Figure 1. Employers Provide Health Benefits to More than
160 Million Working Americans and Family Members
Numbers in millions, 2006
Military
3.4
(1%)
Uninsured
47.0
(16%)
Employer
163.3
(55%)
Individual
16.0
(5%)
Uninsured
46.4
(18%)
Military
3.4
(1%)
Employer
160.8
(62%)
Individual
15.8
(6%)
Medicaid
27.9
(9%)
Medicaid
27.9
(11%)
Medicare
39.1
(13%)
Total population = 296.7
Medicare
6.4
(2%)
Under-65 population = 260.7
Source: S. R. Collins, C. White, and J. L. Kriss, Whither Employer-Based Health Insurance? The Current and Future Role
of U.S. Companies in the Provision and Financing of Health Insurance (New York: The Commonwealth Fund, Sept. 2007).
Data: Current Population Survey, Mar. 2007.
Figure 2. Individual Market Insurance
Is Not an Affordable Option for Many People
Adults ages 19–64 with
individual coverage or who
thought about or tried to buy
it in past three years who:
Total
Health
problem
No
health
problem
<200%
poverty
200%+
poverty
34%
48%
24%
43%
29%
Found it very difficult or
impossible to find affordable
coverage
58
71
48
72
50
Were turned down or charged
a higher price because of a
pre-existing condition
21
33
12
26
18
Never bought a plan
89
92
86
93
86
Found it very difficult or
impossible to find coverage
they needed
Source: S. R. Collins, J. L. Kriss, K. Davis, M. M. Doty, and A. L. Holmgren, Squeezed: Why Rising Exposure to Health Care
Costs Threatens the Health and Financial Well-Being of American Families (New York: The Commonwealth Fund, Sept. 2006).
Figure 3. People with Employer Insurance Have More Stable
Coverage than Those with Individual Market Insurance
Retention of initial insurance over a two-year period, 1998–2000
Retained initial
insurance status
One or more spells
uninsured
Other transition
2%
12%
26%
53%
86%
21%
Employer
insurance
Individual
insurance
Source: K. Klein, S. A. Glied, and D. Ferry, Entrances and Exits: Health Insurance Churning, 1998–2000 (New York:
The Commonwealth Fund, Sept. 2005). Data: Authors’ analysis of the 1998–2000 Medical Expenditure Panel Survey.
Figure 4. Percent of Uninsured Children Declined
Since Implementation of SCHIP, But Gaps Remain
1999–2000
2005–2006
U.S. Average: 12.0%
U.S. Average: 11.3%
WA
VT
NH ME
NH
WA
ND
MT
VT
MT
MN
OR
ID
NY
WI
SD
MI
WY
PA
IA
NE
CA
OH
IN
NV
UT
IL
CO
MA
KS
MO
WV
VA
KY
NJ
RI
CT
MN
OR
ID
MI
PA
IA
NE
CA
IL
CO
KS
MO
AZ
NM
MS
TX
AL
NC
AZ
GA
NM
OK
LA
TX
GA
FL
AK
16% or more
10%–15.9%
AL
LA
FL
HI
SC
AR
MS
AK
VA
TN
SC
AR
WV
KY
TN
OK
OH
IN
NV
UT
MA
RI
NY
WI
SD
WY
DE
MD
DC
NC
ME
ND
HI
7%–9.9%
Less than 7%
Source: J. C. Cantor, C. Schoen, D. Belloff, S. K. H. How, and D. McCarthy, Aiming Higher: Results from
a State Scorecard on Health System Performance (New York: The Commonwealth Fund, June 2007).
Updated data: Two-year averages 1999–2000, updated with 2007 CPS correction, and 2005–2006 from
the Census Bureau’s March 2000, 2001 and 2006, 2007 Current Population Surveys.
NJ
CT
DE
MD
DC
Figure 5. Number of States with 23 Percent or More
Uninsured Nonelderly Adults Rose from 2 to 9 in Last Six Years
1999–2000
2005–2006
U.S. Average: 17.3%
U.S. Average: 20.1%
WA
VT
NH ME
NH
WA
ND
MT
VT
MT
MN
OR
ID
NY
WI
SD
MI
WY
PA
IA
NE
CA
OH
IN
NV
UT
IL
CO
MA
KS
MO
WV
VA
KY
NJ
RI
CT
MN
OR
ID
MI
PA
IA
NE
CA
IL
CO
KS
MO
AZ
NM
MS
TX
AL
NC
AZ
GA
NM
OK
LA
TX
GA
FL
AK
23% or more
19%–22.9%
AL
LA
FL
HI
SC
AR
MS
AK
VA
TN
SC
AR
WV
KY
TN
OK
OH
IN
NV
UT
MA
NY
WI
SD
WY
DE
MD
DC
NC
ME
ND
HI
14%–18.9%
Less than 14%
Source: J. C. Cantor, C. Schoen, D. Belloff, S. K. H. How, and D. McCarthy, Aiming Higher: Results from
a State Scorecard on Health System Performance (New York: The Commonwealth Fund, June 2007).
Updated data: Two-year averages 1999–2000, updated with 2007 CPS correction, and 2005–2006 from
the Census Bureau’s March 2000, 2001 and 2006, 2007 Current Population Surveys.
NJ
RI
CT
DE
MD
DC
Figure 6. The Majority of Uninsured Adults
Are in Working Families
Adults ages 19–64 with any time uninsured
Not
currently
employed
36%
Full-time
49%
No worker
in family
21%
At least one
full-time
worker
67%
Only
part-time
worker(s)
11%
Part-time
15%
Adult work status
Family work status
Note: Percentages may not sum to 100% because of rounding.
Source: S. R. Collins, K. Davis, M. M. Doty, J. L. Kriss, and A. L. Holmgren, Gaps in Health Insurance:
An All-American Problem (New York: The Commonwealth Fund, Apr. 2006).
Figure 7. Employer-Provided Health Insurance,
by Income Quintile, 2000–2006
Percent of population under age 65 with health benefits from employer
100%
90%
88%
88%
87%
80%
86%
85%
84%
70%
77%
77%
62%
60%
60%
50%
75%
57%
87%
84%
74%
87%
83%
74%
87%
82%
72%
86%
82%
Highest
Quintile
Fourth
72%
Third
55%
54%
54%
53%
40%
30%
29%
26%
25%
23%
23%
20%
22%
22%
10%
Second
Lowest
quintile
0%
2000
2001
2002
2003
2004
2005
2006
Source: E. Gould, The Erosion of Employment-Based Insurance: More Working Families Left Uninsured,
EPI Briefing Paper No. 203 (Washington, D.C.: Economic Policy Institute, Nov. 2007).
Figure 8. Uninsured Rates High Among Adults
with Low and Moderate Incomes, 2001–2005
Percent of adults ages 19–64
Insured now, time uninsured in past year
75
Uninsured now
49
50
16
25
28
24 26
9
9 9
52 53
15 16
28
33 37 37
15 17 18
0
2001 2003 2005
Total
35
Low
income
13
11
17
2001 2003 2005
11
41
24 28
2001 2003 2005
Moderate
income
13
7
6
16 18
9
9
7
9
4
3
4
2
7
3
2001 2003 2005
2001 2003 2005
Middle
income
High
income
Note: Income refers to annual income. In 2001 and 2003, low income is <$20,000, moderate income is $20,000–$34,999,
middle income is $35,000–$59,999, and high income is $60,000 or more. In 2005, low income is <$20,000, moderate income
is $20,000–$39,999, middle income is $40,000–$59,999, and high income is $60,000 or more.
Source: The Commonwealth Fund Health Insurance Surveys (2001, 2003, and 2005).
Figure 9. Workers Who Are Offered, Eligible for, and Participate
in Their Employer’s Health Plan, by Firm Size and Hourly Wage
Percent of working adults^ ages 19–64
100
Employer offers a plan
Eligible for employer plan
Covered through own employer
75
50
51
42
50
98
89
95
83
75
57
45
34
25
21
0
Less than $15/hr
More than $20/hr
Small employer
(fewer than 50 employees)
Less than $15/hr
More than $20/hr
Medium to large employer
(50 or more employees)
^ Includes both part-time and full-time workers.
Source: S. R. Collins, C. Schoen, D. Colasanto, and D. A. Downey, On the Edge: Low-Wage Workers
and Their Health Insurance Coverage (New York: The Commonwealth Fund, Apr. 2003).
Updated data from The Commonwealth Fund Biennial Health Insurance Survey (2005).
Figure 10. Percent Uninsured Workers
by Firm Size and Hourly Wage
Percent of working adults^ ages 19–64 who are uninsured
75
50
39
25
15
17
1
0
Less than $15/hr
More than $20/hr
Small employer
(fewer than 50 employees)
Less than $15/hr
More than $20/hr
Medium to large employer
(50 or more employees)
^ Includes both part-time and full-time workers.
Source: S. R. Collins, C. Schoen, D. Colasanto, and D. A. Downey, On the Edge: Low-Wage Workers
and Their Health Insurance Coverage (New York: The Commonwealth Fund, Apr. 2003).
Updated data from The Commonwealth Fund Biennial Health Insurance Survey (2005).
Figure 11. Nonstandard Workers Are Less Likely to Have
Health Insurance Coverage Through Their Own Job, 2001
100%
80%
12%
3%
11%
60%
40%
74%
Uninsured
1%
24%
5%
10%
39%
20%
21%
0%
Standard
All nonstandard
workers
workers
Medicare/Medicaid/
other government source
Other source of health
insurance
Spouse/family member plan
Own employer's health
insurance
Notes: Self-employed independent contractors are excluded from analysis. “Other source of health insurance” includes insurance
from the individual market, from another job, from a previous job, or from an association, school, or other unidentified source.
Source: E. Ditsler, P. Fisher, and C. Gordon, On the Fringe: The Substandard Benefits of Workers in Part-Time, Temporary, and
Contract Jobs (New York: The Commonwealth Fund, Dec. 2005).
Data: Authors’ analysis of the 2001 Contingent Work Supplement to the Current Population Survey.
Figure 12. Distribution of Uninsured Young Adults Ages 19–29,
by Poverty Status and Race/Ethnicity, 2005
Other
7%
200% FPL
or more
28%
Less than
100% FPL
41%
100%–
199% FPL
31%
Hispanic
32%
White
46%
African
American
15%
Uninsured young adults = 13.3 million
Source: S. R. Collins, C. Schoen, J. L. Kriss, M. M. Doty, and B. Mahato, Rite of Passage? Why Young Adults
Become Uninsured and How New Policies Can Help (New York: The Commonwealth Fund, updated Aug. 8, 2007).
Data: Analysis of the March 2006 Current Population Survey by S. Glied and B. Mahato for The Commonwealth Fund.
Figure 13. Percent Uninsured, Children and Young Adults,
by Poverty Level, 2005
Percent
Uninsured
Children
Age 18 and Under
Young Adults
Ages 19–29
Total
11%
30%
<100% FPL
20
51
100%–199% FPL
16
42
7
16
>200% FPL
Source: S. R. Collins, C. Schoen, J. L. Kriss, M. M. Doty, and B. Mahato, Rite of Passage? Why Young Adults
Become Uninsured and How New Policies Can Help (New York: The Commonwealth Fund, updated Aug. 8, 2007).
Data: Analysis of the March 2006 Current Population Survey by S. Glied and B. Mahato for The Commonwealth Fund.
Figure 14. Uninsured Rates Are High
Among Hispanics and African Americans, 2005
Percent of adults ages 19–64
75
Insured now, time uninsured in past year
Uninsured now
14
50
28
25
62
9
33
20
8
18
13
Total
White
0
13
48
19
African
Hispanic
American
Note: Because of rounding, totals above stacked bars may not reflect the sum of each insurance category.
Source: M. M. Doty and A. L. Holmgren, Health Care Disconnect: Gaps in Coverage and Care for Minority Adults
(New York: The Commonwealth Fund, Aug. 2006).
Figure 15. More Than Half of Unemployed Adults
Are Uninsured
Percent uninsured, 2005
100
80
52
60
40
20
18
15
All nonelderly adults
Employed nonelderly
Unemployed
adults
nonelderly adults
0
Source: J.L. Lambrew, How the Slowing U.S. Economy Threatens Employer-Based Health Insurance
(New York: The Commonwealth Fund, Nov. 2001).
Updated with data from the Commonwealth Fund Biennial Health Insurance Survey (2005).
Figure 16. Lower Income Workers Are Least Likely
to Be Eligible for COBRA*
Other insurance
20%
Uninsured
6%
COBRAeligible
40%
Other insurance
8%
ESI**
small firm
11%
COBRA-eligible
75%
Uninsured
32%
ESI** small firm
8%
Below 200% poverty
200% poverty or more
* The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) requires employers with 20 or more employees
to offer continuation of health insurance coverage to former employees. ** Employer-sponsored insurance coverage.
Source: L. Duchon, C. Schoen, M. M. Doty, K. Davis, E. Strumpf, and S. Bruegman, Security Matters: How Instability
in Health Insurance Puts U.S. Workers at Risk (New York: The Commonwealth Fund, Dec. 2001).
Figure 17. People with Disabilities in the Waiting Period
for Medicare in 2007, by Source of Coverage
Uninsured
264,504
(15%)
Non-Group
150,121
(9%)
Employer
567,501
(33%)
Medicaid
644,520
(37%)
CHAMPUS
106,697
(6%)
Total people currently in waiting period = 1,733,343
Note: Number of people in the waiting period was estimated using the number of SSDI awards to disabled workers, widowers,
and adult children in 2004 and 2005 from the Social Security Administration Annual Statistical Supplement (2005 and 2006).
Source: S. R. Collins, K. Davis, and J. L. Kriss, An Analysis of Leading Congressional Health Care Bills, 2005-2007:
Part I, Insurance Coverage (New York: The Commonwealth Fund, Mar. 2007).
Figure 18. Nearly One-Quarter of Medicare Beneficiaries
Were Uninsured Just Before Enrolling
Percent of Medicare beneficiaries ages 50–70
75
50
25
41
24
38
18
11
0
All on
Medicare
Ages 65–70
Ages 50–64,
Less than
200% poverty
disabled
200% poverty
or more
Source: S. R. Collins, K. Davis, C. Schoen, M. M. Doty, S. K. H. How, and A. L. Holmgren, Will You Still Need Me? The
Health and Financial Security of Older Americans (New York: The Commonwealth Fund, June 2005).
Data from the Commonwealth Fund Survey of Older Adults, 2004.
Figure 19. Lacking Health Insurance for Any Period
Threatens Access to Care
Percent of adults ages 19–64 reporting the following problems
in past year because of cost:
Insured all year
Insured now, time uninsured in past year
Uninsured now
75
60 59
50
25
39
43
18
33
36 39
37
10
44
13
49
28
15
0
Did not fill a
Did not see
Skipped
Had medical
Any of the four
prescription
specialist when
medical test,
problem, did
access
needed
treatment, or
not see doctor
problems
follow-up
or clinic
Source: S. R. Collins, K. Davis, M. M. Doty, J. L. Kriss, and A. L. Holmgren, Gaps in Health Insurance:
An All-American Problem (New York: The Commonwealth Fund, Apr. 2006).
Figure 20. Adults Without Insurance Are Less Likely
to Be Able to Manage Chronic Conditions
Percent of adults ages 19–64 with at least one chronic condition*
Insured all year
Insured now, time uninsured in past year
Uninsured now
75
58
59
50
27
25
18
35
16
0
Skipped doses or did not fill
Visited ER, hospital, or both for chronic
prescription for chronic condition
condition
because of cost
* Hypertension, high blood pressure, or stroke; heart attack or heart disease; diabetes; asthma, emphysema, or lung disease.
Source: S. R. Collins, K. Davis, M. M. Doty, J. L. Kriss, and A. L. Holmgren, Gaps in Health Insurance:
An All-American Problem (New York: The Commonwealth Fund, Apr. 2006).
Figure 21. Many Americans Have Problems Paying Medical Bills
or Are Paying Off Medical Debt
Percent of adults ages 19–64 who had the following problems in past year:
Uninsured during the year
Insured all year
Total
75
53
50
25
42
23
26
26
16
13
8
14
29
21 18
34
26
9
0
Not able to pay
Contacted by
medical bills
collection
agency*
Had to change
Medical bills/
way of life to pay debt being paid
medical bills
off over time
* Includes only those who had a bill sent to a collection agency when they were unable to pay it.
Source: S. R. Collins, K. Davis, M. M. Doty, J. L. Kriss, and A. L. Holmgren, Gaps in Health Insurance:
An All-American Problem (New York: The Commonwealth Fund, Apr. 2006).
Any medical bill
problem or
outstanding debt
Figure 22. One-Quarter of Adults with Medical Bill Burdens
and Debt Were Unable to Pay for Basic Necessities
Percent of adults ages 19–64 with medical bill problems
or accrued medical debt:
Percent of adults
reporting:
Total
Insured
all year
Insured now,
time uninsured
during year
Uninsured
now
19%
28%
40%
Unable to pay for basic
necessities (food, heat
or rent) because of
medical bills
26%
Used up all of savings
39
33
42
49
Took out a mortgage
against your home or
took out a loan
11
10
12
11
Took on credit card
debt
26
27
31
23
Source: S. R. Collins, K. Davis, M. M. Doty, J. L. Kriss, and A. L. Holmgren, Gaps in Health Insurance:
An All-American Problem (New York: The Commonwealth Fund, Apr. 2006).