 December 1997 EBRI Issue Brief

Table 7 Nonelderly Population with Selected Sources of Health Insurance, by Race and Poverty Status, 1996 Race and Employer Coverage Percentage of Total Other Total Poverty Level Total Private Total Own name Dependent Private Public Medicaid Uninsured (millions) Total 234.0 165.8 149.8 76.9 72.9 16.0 37.4 28.2 41.4 0 99% 33.6 7.0 4.3 1.9 2.4 2.6 16.8 15.8 11.4 100% 124% 10.3 4.1 3.1 1.4 1.7 1.0 3.2 2.7 3.7 125% 149% 10.7 5.4 4.4 1.9 2.5 1.0 2.5 2.0 3.4 150% 199% 22.0 13.5 11.6 5.1 6.5 1.9 3.9 2.7 5.9 200% 399% 76.8 62.2 57.1 27.4 29.7 5.1 6.9 3.7 11.3 400% or more 80.6 73.7 69.3 39.1 30.2 4.4 4.1 1.3 5.7 White 164.1 129.7 116.9 59.6 57.2 12.8 19.9 13.0 21.9 0 99% 14.4 4.1 2.2 1.0 1.2 1.8 6.5 5.9 4.7 100% 124% 5.4 2.4 1.7 0.8 0.9 0.7 1.7 1.4 1.7 125% 149% 5.9 3.4 2.6 1.1 1.5 0.8 1.3 1.0 1.6 150% 199% 13.4 8.9 7.5 3.3 4.2 1.4 2.3 1.5 3.1 200% 399% 57.3 48.3 44.2 20.6 23.5 4.1 4.8 2.3 6.7 400% or more 67.7 62.5 58.6 32.8 25.9 3.9 3.2 0.9 4.2 Black 30.6 16.3 14.9 8.4 6.5 1.4 9.2 7.7 7.1 0 99% 8.8 1.4 0.9 0.5 0.5 0.4 5.3 5.1 2.5 100% 124% 2.2 0.8 0.7 0.3 0.3 0.2 0.7 0.6 0.8 125% 149% 2.1 1.0 0.9 0.4 0.5 0.1 0.6 0.5 0.6 150% 199% 3.6 2.1 1.8 0.9 0.9 0.2 0.9 0.6 1.0 200% 399% 8.5 6.3 5.9 3.3 2.6 0.3 1.2 0.7 1.6 400% or more 5.4 4.7 4.6 2.9 1.7 0.1 0.4 0.2 0.6 Hispanic 28.1 12.7 11.7 5.7 6.0 1.0 6.3 5.8 9.9 0 99% 8.4 1.1 0.9 0.4 0.6 0.2 4.0 3.9 3.4 100% 124% 2.3 0.7 0.6 0.2 0.3 0.1 0.6 0.6 1.1 125% 149% 2.3 0.9 0.8 0.3 0.5 0.1 0.5 0.4 1.0 150% 199% 3.9 1.9 1.7 0.7 1.0 0.1 0.6 0.5 1.6 200% 399% 7.6 5.1 4.8 2.4 2.4 0.3 0.5 0.3 2.2 400% or more 3.7 3.1 2.9 1.7 1.2 0.2 0.2 0.1 0.5 Other 11.2 7.2 6.4 3.2 3.2 0.8 2.0 1.7 2.4 0 99% 2.0 0.4 0.2 0.1 0.1 0.2 1.0 0.9 0.7 100% 124% 0.5 0.2 0.1 0.1 0.1 a 0.2 0.1 0.2 125% 149% 0.4 0.2 0.1 0.1 0.1 0.1 0.1 0.1 0.2 150% 199% 1.0 0.6 0.5 0.2 0.3 0.1 0.2 0.1 0.2 200% 399% 3.5 2.5 2.3 1.0 1.2 0.3 0.4 0.3 0.7 400% or more 3.9 3.4 3.1 1.7 1.4 0.2 0.2 0.1 0.4 (percentage within coverage categories) Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 0 99% 14.4 4.2 2.9 2.5 3.3 16.5 45.0 56.0 27.5 100% 124% 4.4 2.5 2.1 1.9 2.3 6.2 8.6 9.7 8.9 125% 149% 4.6 3.3 3.0 2.5 3.4 6.2 6.7 7.2 8.2 150% 199% 9.4 8.1 7.7 6.7 8.9 11.9 10.5 9.6 14.4 200% 399% 32.8 37.5 38.1 35.6 40.8 31.8 18.4 13.0 27.2 400% or more 34.5 44.4 46.2 50.9 41.4 27.4 10.9 4.5 13.8 White 70.1 78.2 78.0 77.6 78.5 79.8 53.1 46.2 53.0 0 99% 6.2 2.5 1.5 1.4 1.6 11.6 17.4 20.9 11.3 100% 124% 2.3 1.5 1.1 1.0 1.2 4.4 4.5 5.0 4.0 125% 149% 2.5 2.0 1.8 1.5 2.1 4.7 3.5 3.4 3.8 150% 199% 5.7 5.4 5.0 4.2 5.8 9.0 6.2 5.4 7.4 200% 399% 24.5 29.1 29.5 26.8 32.3 25.7 12.8 8.3 16.3 400% or more 28.9 37.7 39.1 42.6 35.5 24.3 8.6 3.2 10.3 Black 13.1 9.8 9.9 10.9 8.9 8.7 24.5 27.3 17.2 0 99% 3.8 0.8 0.6 0.6 0.6 2.8 14.2 17.9 6.1 100% 124% 1.0 0.5 0.5 0.4 0.5 1.0 2.0 2.3 1.9 125% 149% 0.9 0.6 0.6 0.5 0.6 0.6 1.6 1.9 1.5 150% 199% 1.6 1.3 1.2 1.2 1.3 1.6 2.3 2.1 2.5 200% 399% 3.6 3.8 3.9 4.3 3.6 2.2 3.2 2.5 3.9 400% or more 2.3 2.8 3.1 3.8 2.3 0.6 1.1 0.6 1.4 (continued) December 1997 EBRI Issue Brief 11

Table 7 (continued) Race and Employer Coverage Percentage of Total Other Total Poverty Level Total Private Total Own name Dependent Private Public Medicaid Uninsured (percentage within coverage categories) Hispanic 12.0% 7.6% 7.8% 7.4% 8.2% 6.3% 17.0% 20.6% 23.9% 0 99% 3.6 0.7 0.6 0.5 0.8 1.2 10.8 13.9 8.3 100% 124% 1.0 0.4 0.4 0.3 0.5 0.6 1.6 2.0 2.7 125% 149% 1.0 0.5 0.5 0.4 0.6 0.4 1.2 1.5 2.5 150% 199% 1.7 1.1 1.2 0.9 1.4 0.9 1.5 1.6 3.9 200% 399% 3.2 3.1 3.2 3.1 3.3 2.2 1.4 1.2 5.2 400% or more 1.6 1.8 1.9 2.2 1.6 1.1 0.5 0.4 1.3 Other 4.8 4.4 4.3 4.2 4.4 5.2 5.5 6.0 5.9 0 99% 0.8 0.2 0.1 0.1 0.2 1.0 2.6 3.3 1.7 100% 124% 0.2 0.1 0.1 0.1 0.1 0.1 0.5 0.5 0.4 125% 149% 0.2 0.1 0.1 0.1 0.1 0.4 0.3 0.4 0.5 150% 199% 0.4 0.4 0.4 0.3 0.4 0.5 0.5 0.5 0.6 200% 399% 1.5 1.5 1.5 1.3 1.7 1.7 1.0 0.9 1.8 400% or more 1.6 2.0 2.1 2.3 1.9 1.4 0.6 0.4 1.0 (percentage within race and poverty categories) Total 100.0% 70.9% 64.0% 32.9% 31.2% 6.8% 16.0% 12.1% 17.7% 0 99% 100.0 20.7 12.8 5.8 7.1 7.9 50.1 47.0 33.8 100% 124% 100.0 39.5 29.9 13.9 16.0 9.6 31.0 26.6 35.8 125% 149% 100.0 50.7 41.4 18.0 23.4 9.3 23.4 18.9 31.7 150% 199% 100.0 61.5 52.8 23.3 29.5 8.7 17.8 12.3 27.1 200% 399% 100.0 81.0 74.4 35.6 38.7 6.6 9.0 4.8 14.7 400% or more 100.0 91.4 85.9 48.5 37.4 5.4 5.0 1.6 7.1 White 100.0 79.0 71.2 36.3 34.9 7.8 12.1 7.9 13.4 0 99% 100.0 28.3 15.5 7.2 8.3 12.8 45.0 40.8 32.3 100% 124% 100.0 45.0 31.8 14.9 16.9 13.2 31.7 26.1 30.9 125% 149% 100.0 57.5 44.6 19.1 25.5 12.9 22.3 16.4 26.3 150% 199% 100.0 66.6 55.9 24.3 31.6 10.8 17.4 11.4 22.9 200% 399% 100.0 84.2 77.1 36.0 41.1 7.2 8.4 4.1 11.8 400% or more 100.0 92.4 86.6 48.4 38.2 5.8 4.8 1.3 6.3 Black 100.0 53.1 48.6 27.4 21.2 4.6 29.9 25.1 23.2 0 99% 100.0 15.5 10.5 5.3 5.2 5.1 60.7 57.6 28.9 100% 124% 100.0 38.0 30.6 15.1 15.5 7.4 33.5 28.7 34.5 125% 149% 100.0 47.5 42.7 20.1 22.7 4.7 29.1 25.8 29.3 150% 199% 100.0 57.6 50.7 25.3 25.4 6.9 23.6 16.2 28.1 200% 399% 100.0 73.9 69.8 39.2 30.6 4.1 14.4 8.5 19.0 400% or more 100.0 86.9 85.3 53.8 31.5 1.6 7.6 2.9 10.5 Hispanic 100.0 45.1 41.5 20.2 21.3 3.6 22.6 20.6 35.1 0 99% 100.0 13.4 11.2 4.2 7.0 2.3 48.0 46.7 41.0 100% 124% 100.0 28.9 24.8 10.2 14.6 4.0 25.7 24.5 48.6 125% 149% 100.0 37.5 34.4 14.2 20.2 3.1 20.2 17.9 45.5 150% 199% 100.0 47.6 44.1 18.2 25.9 3.5 14.0 11.6 41.0 200% 399% 100.0 67.6 63.0 31.4 31.6 4.6 6.8 4.6 28.5 400% or more 100.0 83.5 78.6 46.1 32.5 4.9 5.5 2.8 14.2 Other 100.0 64.6 57.2 28.6 28.6 7.4 18.2 15.1 21.8 0 99% 100.0 19.0 11.0 3.9 7.1 8.0 49.0 47.1 36.1 100% 124% 100.0 33.8 29.3 14.3 15.0 4.5 38.0 31.6 35.7 125% 149% 100.0 43.3 28.3 13.8 14.5 15.0 27.2 25.4 42.6 150% 199% 100.0 61.3 53.0 23.5 29.6 8.3 17.5 13.7 23.8 200% 399% 100.0 73.3 65.5 29.8 35.7 7.8 10.7 7.4 21.4 400% or more 100.0 87.1 81.2 45.0 36.2 5.9 6.0 2.8 10.2 Note: Details may not add to totals because individuals may receive coverage from more than one source. a Fewer than 50,000 respondents (weighted) in this category. 12 December 1997 EBRI Issue Brief

Table 8 Nonelderly Population with Selected Sources of Health Insurance, by Region and State, 1996 Employer Coverage Total Other Total Region and State Total Private Total Own name Dependent Private Public Medicaid Uninsured (millions) Total 234.0 165.8 149.8 76.9 72.9 16.0 37.4 28.2 41.4 New England 11.6 9.0 8.3 4.1 4.2 0.7 1.6 1.2 1.5 Maine 1.0 0.8 0.7 0.4 0.3 0.1 0.1 0.1 0.1 New Hampshire 1.0 0.8 0.7 0.4 0.4 0.1 0.1 0.1 0.1 Vermont 0.5 0.4 0.3 0.2 0.2 0.1 0.1 0.1 0.1 Massachusetts 5.4 4.1 3.8 1.9 1.9 0.3 0.8 0.6 0.8 Rhode Island 0.8 0.6 0.6 0.3 0.3 0.1 0.1 0.1 0.1 Connecticut 2.9 2.2 2.1 1.0 1.1 0.1 0.4 0.3 0.4 Middle Atlantic 33.1 23.7 21.9 11.3 10.6 1.8 5.1 4.4 5.5 New York 16.2 10.6 9.9 5.1 4.8 0.7 3.1 2.7 3.1 New Jersey 6.8 5.0 4.7 2.5 2.2 0.4 0.7 0.5 1.3 Pennsylvania 10.2 8.1 7.4 3.7 3.7 0.7 1.3 1.1 1.1 East North Central 38.2 30.1 27.9 13.7 14.3 2.2 5.1 3.9 4.5 Ohio 9.8 7.5 7.0 3.4 3.6 0.5 1.3 1.0 1.3 Indiana 4.9 4.1 3.7 1.9 1.8 0.4 0.4 0.3 0.6 Illinois 10.5 8.1 7.5 3.7 3.8 0.6 1.5 1.2 1.3 Michigan 8.4 6.7 6.2 3.0 3.3 0.5 1.2 1.1 0.8 Wisconsin 4.6 3.8 3.5 1.7 1.7 0.3 0.6 0.4 0.4 West North Central 16.1 12.5 10.7 5.4 5.4 1.8 2.3 1.7 2.1 Minnesota 4.3 3.3 2.9 1.4 1.5 0.4 0.6 0.5 0.5 Iowa 2.5 2.1 1.7 0.9 0.9 0.4 0.2 0.2 0.3 Missouri 4.5 3.4 2.9 1.6 1.4 0.5 0.7 0.5 0.7 North Dakota 0.5 0.4 0.4 0.2 0.2 0.1 0.1 a 0.1 South Dakota 0.6 0.5 0.4 0.2 0.2 0.1 0.1 0.1 0.1 Nebraska 1.4 1.1 0.9 0.5 0.5 0.2 0.2 0.1 0.2 Kansas 2.2 1.7 1.5 0.7 0.8 0.2 0.4 0.2 0.3 South Atlantic 40.8 28.5 25.8 14.2 11.7 2.7 6.8 4.4 7.6 Delaware 0.6 0.5 0.5 0.2 0.2 a 0.1 0.1 0.1 Maryland 4.5 3.5 3.2 1.6 1.6 0.3 0.6 0.4 0.6 District of Columbia 0.5 0.3 0.3 0.2 0.1 a 0.1 0.1 0.1 Virginia 5.7 4.1 3.8 2.1 1.7 0.3 1.0 0.5 0.8 West Virginia 1.5 1.0 0.9 0.4 0.4 0.1 0.3 0.2 0.3 North Carolina 6.3 4.6 4.3 2.4 1.8 0.3 1.0 0.5 1.2 South Carolina 3.3 2.4 2.1 1.2 1.0 0.2 0.5 0.3 0.6 Georgia 6.6 4.5 4.2 2.3 1.9 0.3 1.1 0.8 1.3 Florida 11.8 7.7 6.7 3.8 2.8 1.0 2.1 1.4 2.7 East South Central 14.4 9.8 8.9 4.6 4.2 0.9 3.1 2.3 2.5 Kentucky 3.4 2.3 2.1 1.1 1.0 0.2 0.7 0.5 0.6 Tennessee 4.8 3.2 2.9 1.6 1.3 0.4 1.3 1.0 0.8 Alabama 3.7 2.7 2.5 1.2 1.2 0.2 0.6 0.4 0.5 Mississippi 2.5 1.7 1.4 0.8 0.7 0.2 0.5 0.4 0.5 West South Central 26.3 16.6 15.0 7.9 7.1 1.6 4.3 3.1 6.7 Arkansas 2.3 1.4 1.2 0.6 0.6 0.2 0.4 0.3 0.6 Louisiana 3.8 2.3 2.1 1.1 1.0 0.2 0.7 0.5 0.9 Oklahoma 2.9 1.9 1.7 0.9 0.8 0.2 0.6 0.4 0.6 Texas 17.4 11.0 10.0 5.3 4.7 1.0 2.5 1.9 4.7 Mountain 14.9 10.2 9.0 4.3 4.7 1.2 2.5 1.8 3.1 Montana 0.8 0.5 0.5 0.2 0.2 0.1 0.2 0.2 0.1 Idaho 1.0 0.8 0.6 0.3 0.3 0.1 0.2 0.1 0.2 Wyoming 0.4 0.3 0.3 0.1 0.2 a 0.1 a 0.1 Colorado 3.5 2.6 2.2 1.1 1.1 0.4 0.4 0.3 0.6 New Mexico 1.7 0.9 0.8 0.4 0.5 0.1 0.4 0.3 0.4 Arizona 4.2 2.4 2.2 1.0 1.1 0.3 0.9 0.6 1.2 Utah 1.8 1.5 1.3 0.5 0.8 0.2 0.2 0.1 0.2 Nevada 1.4 1.1 1.0 0.6 0.5 a 0.2 0.1 0.3 Pacific 38.5 25.4 22.3 11.5 10.8 3.1 6.8 5.5 7.9 Washington 5.1 3.9 3.3 1.7 1.5 0.6 0.9 0.6 0.8 Oregon 2.8 2.1 1.8 1.0 0.9 0.2 0.4 0.3 0.5 California 28.9 18.4 16.2 8.2 7.9 2.2 5.0 4.3 6.4 Alaska 0.6 0.4 0.4 0.2 0.2 a 0.2 0.1 0.1 Hawaii 1.0 0.7 0.6 0.4 0.3 0.1 0.3 0.2 0.1 (continued) December 1997 EBRI Issue Brief 13

Table 8 (continued) Employer Coverage Total Other Total Region and State Total Private Total Own name Dependent Private Public Medicaid Uninsured (percentage) Total 100.0% 70.9% 64.0% 32.9% 31.2% 6.8% 16.0% 12.1% 17.7% New England 100.0 77.0 71.2 35.2 36.0 5.8 13.9 10.7 13.2 Maine 100.0 77.8 71.4 38.4 33.1 6.3 12.9 8.6 14.0 New Hampshire 100.0 81.7 74.7 36.5 38.1 7.0 10.2 7.0 10.9 Vermont 100.0 75.3 64.7 30.3 34.4 10.6 19.5 17.1 12.4 Massachusetts 100.0 75.8 70.6 34.9 35.7 5.2 14.8 11.3 14.1 Rhode Island 100.0 78.6 71.9 37.2 34.7 6.7 13.0 9.9 12.0 Connecticut 100.0 77.1 72.0 34.4 37.6 5.1 13.1 10.6 12.5 Middle Atlantic 100.0 71.6 66.1 34.0 32.0 5.5 15.4 13.2 16.7 New York 100.0 65.5 61.1 31.5 29.6 4.5 19.1 17.0 19.1 New Jersey 100.0 73.7 68.5 36.5 32.0 5.2 10.3 7.9 19.1 Pennsylvania 100.0 79.7 72.4 36.4 36.0 7.3 12.7 10.9 11.1 East North Central 100.0 78.9 73.1 35.7 37.3 5.8 13.2 10.2 11.7 Ohio 100.0 76.5 71.6 34.3 37.3 4.9 13.7 9.9 13.1 Indiana 100.0 83.4 75.8 38.9 36.9 7.6 7.9 5.7 12.2 Illinois 100.0 76.8 71.5 35.1 36.4 5.3 14.4 11.0 12.5 Michigan 100.0 79.6 74.0 35.3 38.7 5.6 14.9 12.7 10.1 Wisconsin 100.0 82.5 75.0 37.5 37.5 7.4 12.2 9.1 9.5 West North Central 100.0 77.6 66.5 33.4 33.2 11.1 14.1 10.4 13.1 Minnesota 100.0 78.4 68.4 33.7 34.6 10.1 14.1 12.3 11.3 Iowa 100.0 81.3 67.0 33.4 33.6 14.3 9.4 7.7 13.1 Missouri 100.0 74.9 64.9 34.4 30.5 10.0 14.8 11.5 15.3 North Dakota 100.0 80.9 65.4 32.6 32.9 15.4 15.2 7.3 11.3 South Dakota 100.0 77.6 63.7 31.5 32.2 13.9 20.1 13.3 11.1 Nebraska 100.0 76.9 64.3 31.7 32.6 12.6 13.7 9.5 13.0 Kansas 100.0 76.8 68.3 32.3 36.0 8.5 16.7 8.1 13.3 South Atlantic 100.0 69.9 63.3 34.7 28.5 6.6 16.7 10.7 18.6 Delaware 100.0 74.3 69.7 35.8 33.9 4.7 14.3 10.6 14.8 Maryland 100.0 78.4 70.8 35.6 35.2 7.7 13.4 9.4 12.9 District of Columbia 100.0 63.0 56.7 38.5 18.2 6.4 23.7 20.3 16.9 Virginia 100.0 73.1 67.0 36.6 30.4 6.1 18.3 8.4 14.0 West Virginia 100.0 65.6 59.8 30.1 29.7 5.8 20.2 15.4 17.9 North Carolina 100.0 72.0 67.1 38.0 29.1 4.9 15.2 8.5 18.2 South Carolina 100.0 71.8 64.4 34.9 29.4 7.5 16.0 8.9 18.7 Georgia 100.0 68.2 63.7 34.3 29.4 4.5 17.1 12.1 19.7 Florida 100.0 64.9 56.4 32.3 24.1 8.5 17.5 12.2 22.9 East South Central 100.0 68.0 61.5 32.1 29.3 6.6 21.2 16.1 17.3 Kentucky 100.0 66.7 61.8 31.2 30.7 4.9 20.5 13.8 17.6 Tennessee 100.0 66.4 59.0 32.6 26.4 7.4 26.7 21.5 17.2 Alabama 100.0 72.8 66.9 33.8 33.2 5.9 15.7 11.6 14.9 Mississippi 100.0 65.9 57.7 30.1 27.6 8.2 19.6 15.6 20.6 West South Central 100.0 63.0 56.9 29.9 27.0 6.1 16.2 11.8 25.3 Arkansas 100.0 61.0 53.0 26.0 27.0 8.0 19.6 13.0 24.9 Louisiana 100.0 62.2 55.9 29.4 26.5 6.3 17.7 13.1 23.3 Oklahoma 100.0 66.1 58.0 30.3 27.8 8.1 21.4 14.4 19.8 Texas 100.0 63.0 57.4 30.5 26.9 5.5 14.6 10.9 26.7 Mountain 100.0 68.5 60.7 29.1 31.6 7.8 16.5 11.8 20.7 Montana 100.0 68.3 58.6 29.4 29.2 9.7 24.2 19.7 15.4 Idaho 100.0 71.8 61.3 29.7 31.6 10.4 14.6 10.8 18.6 Wyoming 100.0 72.8 65.4 29.8 35.6 7.4 15.8 9.6 15.2 Colorado 100.0 74.8 63.9 32.5 31.4 10.9 12.2 7.4 17.9 New Mexico 100.0 55.5 50.2 22.0 28.2 5.3 24.7 19.8 24.7 Arizona 100.0 58.6 52.4 25.0 27.5 6.2 20.4 14.9 27.7 Utah 100.0 82.7 73.8 29.4 44.5 8.9 8.8 6.3 13.3 Nevada 100.0 75.4 72.2 40.1 32.0 3.3 13.1 8.1 17.7 Pacific 100.0 66.0 57.9 29.8 28.1 8.1 17.6 14.3 20.5 Washington 100.0 75.1 64.0 34.1 29.9 11.1 17.6 12.6 14.8 Oregon 100.0 73.4 64.6 34.1 30.5 8.8 14.8 11.5 17.5 California 100.0 63.5 55.9 28.4 27.5 7.6 17.3 14.7 22.3 Alaska 100.0 67.4 61.9 29.4 32.5 5.5 32.7 19.5 14.3 Hawaii 100.0 70.3 63.5 37.3 26.2 6.8 25.9 15.1 10.0 Note: Details may not add to totals because individuals may receive coverage from more than one source. a Fewer than 50,000 respondents (weighted) in this category. 14 December 1997 EBRI Issue Brief

Chart 1 Percentage of Uninsured, by State, 1996 19.7% 27.8% 17.5% 19.7% 14.1% 17.5% 12.5% 14.1% 9.4% 12.5% 0.197 to 0.278 ( 0 175t 0 197 (1 Brazoria, Texas CMSA had the highest percentage uninsured among CMSAs at 30.1 percent, followed by 27.1 percent uninsured Miami-Fort Lauderdale, Florida, and 26.2 percent in Los Angeles-Riverside-Orange County, California. This compares with 9.3 percent uninsured in the Detroit-Ann Arbor, Michigan CMSA and 9.4 percent in the Milwaukee-Racine, Wisconsin CMSA. Citizenship Citizenship is a primary factor in the likelihood of an individual having coverage and the source of that coverage (table 10). In California, for example, 18.2 percent of nonelderly individuals reported that they were noncitizens, compared with 6.7 percent of the nation as a whole. Over 44 percent of nonelderly respondents indicating they were noncitizens were uninsured in 1996, compared with 15.8 percent of citizens. This may be due in part to the fact that a higher proportion of noncitizens than citizens were in low-income families, were more likely to be nonworkers, or were more likely to work in small firms. Employment Eighty-five percent of the uninsured lived in families headed by workers in 1996, primarily because most people live in families headed by workers, including oneperson families (chart 2). Fifteen percent of the uninsured were in families in which the family head did not work. Industry The majority of uninsured workers reported their industry of primary employment as retail trade, services, or manufacturing (table 4). However, workers were most likely to be uninsured if they were self-employed or working in agriculture, construction, retail trade, personal services, or business services (chart 3). Agricultural workers are generally paid low hourly wages and are often migratory. Construction workers are often employed on a contractual basis for a particular project. Because many of these workers are not consistently employed by the same employer, they are less likely to have employment-based health insurance. Retail sales December 1997 EBRI Issue Brief 15