The Challenge of Covering the
Low-Income Population
Diane Rowland, Sc.D.
Executive Director
The Kaiser Commission on Medicaid and the Uninsured
for
National Health Policy Conference
Critical Issues for a New Administration
Washington, DC
February 1, 2001
K A I S E R
C O M M I S S I O N
O N
Medicaid and the Uninsured
Figure 1
Health Insurance Coverage
by Poverty Level, 1999
100%
7%
9%
10%
6%
8%
16%
Other*
75%
45%
65%
37%
Employer
71%
50%
Medicaid
86%
Uninsured
16%
25%
10%
39%
29%
18%
0%
U.S. Total
Poor (<100%
FPL)
Near Poor
(100-199%
FPL)
5%
1%
16%
7%
Moderate
(200-299%
FPL)
High (300%+
FPL)
*Other includes individually-purchased private insurance and other public coverage.
Note: The federal poverty level for a family of three in 1999 was $13,290.
SOURCE: Urban Institute and Kaiser Commission on Medicaid and the Uninsured,
analysis of March 2000 Current Population Survey, 2000.
K A I S E R
C O M M I S S I O N
O N
Medicaid and the Uninsured
Figure 2
Characteristics of the Uninsured
Age
Children
Under 19
26%
Income
Adults
19-34
37%
Adults
55-64
8%
Work Status
2 or More
Full-Time
Workers
16%
300% FPL
and Above
20%
<100% FPL
36%
1 Full-Time
Worker
55%
200-299%
FPL
15%
Adults
35-54
29%
Part-Time
Workers
12%
No Workers
18%
100-199% FPL
29%
Total = 42 million Uninsured
SOURCE: Urban Institute and Kaiser Commission on Medicaid and the
Uninsured, analysis of March 2000 Current Population Survey, 2000.
K A I S E R
C O M M I S S I O N
O N
Medicaid and the Uninsured
Figure 3
Access to Employer-Based Coverage for
Low and High Wage Workers, 1996
Covered by
Employer
42%
Declined
Access
55%
Not Offered
90%
13%
Access
96%
45%
6%
Low-Wage Workers
(Wage ≤ $7 per hour)
4%
High-Wage Workers
(Wage > $15 per hour)
Note: Annualized wage income at < $7/hour would be ≤ $12,740 and
at >$15/hour would be > $27,300.
SOURCE: Cooper P, and Schone B, 1997.
K A I S E R
C O M M I S S I O N
O N
Medicaid and the Uninsured
Figure 4
Average Annual Premium Costs for
Covered Workers, 2000
$6,348
$2,424
$1,656
$336
Single Coverage
Worker Contribution
Family Coverage
Employer Contribution
SOURCE: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2000.
K A I S E R
C O M M I S S I O N
O N
Medicaid and the Uninsured
Figure 5
Health Insurance Coverage
of Adults and Children, 1999
Medicaid
Poor
CHILDREN
53%
(<100 Poverty)
Near-Poor
26%
(100-199% Poverty)
Poor
WOMEN
Near-Poor
Poor
(<100 Poverty)
MEN
Near-Poor
(100-199% Poverty)
28%
20%
31%
(<100 Poverty)
(100-199% Poverty)
Uninsured
12%
42%
30%
18%
8%
52%
38%
Note: Adults age 19-64. Federal Poverty Level was $13,290
for a family of three in 1999.
SOURCE: Urban Institute and Kaiser Commission on Medicaid
and the Uninsured, analysis of March 2000 Current Population Survey, 2000.
K A I S E R
C O M M I S S I O N
O N
Medicaid and the Uninsured
Figure 6
Medicaid Income Eligibility Standards, 2001
Percent of Federal Poverty Level
200%
250%
185%
133%
Federal
Mandate
State
Option
133%
100%
100%
National AFDC
Average*
100%
73%
41%
Phase-in by
2002
41%
0%
0%
Pregnant
Women/
Infants
18
SSI/
Preschool School-age
year-olds
Disabled
1 to 5
6 to 17
*AFDC average for 1996 is the standard used for Section 1931 eligibility.
Note: Some states have increased eligibility through Sec. 1115 or Sec. 1902(r)(2)
or SCHIP. Federal Poverty Level is $14,150 for a family of three for 2000.
Nonelderly
Adults
Adults
with
without
Children
Children
K A I S E R
C O M M I S S I O N
O N
Medicaid and the Uninsured
Figure 7
Medicaid/CHIP Income Eligibility Levels for
Children, 2000
NH
VT
WA
MT
ND
MN
OR
ID
WI
RI
MI
WY
NE
OH
IN
IL
NV
CO
CT
NJ
PA
IA
CA
DE
WV
VA
KS
MD
KY
MO
NC
DC
TN
OK
AZ
NM
SC
AR
MS
TX
AK
MA
NY
SD
UT
ME
AL
GA
LA
FL
HI
Medicaid/CHIP Income Levels
< 150% FPL (8 states)
151% - 199% FPL (7 states)
> 200% FPL (36 states)
NOTE: The Federal Poverty Level (FPL) is $14,150
for a family of three in 2000.
SOURCE: Center on Budget and Policy Priorities, 2000.
K A I S E R
C O M M I S S I O N
O N
Medicaid and the Uninsured
Figure 8
Health Coverage of Low-Income Children,
1998
Not Eligible
4%
CHIP
7%
Eligible for
CHIP
27%
Private
28%
Uninsured
16%
Medicaid
49%
Total = 31.3 million
NOTE: Low-income refers to families with incomes less than 200% of the Federal
Poverty Level.
SOURCE: Urban Institute simulations, 2000. Based on the March 1997 Current
Population Survey, projected to 1998.
Eligible for
Medicaid
69%
5.2 million
uninsured
K A I S E R
C O M M I S S I O N
O N
Medicaid and the Uninsured
Figure 9
Medicaid Income Eligibility Levels for
Parents, 2000
NH
VT
WA
MT
ND
MN
OR
ID
WI
RI
MI
WY
NE
OH
IN
IL
NV
CO
CT*
NJ*
PA
IA
CA
MA
NY*
SD
UT
ME
DE
WV
VA
KS
KY
MO
NC
TN
OK
AZ
NM
DC
SC
AR
MS
TX
MD
AL
GA
LA
AK
FL
HI
Medicaid Income Eligibility Levels
(US Median = 67% FPL)
< 50% FPL (14 states)
50% - 99% FPL (19 states)
*Connecticut, New Jersey, and New York have enacted but have not yet
implemented their Medicaid expansion for parents.
SOURCE: Center on Budget and Policy Priorities and Families USA, 2000.
> 100% FPL (18 states)
K A I S E R
C O M M I S S I O N
O N
Medicaid and the Uninsured
Figure 10
Health Coverage of Low-Income
Parents, 1998
Private
42%
Uninsured
29%
Medicaid
29%
Total = 20.1 million
NOTE: Low-income refers to families with incomes less than 200% of the Federal
Poverty Level.
SOURCE: Urban Institute simulations, 2000. Based on the March 1997 Current
Population Survey, projected to 1998.
Not Eligible
for Medicaid
76%
Eligible for
Medicaid
24%
5.9 million
uninsured
K A I S E R
C O M M I S S I O N
O N
Medicaid and the Uninsured
Figure 11
Uninsured Rates Among the Nonelderly
Low-Income Population by State, 1997-1999
National Average = 34%
Note: Low-income defined as < 200% of poverty level,
or $26,580 for a family of three in 1999.
SOURCE: Urban Institute and Kaiser Commission on Medicaid
and the Uninsured, analysis of 3 year-pooled data from March
1998, 1999, and 2000 Current Population Survey, 2000.
<26% (12 states)
33-36% (11 states)
26-32% (13 states & DC)
>36% (14 states)
K A I S E R
C O M M I S S I O N
O N
Medicaid and the Uninsured
Figure 12
The Uninsured Population, 1999
Other Children
7%
Low-Income*
Children
18%
Other Adults
28%
Low-Income*
Adults with
Children
22%
Low-Income*
Adults without
Children
25%
Total = 42 million
Low-income defined as < 200% of poverty level,
or $26,580 for a family of three in 1999.
SOURCE: Urban Institute and Kaiser Commission on Medicaid
and the Uninsured, analysis of March 2000 Current Population Survey, 2000.
K A I S E R
C O M M I S S I O N
O N
Medicaid and the Uninsured
Figure 13
The Impact of Being Uninsured
Percent reporting:
39%
Postponed
Care Due to Cost
10%
36%
No Regular
Source of Care
9%
30%
Did Not Fill Prescription
Due to Cost
Did Not Get Medical Care
for a Serious Condition
Contacted by a Collection
Agency About Medical Bills
12%
Uninsured
Insured
20%
3%
27%
7%
Medical Bills Had Major
Impact on Life
NOTE: Among adults under age 65.
SOURCE: NewsHour with Jim Lehrer/Kaiser Family Foundation
National Survey on the Uninsured, March 2000.
39%
27%
K A I S E R
C O M M I S S I O N
O N
Medicaid and the Uninsured
Figure 14
Public Support for Strategies to
Expand Health Insurance Coverage
Percent choosing as single best option:
Expand state government
programs for low-income people
21%
Mandate businesses to offer
coverage for employees
21%
Offer tax credits or other financial
assistance to help people
purchase private coverage
Expand Medicare to uninsured
people under age 65
20%
14%
Use taxes to finance a single,
national government health plan
for all Americans
SOURCE: NewsHour with Jim Lehrer/Kaiser Family
Foundation National Survey on the Uninsured, March 2000.
21%
K A I S E R
C O M M I S S I O N
O N
Medicaid and the Uninsured
K A I S E R
C O M M I S S I O N
O N
Medicaid and the Uninsured