rwjf uninsured data

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Facts on Health Coverage in the USA

Prepared for Cover the Uninsured and the Robert Wood Johnson Foundation by the Employee Benefit Research Institute (EBRI) using the Census Bureau’s Current Population Survey (CPS) numbers.

Although EBRI uses CPS numbers, the same dataset used by the Census Bureau, EBRI estimates may vary from Census estimates due to the fact that EBRI's analysis excludes Medicare beneficiaries and active-duty military. Please note that EBRI's analysis defines children as individuals ages 0-17, whereas other sources may define children as ages 0-18. This difference accounts for the variance between the reported numbers of uninsured children, depending on the source and method of analysis.

Updated February 2008

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Table of Contents:Facts on Health Coverage in the USA

Overview 3Age & Gender 4-5Uninsured Children 6-10Race/Ethnicity 11Educational Attainment 12-13Income & Poverty Status 14-15Workers 16-17Source of Coverage 18Employment-Based Coverage 19-21Industry and Occupation 22-23Retiree Health Benefits 22Health Behavior 24-26National Spending on Healthcare 27-31Health Insurance Premiums 32-34Out-of-Pocket Spending on Health Care Services 35-37

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OverviewThe problem of the uninsured is continuing to grow. The federal government estimates that 47 million individuals lacked health insurance coverage of any kind during 2006. Other research shows that tens of millions more Americans go without health coverage for shorter periods of time.

Source: Employee Benefit Research Institute estimates from the Current Population Survey, March 1988-2007 Supplements.

Note: 1987-2003 data are adjusted for Census correction announced in March 2007.

Percentage of Nonelderly Americans Without Health Insurance Coverage, 1987-2006

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Age & GenderThe likelihood of being uninsured varies by age and gender. Men are more

likely to be uninsured than women. More than 22 percent of men are uninsured, while 18.1 percent of women are uninsured.1 As a result, men account for more

of the uninsured than women.

Source: Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.

Uninsured Nonelderly Adult Population by Gender, 2006

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Percentage Uninsured Among Nonelderly Adults by Age, 2006

Age & Gender


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Uninsured Children

Nearly twenty percent of uninsured Americans – 8.7 million individuals – are children. The likelihood that a child is uninsured has fallen from 13.9 percent in 1998 to 10.5 percent in 2004. It has since increased to 11.7 percent in 2006. While children are more likely to be insured than non-elderly adults, health insurance is particularly important for children. Uninsured children are more likely than insured children to lack a usual source of health care, to go without needed care and to experience worse health outcomes.1 Percentage of Children Under Age 18 Without Health Insurance, 1994-2006

Source: Employee Benefit Research Institute estimates from the Current Population Survey, March 1995-2007 Supplements. Note: 1994-2003 data are adjusted for Census correction

announced in March 2007.

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Uninsured Children


Uninsured Children by Race and Ethnic Origin, 2006

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Uninsured Children


Uninsured Children by Age, 2006

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Uninsured Children


Uninsured Children by Family Poverty Status, 2006

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Source: Employee Benefit Research Institute estimates from the March Current Population

Survey, 2007 Supplement.

Uninsured Children

Uninsured Children by Work Status of the Family Head, 2006

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Race/Ethnicity

Percentage Uninsured Among the Non-elderly Population by Race and Ethnic Origin, 2005

Relative to their numbers in the overall population, members of racial and ethnic minority groups make up a disproportionate share of the uninsured population. A variety of economic and social factors underlie these disparities. When differences in income, occupation, employment sector and firm size, education, health status, age, gender, citizenship status, and geography are statistically removed, two-thirds of the difference in uninsured rates between Hispanics and non-Hispanic Whites is eliminated.1

Source: Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement

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Educational Attainment The likelihood of being insured increases as level of educational attainment rises. However, fully 40 percent of the difference in insured rates between those with no high-school diploma and those with some post-college education would disappear if the two groups were alike with respect to demographic, geographic and health status factors.1



Percentage Uninsured Among Nonelderly Adults by Education, 2006

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Educational Attainment

Uninsured Nonelderly Adults by Education, 2006



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Income & Poverty Status National surveys consistently show that the high cost of health insurance is the primary reason people are uninsured.1

Uninsured Non-elderly Population by Family Poverty Status, 2006


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Income & Poverty Status


Percentage Uninsured Among Nonelderly Population by Family Poverty Status, 2006

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WorkersHaving a job, even a full-time job, does not guarantee access to health insurance.

Uninsured Nonelderly Population by Work Status of Family Head, 2006

Source: Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement

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Workers

Nonelderly Adult Uninsured Workers by Work Status, 2006


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Source of CoverageEmployment-based health insurance continues to be the predominant source of coverage for the non-elderly population.

Health Insurance Coverage of Nonelderly Americans, by Source of Coverage, 2006


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Employment-Based Coverage

Percentage of Non-elderly Adult Workers Without Health Insurance, 1987-2006

Average annual increases in health insurance premiums for all firms escalated from 0.8 percent in 1996 to 13.9 percent in 2003, but then declined to 6.1 percent in 2007.1 Over approximately the same period, the percentage of workers without health insurance increased from 16.0 percent in 1996 to 18.8 percent in 2006, with workers accounting for 27.6 million of the 46.5 million uninsured.2

Source: Employee Benefit Research Institute estimates from the Current Population Survey, March 1988-2007 Supplements.

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Non-elderly Adult Uninsured Workers by Firm Size, 2006


Almost one-half (49.2 percent) of all non-elderly, adult uninsured workers work in firms with fewer than 25 employees.3

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Percentage of Employers Offering Health Benefits by Firm Size, 1996-2007

Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits.

Almost all employers with more than 200 workers offer health benefits (99 percent in 2007). In contrast, 45 percent of firms with three to nine employees offered health insurance in 2006.4

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Industry and Occupation More than one-third (36.3 percent) of workers employed in agriculture, forestry, fishing, mining and construction are uninsured, compared to 22.5 percent in personal services, 18 percent in wholesale and retail trade, 15.1 percent in manufacturing and 6.1 percent in the public sector. Workers in wholesale and retail trade and personal services account for 61.4 percent of all uninsured workers.1

Non-elderly Adult Uninsured Workers by Industry, 2006


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Industry and Occupation

Non-elderly Adult Uninsured Workers by Occupation, 2005


The uninsured are disproportionately concentrated in blue collar jobs. Whereas about one-quarter of the workforce is employed in such jobs as

construction, transportation, maintenance and farming, these workers account for 35.3 percent of all uninsured workers.2

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Health Behavior Health insurance coverage is an important predictor of whether individuals obtain health-promoting and life-extending health screenings.

Source: Employee Benefit Research Institute estimates from the 2005 Medical Expenditure Panel Survey.

Time Since Last Pap Smear, Female Adult Workers by Insurance Status, 2005

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Health Behavior Time Since Last Mammogram, Female Workers Ages 30-64,

by Insurance Status, 2005

.

Source: Employee Benefit Research Institute estimates from the 2005 Medical Expenditure Panel Survey

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Health Behavior

Source: Employee Benefit Research Institute estimates from the 2005 Medical Expenditure Panel Survey

Time Since Last Prostate Specific Antigen (PSA) Test, Male Workers Ages 39-64, by Insurance Status, 2005

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National Spending on Health Care

Health care spending in the United States has grown rapidly since the 1960s, at an average rate of 10 percent a year.

National Health Expenditures (NHE), Aggregate and Share of Gross Domestic Product (GDP), 1960-2017

Source: Employee Benefit Research Institute estimates from Centers for Medicare and Medicaid Services and U.S. Department of Commerce. (2006-2017 data are projected.)

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While health care spending has been increasing, the distribution of health care spending among different services has been changing.

Distribution of National Health Expenditures, by Type of Expenditure, 1960-2017

Source: Employee Benefit Research Institute estimates from Centers for Medicare & Medicaid

Services. (2006-2017 data are projected.)

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The share of private health care spending that health insurance covers has more than doubled since the 1960s.

Out-of-Pocket Spending as a Percent of Total Private Spending, 1960-2017

Source: Employee Benefit Research Institute estimates from Centers for Medicare & Medicaid

Services. (2006-2017 data are projected.)

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The cost of providing health care services has been increasing faster than the Gross Domestic Product (GDP) since 1998, but the gap between the two declined recently as the economy recovered from recession and health care costs grew more slowly.

Annual Growth Rates for Spending on Health Care Services and Gross Domestic Product (GDP), 1998-2006

Source: Bradley C. Strunk, Paul B. Ginsburg, and John P. Cookson. "Tracking Health Care Costs: Declining Growth Trend Pauses In 2004." Health Affairs Web Exclusive, June 21, 2005; and Ginsburg,

Paul B., Bradley C. Strunk, Michelle I. Banker, and John P. Cookson. "Tracking Health Care Costs: Continued Stability But At High Rates In 2005." Health Affairs Web Exclusive, Oct. 3, 2006.

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Recent spending on health care services has slowed for all categories of health care, but cost increases for hospital outpatient services and prescription drugs continue to outpace those for inpatient and physician services.

Annual Per Capita Percentage Change in Health Care Spending, by Category of Service, 2001-2006

Source: Bradley C. Strunk, Paul B. Ginsburg, and John P. Cookson. "Tracking Health Care Costs: Declining Growth Trend Pauses In 2004." Health Affairs Web Exclusive, June 21, 2005; and Ginsburg,

Paul B., Bradley C. Strunk, Michelle I. Banker, and John P. Cookson. "Tracking Health Care Costs: Continued Stability But At High Rates In 2005." Health Affairs Web Exclusive, Oct. 3, 2006.

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Health Insurance Premiums With a few exceptions, growth in health insurance premiums has been outpacing overall inflation and increases in workers earnings since the late 1980s.

Annual Growth Rates for Health Insurance Premiums, Workers Earnings, and Overall Inflation, 1988-2007

Source: Kaiser Family Foundation/Health Research and Educational Trust.

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Health Insurance Premiums Workers have been paying more per year for health benefits in the workplace, but they continue to pay the same share of total premiums.

Average Monthly Worker Premium Contribution, 1988-2007


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Health Insurance Premiums Workers have been paying more per year for health benefits in the workplace, but they continue to pay the same share of total premiums.

Percentage of Premium Paid by Covered Workers, 1988-2007


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Out-of-Pocket Spending on Health Care Services

Distribution of Deductibles for Employee-Only PPO Coverage, 2000-2007

Source: Kaiser Family Foundation/Health Research and Educational Trust. *Distribution is statistically different from distribution for the previous year shown at p<.05.

In recent years, individuals with health insurance coverage have experienced increases in out-of-pocket expenses for health care.

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Many workers are paying higher co-payments for physician visits in HMOs.

Percentage of Covered Workers Facing Various HMO Co-payment Amounts for Physician Office Visits, 1996-2007


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Co-payment levels for prescription drugs have increased, and employers have added a fourth tier to the common three-tier co-payment system.

Average Co-payments Per Prescription in Multi-Tier Arrangements, 2000-2007

Source: Kaiser Family Foundation/Health Research and Educational Trust. Note: Four-tier drugs: New types of cost-sharing arrangements that typically build additional layers of higher co-payments or coinsurance for specially identified types of drugs, such as lifestyle or injectable drugs.

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