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October 2006
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Over 46 million Americans were without health insurance in 2005. The number
of uninsured under age 65 grew by 1.3 million from 2004 to 2005, continuing an
upward trend from 2000. While the number of uninsured Americans has been
increasing, who they are has remained constant. Two-thirds of the uninsured
are low-income, and eight in ten come from working families. Many uninsured
work for firms that do not offer insurance, and those who are offered insurance
often find their share of the premiums unaffordable. Young adults, racial and
ethnic minorities, and those who are non-citizens are more likely to be uninsured;
however, most of the uninsured are adults over the age of 30, white, and
American citizens.
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James R. Tallon
Chairman
James
R. R.
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James
Tallon
Chairman
Chairman
Diane Rowland, Sc.D.
Executive Director
Diane
Rowland,
Sc.D.
Diane
Rowland,
Sc.D.
Executive
Director
Executive
Director
The Uninsured: A Primer
Key Facts About
Americans Without Health Insurance
Over 46 million Americans under the age of 65 lacked health insurance coverage in
2005, an increase of 1.3 million from the year before and an
increase of over seven million since 2000.
Fundamental facts useful to understanding this many-faceted problem are framed in this primer under these
nine questions:
How do most Americans obtain health insurance?...........................................................................1
Most under the age of 65 obtain health coverage as an employer benefit. While Medicare covers all of the
elderly, the nonelderly who do not have access to or cannot afford private insurance go without health
coverage unless they qualify for the Medicaid program, SCHIP, or other state-subsidized insurance
programs.
Who are the uninsured?.............................................................................................................3
While the number of uninsured has been growing, who the uninsured are and the social and economic
factors that place a person at risk of being uninsured have not changed substantially over time. The
uninsured are largely low-income adults in working families, for whom coverage is either unavailable or
unaffordable.
How does lack of insurance affect access to health care services?...........................................6
Health insurance makes a difference in whether and when people get necessary medical care, where
they get their care, and ultimately, how healthy people are. The consequences of reduced access to
care can be serious, particularly when preventable conditions go undetected.
How do the uninsured pay for medical care?.............................................................................8
For many of the uninsured, the costs of health insurance and medical care are weighed against equally
essential needs. Medical bills can mount quickly for the uninsured, even for relatively minor problems
like dental care, and the financial impact, particularly on a low-income family, can be severe.
1
How is uncompensated care financed?....................................................................................10
Federal and state governments fund the vast majority of uncompensated care. That money is vital to
the public hospitals and clinics that provide the bulk of such care, but funding levels have not kept pace
with the rising number of uninsured and increasing medical costs.
How and why has the number of uninsured changed recently?...............................................12
Changes in the overall economy and its impact on employment and family incomes, the rapid growth in
health care costs and insurance premiums, and the ability of Medicaid and other public safety net
programs to cover more of the uninsured, largely explain the trends in health coverage over the past
decade.
Why doesn’t employer-sponsored insurance cover more Americans?.....................................15
Employer-sponsored health insurance is voluntary for employers and employees. Thirty-seven million
people from working families were uninsured in 2005 because not all businesses offer health benefits,
not all workers qualify for coverage, and many employees cannot afford their share of the health
premium.
What is Medicaid’s role?...........................................................................................................19
Medicaid is this country’s public health insurance program for low-income Americans, providing
coverage based not only on a person’s or family’s income, but also on whether they fit into specific
eligibility categories. Medicaid covers some of these basic groups of nonelderly, low-income people:
children, their parents, pregnant women, and people with disabilities.
What can be done to decrease the number of uninsured?.......................................................23
The majority of the general public believes decreasing the number of uninsured is an important policy
priority, but there is little agreement on how to achieve this goal. Building on the nation’s mixed system
of public and private insurance, the strategies being discussed vary not only by the means of insuring
more Americans, but also by who is to be included in the reform. In the absence of national reform,
more governors and state legislators are seeking solutions to help address the problem in their own
state.
Tables..…………………………………………………...………………………...………………………..27
Data Notes…….….……………………………………………………………………………….………...38
2
00
How Do Most Americans Obtain Health Insurance?
Most Americans under the age of 65 receive health insurance coverage as an employer benefit—61% in
2005. While Medicare covers virtually all those who are 65 years or older, the nonelderly who do not have
access to or cannot afford private insurance go without health coverage unless they qualify for the Medicaid
program, the State Children’s Health Insurance Program (SCHIP), or other state-subsidized insurance
programs. The gaps in our private and public health insurance systems left 46.1 million nonelderly
Americans—18% of those under age 65—without health coverage in 2005 (Figure 1).
Figure 1
Health Insurance Coverage of
the Nonelderly Population, 2005
Uninsured
18%
Medicaid/Other Public*
16%
EmployerSponsored
61%
Private Non Group
5%
Total = 257.4 million
* Medicaid/Other Public includes Medicaid, SCHIP, other state programs, Medicare and military-related coverage.
SOURCE: KCMU/Urban Institute analysis of March 2006 CPS.
Private Health Insurance Coverage
�
Many, but not all, employers offer group health insurance policies to their employees as a
benefit and also often extend coverage to their employees' families. About half of Americans
insured through employer-sponsored health plans are covered by their own employer (51%) and half
are covered as an employee’s dependent (49%). Health insurance offer rates vary among businesses,
with large firms and those with more high-wage workers more likely to offer coverage.1
�
Employer-sponsored health insurance is voluntary; businesses are not legally required to offer
health benefits, and employees can choose not to participate. In 2006, 61% of firms offered health
benefits to at least some of their employees, down from 69% in 2000.2 Even when businesses offer
health benefits, some employees are ineligible because they are part-time employees or recent hires
and some do not sign up because of the required employee share of the premium.
�
Private policies directly purchased in the non-group market (i.e., outside of employersponsored benefits) cover only 5% of nonelderly Americans. Private, non-group insurance
premiums are based on individual health risk and are substantially more expensive than group plans
purchased by employers, with costs varying by age and health status. The share of the nonelderly with
private non-group insurance has changed very little over time. Obtaining coverage in the individual
3
1
market can be difficult—in 2005, nearly three in five adults who sought coverage had difficulty finding a
plan they could afford, and one in five were denied coverage, charged a higher price, or had a specific
health condition excluded from coverage.3
�
Private health insurance coverage is subsidized through the federal tax system in several ways.
The most common form of private insurance subsidy is the employee tax exclusion of the health
insurance premiums paid by employers. Those who are self-employed are now allowed to deduct all of
the costs of their insurance premiums from their taxes. In addition, people with unusually high health
care expenses (exceeding 7.5% of their adjusted gross income) can deduct the costs, including
premiums, on their tax returns. Tax advantages are also available for health savings accounts (HSAs)
and flexible spending accounts.
Public Health Insurance Coverage
�
The Medicaid program provides coverage to some, but not all, of the low-income and disabled
uninsured. Covering 13% of the nonelderly, Medicaid is larger than any single private health insurer.
It provides health coverage based on both income and categories of eligibility, primarily covering four
main groups of nonelderly, low-income people: children, their parents, pregnant women, and
individuals with disabilities. Although Medicaid covers over 40% of the poor, the categorical nature of
the program means that 37% of those below the poverty level remain uninsured (Figure 2).
Figure 2
Health Insurance Coverage
by Poverty Level, 2005
Employer/Other Private
Medicaid/Other Public
100%
75%
50%
37%
18%
7%
4%
11%
26%
43%
25%
0%
30%
Uninsured
71%
89%
45%
20%
<100% FPL
100-199% FPL 200-299% FPL
300% + FPL
The federal poverty level was $19,971 for a family of four in 2005. Data may not total 100% due to rounding.
SOURCE: KCMU/Urban Institute analysis of March 2006 CPS.
�
Medicaid and the State Children’s Health Insurance Program (SCHIP) cover one quarter of all
children and half of low-income children. Medicaid is the largest source of health insurance for
children in the U.S., covering 28 million children. SCHIP supplements Medicaid by covering six million
children who are low-income but whose family incomes are too high to qualify for Medicaid.4
�
Medicaid covers one in five people with severe disabilities. Medicaid provides health and longterm care coverage for eight million nonelderly people with disabilities, including over one million
disabled children. Its role is more prominent for people with certain conditions, such as HIV/AIDS.
However, eligibility for Medicaid for people with disabilities in most states is limited to those with
incomes below the federal poverty level.
4
2
00
00
Who Are the Uninsured?
In 2005, 46.1 million Americans under the age of 65 lacked health insurance. While the number of
uninsured Americans has been growing, who the uninsured are and the social and economic factors that
place a person at risk of being uninsured, have not changed substantially over time. The uninsured are
largely low-income adult workers for whom coverage is either unavailable or unaffordable.
�
In 2005, over eight in ten uninsured came from working families—almost 70% from families with
one or more full-time workers and 11% from families with part-time workers. Only 19% of the
uninsured are from families that have no connection to the workforce (Figure 3). Even at lower income
levels, the majority of the uninsured have workers in their family. Fifty-three percent of the uninsured
who are poor have at least one worker in the family. (Poor is defined as an income less than 100% of
the federal poverty level – $19,971 for a family of four in 2005).
�
Because of the high cost of health insurance, the poor and near-poor have the greatest risk of
being uninsured. The uninsured rate among the nonelderly poor is twice as high as the national
average (36% vs.18%). Were it not for the Medicaid program, many more of the poor would be
uninsured. The near-poor (those with incomes between 100% and 199% of poverty) also run a high
risk of being uninsured (30%), in part, because they are less likely to be eligible for Medicaid. Twothirds of the uninsured are either poor or near-poor.
�
Adults are more likely to be uninsured than children. Adults make up about 70% of the nonelderly
population, but 80% of the uninsured (Figure 3). Most low-income children qualify for Medicaid or
SCHIP, but low-income adults under age 65 qualify for Medicaid only if they are disabled, pregnant, or
have dependent children. Income eligibility levels are generally much lower for parents than for
children.
Figure 3
Characteristics of the Uninsured, 2005
Family Work Status
Part-Time
Workers
11%
Family Income
200% FPL
and Above
35%
No
Workers
19%
Age
0-18
20%
55-64
9%
<100% FPL
36%
35-54
32%
1 or More FullTime Workers
69%
100-199% FPL
29%
19-34
40%
Total = 46.1 million uninsured
The federal poverty level was $19,971 for a family of four in 2005. Data may not total 100% due to rounding.
SOURCE: KCMU/Urban Institute analysis of March 2006 CPS.
5
3
�
More than 60% of non-elderly uninsured adults did not attend college, making them less able to
get higher-skilled jobs that more typically provide health coverage. Those with less education are
also more likely to be uninsured for longer periods of time.
�
Minorities are much more likely to be uninsured than white Americans. About one third of
Hispanics and Native Americans are uninsured compared to 13% of whites. The uninsured rates
among African Americans (21%) and Asian Americans (19%) are also much higher than that of whites.
These differences are only partly explained by income disparities—insurance disparities exist at both
lower and higher income levels (Figure 4).
Figure 4
Uninsured Rates Among Racial/Ethnic
and Income Groups, 2005
Poverty Level
< 200% FPL
White, Non-Hispanic
29%
Black, Non-Hispanic
29%
Hispanic
44%
Asian1
37%
American Indian2
White, Non-Hispanic
Black, Non-Hispanic
200% + FPL
44%
8%
12%
21%
Hispanic
Asian1
American Indian2
11%
16%
1Asian group includes Pacific Islanders. 2American Indian group includes Aleutian Eskimos. 200% of the
poverty level was $39,942 for a family of four in 2005.
SOURCE: KCMU/Urban Institute analysis of March 2006 CPS.
�
The large majority of the uninsured (80%) are native or naturalized U.S. citizens. Non-citizens
have high uninsured rates (roughly 40% to 50%) compared to citizens due to their employment in lowwage jobs that are less likely to offer health coverage and restrictions on their eligibility for public
coverage (Figure 5). However, studies show that new immigrants are not primarily responsible for the
growth in the overall uninsured population, mainly because they comprise a small share of the total
U.S. population.5
6
4
00
00
Figure 5
Nonelderly Uninsured by Citizenship, 2005
Uninsured Rates
Native and
Naturalized
Citizens
Non-Citizens,
Residents
5+ Yrs.
Non-Citizens,
Residents
<5 Yrs.
National Rate = 18%
Non-Citizens,
Residents <5 Yrs.
6%
Non-Citizens,
Residents 5+ Yrs.
15%
16%
44%
51%
Native and Naturalized
Citizens
80%
Total = 46.1 million uninsured
SOURCE: KCMU/Urban Institute analysis of March 2006 CPS. Data may not total 100% due to rounding.
�
The uninsured tend to be in worse health than the privately insured. Ten percent of the uninsured
are in fair or poor health, compared to 5% of those with private coverage. Almost half of all uninsured
nonelderly adults have a chronic condition.6 Those with such conditions and others who are not in good
health may find non-group coverage to be unavailable or unaffordable if they do not have job-based
coverage.
�
The majority of uninsured adults (59%) have gone without coverage for a period of at least two
years.7 Because health insurance is primarily obtained as an employment benefit, health coverage
can be disrupted when people change jobs. This, as well as other changes in income and family
composition, can cause temporary gaps in health insurance.
7
5
How Does Lack of Insurance Affect Access to Health Care Services?
Health insurance makes a difference in whether and when people get necessary medical care, where they
get their care, and ultimately, how healthy people are. Uninsured adults are far more likely than the insured
to postpone or forgo health care altogether and less able to afford prescription drugs or follow through with
recommended treatments. The consequences of reduced access to care can be severe, particularly when
preventable conditions go undetected.
�
The uninsured are up to three times more likely than those with insurance to report problems
getting needed medical care, even for serious conditions. Part of the reason many of the
uninsured postpone or forgo needed care is because over 40% do not have a regular place to go when
they are sick or need medical advice, compared to just 9% of those with coverage (Figure 6). About
20% of the uninsured (compared to 3% of those with coverage) say their usual source of care is an
emergency room.8
�
Anticipating high medical bills, many of the uninsured are not able to follow recommended
treatment. Over a third of uninsured adults say they did not fill a drug prescription in the past year and
over a third went without a recommended medical test or treatment due to cost.9 Insured nonelderly
adults are at least 50% more likely to have had preventive care such as pap smears, mammograms,
and prostate exams compared to uninsured adults.10
Figure 6
Barriers to Health Care by Insurance
Status, 2003
Percent experiencing in past 12 months:*
No Regular Source of Care
42%
9%
47%
Postponed Seeking Care
because of Cost
Needed Care but Did Not Get It
Did Not Fill a Prescription
because of Cost
15%
Uninsured
Insured
35%
9%
37%
13%
* Experienced by the respondent or a member of their family.
Insured includes those covered by public or private health insurance.
SOURCE: Kaiser Family Foundation, Kaiser 2003 Health Insurance Survey.
�
Problems getting needed care also exist for uninsured children, who are generally healthy and
for whom access to care is a solid investment. Uninsured children are much more likely to lack a
usual source of care, to delay care, or to have unmet medical needs than children with insurance.
Uninsured children with common childhood illnesses and injuries often do not receive the same level of
care. As a result, they are at higher risk for preventable hospitalizations and for missed diagnoses of
serious health conditions (Figure 7).11
8
6
00
00
Figure 7
Children’s Access to Care,
by Health Insurance Status, 2004
Private
Medicaid/Public
Uninsured
36%
25%
21%
17%
11%
2%
4%
No Usual
Place of
Care
2% 3%
Delayed
Care due to
Cost
1% 2%
Unmet
Medical
Need
17%
14%
2%
4%
Last MD *
Visit >2
Years Ago
12%
8%
4%
Unmet
Last Dental
Dental Need
Visit >2
Years Ago
* MD or any health care professional, including time spent in a hospital. All estimates are age-adjusted.
SOURCE: National Center for Health Statistics, CDC. 2006. Summary of Health Statistics for U.S. Children:
National Health Interview Survey, 2004.
�
Lack of health coverage, even for short periods of time, results in decreased access to care.
Those who have been uninsured for less than six months are already less likely than those with
continuous health coverage to have a usual source of care and more likely to report having an unmet
need for medical care or a prescription drug in the past year. As the period without coverage
lengthens, more of the uninsured face these kinds of access problems.12
�
Access to health care improves after an uninsured person obtains health insurance; similarly,
losing coverage, whether it is private insurance or Medicaid, substantially decreases access to
care. For example, people who have lost Medicaid coverage are two to three times more likely than
Medicaid beneficiaries to report going without medical care because it is too expensive and they are
worried about medical bills.13
�
Because the uninsured are less likely than the insured to have regular outpatient care, they are
more likely to be hospitalized for avoidable health problems. When they are hospitalized, they are
more likely to receive fewer services and to die in the hospital than are insured patients.14
�
The uninsured are also less likely to receive timely preventive care. For example, people with
insurance are significantly more likely to have had recent mammograms and colon and cervical cancer
screenings. Consequently, uninsured cancer patients are diagnosed in later stages of the disease and
die earlier than those with insurance.
�
Having insurance improves health overall and could reduce mortality rates for the uninsured by
10-15%. It has been estimated that the number of excess deaths among uninsured adults age 25-64 is
in the range of 18,000 a year.15
9
7
How Do the Uninsured Pay for Medical Care?
For many of the uninsured, the costs of health insurance and medical care are weighed against equally
essential needs. The uninsured are twice as likely as those with health coverage to live in a household that
is having difficulty paying monthly expenses as basic as rent, food, and utilities. Medical bills can mount
quickly for the uninsured, even for relatively minor problems like dental care, and the financial impact on a
family can be serious.
�
Among the nonelderly in 2004, the costs of medical care received by those uninsured for the
full year were just over half that of those with insurance. Because the uninsured receive less care,
their per capita costs were $1,629 compared to $2,975 for the insured. Over a third (35%) of the costs
of care received by the full-year uninsured are paid for themselves out-of-pocket.16
�
Having health insurance makes a difference in the debt individuals and families face because of
medical bills. The uninsured are more than twice as likely to have had problems paying medical bills
in the past year as those who have coverage. In addition, the impact of these bills is much greater on
uninsured families (Figure 8). Nearly a quarter (23%) of the uninsured reported spending less on other
basic needs such as food and heat in order to pay medical bills.17
�
Having health insurance makes a difference to a person's credit history. Like any bill, when
medical bills are not paid or paid off too slowly, they are turned over to a collection agency, and a
person's ability to get further credit is significantly limited. About a quarter (23%) of the uninsured
report that they were contacted by a collection agency about unpaid medical bills in just the past year.18
Figure 8
Financial Burden of Medical Bills by
Insurance Status, 2003
Percent experiencing in past 12 months:
36%
Had Problem Paying Medical
Bill
Changed Way of Life
Significantly to Pay Medical
Bills
Contacted by Collection
Agency about Medical Bills
16%
Uninsured
Insured
23%
9%
23%
8%
Insured includes those with public or private insurance coverage.
SOURCE: Kaiser Family Foundation, Kaiser 2003 Health Insurance Survey.
10
8
00
00
�
The uninsured are increasingly paying "up front" before services will be rendered. When the
uninsured are unable to pay the full medical bill in cash at the time of service, they can sometimes
negotiate a payment schedule with a provider, pay with credit cards (typically with high interest rates),
or can be turned away.19
�
Most of the uninsured do not receive health services for free or at reduced charge. Hospitals
frequently charge uninsured patients two to four times what health insurers and public programs
actually pay for hospital services.20 Only about one quarter of low-income uninsured adults (those with
incomes under 200% of the poverty line) report they have received care for free or at reduced rates in
the past year.21
11
9
How Is Uncompensated Care Financed?
When the uninsured are unable to pay for care they receive, that uncompensated care is paid for through a
patchwork of federal, state, and private funds. The bulk of such care is funded by the government and is
crucial to the strength of the nation’s public hospitals and clinics, which provide most of the uncompensated
care the uninsured receive. Although this funding remains important, it has not kept pace with the rising
numbers of uninsured and increasing medical costs.
�
The costs of uncompensated care were estimated to be about $41 billion in 2004. Projected
government spending available to pay for the care of the uninsured in 2004 was $34.6 billion—about
85% of the total uncompensated care bill (Figure 9). More than half of all funds for uncompensated
care come from the federal government, with the majority of federal dollars flowing through Medicare
and Medicaid.
Most government dollars for uncompensated care are paid to hospitals based partly on the share of
uncompensated care they provide. Uncompensated care costs in direct service programs, such as
community health centers and the Veterans Affairs health system, are funded almost completely by
public dollars.22
Figure 9
Payment Sources for Uncompensated Care,
2004
Private Dollars
$6 Billion
(15%)
Federal Dollars
$24 Billion
(58%)
State Dollars
$11 Billion
(27%)
Total = $40.7 billion
SOURCE: Derived from Hadley J. and J. Holahan. 2004. The Cost of Care for the Uninsured: What Do We
Spend, Who Pays, and What Would Full Coverage Add to Medical Spending? KCMU, Issue Update, May
2004.
�
The federal uncompensated care funding that flows through Medicaid is a major source of
financing for health care providers that serve the low-income and uninsured populations.
Medicaid is the largest source of third-party payments for community health centers, accounting for
over one-third of their operating revenues. Medicaid also provides 37% of public hospital net revenues
(Figure 10).
12
10
00
00
Figure 10
Figure 10
Medicaid Financing of
Providers
FigureSafety-Net
10
Medicaid Financing of Safety-Net Providers
Medicaid
Financing
Providers
Public Hospital
Net Revenues of Safety-Net
Health Center
Revenues
Public Hospital
Net
Revenues
by Payer,
2003
Self Pay/
Public
Hospital
Net
Revenues
by Payer,
2003
Other
Self
Pay/
6% by Payer, 2003
Other
Self
Pay/
6%
Other
6%
Medicare
19%
Medicare
Medicaid
37%
Medicaid
19%
Medicare
19%
37%
Medicaid
37%
Commerical
23%
Commerical
State/Local
23%
Subsidies
Commerical
State/Local
15%
23%
Subsidies
State/Local
15%
Subsidies
15% billion
Total = $25.65
Health
byCenter
Payer, Revenues
2004
Health
byCenter
Payer, Revenues
2004
Self Pay
by Payer, 2004
6%
Self Pay
Private
6%
Self
Pay
6% 6%
Private
6%
Private
Medicare
6%
6%
Medicare
6%
Medicare
6%
Other
8%
Other
8%
Other
8%
Federal
Grants
Federal
24%
Grants
Federal
24%
Grants
24%
Medicaid
37%
Medicaid
37%
Medicaid
37%
State/
Local
State/
13%
Local
State/
13%
Local
13%
Total = $6.7 billion
Total = $25.65 billion
Total = $6.7 billion
SOURCE: National
of Public
Hospitals and Health Systems, 2003
, National
Association
TotalAssociation
= $25.65
billion
Total
= $6.7
billionof
�
�
�
Centers
Public
Hospitals
andAssociation
Health Systems,
October
2005.
Rosenbaum
and Shin,
SOURCE:
National
of Public
Hospitals
and
Health Systems,
2003Health
, National
Association of
, Kaiser
Commission
on Medicaid and the
Reauthorization:
An Overview
of Achievements
and Challenges
Health
Centers
Public
Hospitals
and
Health
Systems,
October
2005.
Rosenbaum
and
Shin,
SOURCE:
National
Association of Public Hospitals and Health Systems, 2003, National
Association of
Uninsured,
March
2006.
, Kaiser
Commission
on Medicaid and the
Reauthorization:
An Overview
of Achievements
and Challenges
Health Centers
Public
Hospitals and
Health Systems,
October 2005.
Rosenbaum
and Shin,
Uninsured, MarchAn
2006.
Reauthorization:
Overview of Achievements and Challenges, Kaiser Commission on Medicaid and the
Uninsured, March 2006.
Federal spending on uncompensated care has not kept up with the recent growth in the number
Federal
spending
on uncompensated
has not kept
upcenters
with theincreased
recent growth
the number
of uninsured.
Although
federal support care
for community
health
by moreinthan
50%
Federal
spending
on
uncompensated
care
has
not
kept
up
with
the
recent
growth
in
of
uninsured.
Although
federal
support
for
community
health
centers
increased
by
more
than
50%
between 2001 and 2004 (from $430 million to $670 million), these expenditures account forthe
lessnumber
than
of
uninsured.
Although
federal
support
for
community
health
centers
increased
by
more
than
50%
between
2001
and
2004
(from
$430
million
to
$670
million),
these
expenditures
account
for
less
3% of total federal spending for uncompensated care. As the number of uninsured increased by than
11%
between
2001
and
2004
$430
million
to $670
million),
expenditures
account
foronly
less
than
3%
of total
federal
uncompensated
care.
As thethese
number
of uninsured
increased
by1%,
11%
between
2001
and spending
2004,(from
totalforfederal
spending
on
the
health
care
safety
net increased
by
3%
of
total
federal
spending
for
uncompensated
care.
As
the
number
of
uninsured
increased
by
11%
between
and 2004,
total spending
federal spending
on the person
health care
net increased
by2001
only to
1%,
leading to2001
a decline
in federal
per uninsured
from safety
an average
of $546 in
$498
between
2001
and
2004,
total
federal
spending
on
the
health
care
safety
net
increased
by
only
1%,
leading
a decline
in 2004 to
(Figure
11).23in federal spending per uninsured person from an average of $546 in 2001 to $498
leading
a decline
person from an average of $546 in 2001 to $498
Figure 11
in 2004 to
(Figure
11).23in federal spending per uninsured
Figure 11
in 2004 (Figure 11).23
Federal Spending
on the Safety Net
Figure 11
Federal
Spending
on2001-2004
the Safety Net
per Uninsured,
Federal
Spending
on
the Safety Net
per Uninsured, 2001-2004
per Uninsured, 2001-2004
$546
$546
$546
2001
2001
�
�
�
$498
$498
$498
2004
2004
Federal spending includes payments to hospitals through Medicaid and Medicare and funding for direct care
programs, such as the Veterans
Service and the Ryan White Care Act.
2001Health Administration, the Indian Health 2004
Federal spending includes payments to hospitals through Medicaid and Medicare and funding for direct care
SOURCE: Hadley J, M Cravens, T Coughlin, J Holahan. 2005. Federal Spending on the Health Care Safety Net
programs, such as the Veterans Health Administration, the Indian Health Service and the Ryan White Care Act.
Federal
spendingHas
includes
payments
to hospitals
through
and Medicare
andCommission
funding for direct
care
from 2001-2004:
Spending
Kept Pace
with the
GrowthMedicaid
in the Uninsured?
Kaiser
on Medicaid
SOURCE: Hadley J, M Cravens, T Coughlin, J Holahan. 2005. Federal Spending on the Health Care Safety Net
programs,
such as (#7425;
the Veterans
Health Administration, the Indian Health Service and the Ryan White Care Act.
and the Uninsured
November).
from 2001-2004: Has Spending Kept Pace with the Growth in the Uninsured? Kaiser Commission on Medicaid
SOURCE: Hadley J, M Cravens, T Coughlin, J Holahan. 2005. Federal Spending on the Health Care Safety Net
and the Uninsured (#7425; November).
from 2001-2004: Has Spending Kept Pace with the Growth in the Uninsured? Kaiser Commission on Medicaid
and the Uninsured (#7425; November).
The cost of uncompensated care provided by physicians (estimated at $5 billion in 2001) is not
24 Financial
The
costorofindirectly
uncompensated
careby
provided
by physicians
(estimated
at $5
in 2001) is not
directly
reimbursed
public dollars.
pressures
andbillion
time constraints,
24 Financial
The
cost
of
uncompensated
care
provided
by
physicians
(estimated
at
$5
billion
in 2001)
directly
or
indirectly
reimbursed
by
public
dollars.
pressures
and
time
constraints,
coupled with changing physician practice patterns, have
contributed to a decline in charity
care is not
24 Financial pressures and time constraints,
directly
or
indirectly
reimbursed
by
public
dollars.
coupled
changing physician
practice
haveprovide
contributed
to acare
decline
charity
care
providedwith
by physicians.
The percent
of allpatterns,
doctors who
charity
fell toin68%
in 2004-2005
coupled
with
changing
physician
practice
patterns,
have
contributed
to
a
decline
in
charity
care
provided
by
physicians.
The
percent
of
all
doctors
who
provide
charity
care
fell
to
68%
in
2004-2005
25
from 76% in 1996-1997.
25
provided
by
physicians.
The
percent
of
all
doctors
who
provide
charity
care
fell
to
68%
in
2004-2005
from 76% in 1996-1997.
13
from 76% in 1996-1997.25
13
13
11
How and Why Has the Number of Uninsured Changed?
Lack of health insurance coverage is a problem for many more Americans today than it was ten years ago.
Even through most of the 1990s, when the economy was rapidly growing and competition for workers was
high, the number of uninsured increased by about one million a year—leveling off only at the end of the
economic boom. The 2001 recession, brief as it was, triggered a downturn in job-based coverage that
continued to affect health insurance coverage even in 2005, as job opportunities shifted and family incomes
declined. Between 2000 and 2004 the number of uninsured Americans increased by about 6 million. Most
recently, the number of nonelderly uninsured grew by 1.3 million between 2004 and 2005 (Figure 12).
Figure 12
Number of Nonelderly Uninsured Americans,
1994 - 2005
Uninsured in Millions
Previous Method
1999 Revised Method
2004 Revised Method
50
39.8
40.6
41.7
‘95
‘96
43.1
43.9
42.1
40.0
39.6
40.9
43.3
44.7
45.5
44.8
46.1
25
0
‘94
‘97
‘98
'99*
‘00
‘01
‘02
‘03
’04*
‘05
* The Census Bureau periodically revises its CPS methods, which means data before and after the revision are
not comparable. Comparison across years can be made between 1994 and 1999, 1999 through 2004, and
2004 vs. 2005.
SOURCE: KCMU/Urban Institute analysis of March 2006 CPS.
�
In the mid- and late-1990s, employer-sponsored coverage gradually increased—fueled by a
robust economy, low unemployment rates, increases in real wages, and slower growth in health
premiums. However, until 1999, the increases had not been enough to offset the declines in Medicaid
enrollment that began following welfare reforms implemented in the mid-1990s. As families moved into
the workforce, they often found low-paying jobs that were not likely to offer health benefits. In addition,
as the link between welfare assistance and Medicaid was severed, many eligible families were not
enrolled in Medicaid. The number of uninsured grew by four million between 1994 and 1998.
�
By 1999, the percentage of people covered by Medicaid stabilized, and modest increases in
private coverage helped to decrease the number of uninsured for the first time in over a decade.
As more Americans moved into higher income levels, job-based coverage became more affordable. In
addition, more people gained coverage as states implemented SCHIP and improved Medicaid
enrollment. Expanded public coverage of children in 2000 accounted for another small decline in the
number of uninsured that year.26
�
The decline in the uninsured did not last long, however, as economic growth stalled in 2001.
The share of nonelderly Americans with employer-sponsored health insurance decreased for the first
time since 1993, dropping from 66% in 2000 to 61% by 2004.
14
12
00
00
As the nonelderly population grew by ten million people between 2000 and 2004, the income
distribution shifted so that a greater share of Americans came from poor and near-poor families, where
uninsured rates are highest. In addition, employment continued to shift—more workers in 2004 were
either self-employed or were working in small firms (< 25 workers) and more were working in the kinds
of jobs that are less likely to offer health benefits. The number of nonelderly uninsured grew by six
million, two-thirds of whom were poor or near-poor (Figure 13).
Figure 13
Growth in Nonelderly Uninsured,
by Family Income, 2000 - 2004
High
(400%+ FPL)
12%
Middle
(200-399% FPL)
22%
Poor
(<100% FPL)
46%
Near-Poor
(100-199% FPL)
19%
Growth in Uninsured = 6.0 Million
SOURCE: KCMU/Urban Institute analysis of CPS 2001-2005.
�
Enrollment in both Medicaid and SCHIP increased between 2000 and 2004, in response to
greater numbers who qualified and also because of improved program outreach efforts and
streamlined enrollment systems. Declines in employer-sponsored insurance among children over
this period were fully offset by increases in Medicaid and SCHIP enrollment (Figure 14). Children’s
uninsured rates actually decreased slightly between 2000 and 2004 and the number of uninsured
children did not grow.27
15
13
Figure 14
Changes in ESI, Medicaid and Uninsured Rates
Children vs. Adults, 2000 - 2004
75%
Children
61.6%
Adults
67.9%
56.3%
2000
63.1%
2004
50%
20.5%
25%
26.4%
17.9%
12.3% 11.6%
0%
ESI*
Medicaid*
Uninsured*
20.6%
6.3%7.8%
ESI*
Medicaid*
Uninsured*
Change in Number of Nonelderly Uninsured, 2000 – 2004
-400,000 Children
+6.3 million Adults*
*Statistically significant change 2000-2004 (p<.05). Medicaid includes SCHIP and other state programs.
SOURCE: KCMU/Urban Institute analysis of CPS 2001-2005.
�
Public coverage had also increased among adults between 2000 and 2004, but with Medicaid’s
limits on adult eligibility, it was not enough to buffer the loss of job-based coverage. Adults
accounted for all of the growth in the number of uninsured over these years—increasing by 6.3 million.
� By 2005, the number of nonelderly uninsured was still growing significantly, by 1.3 million
compared to the year before. Most of the growth in the uninsured between 2004 and 2005 occurred
among those with low incomes—1.1 million of the 1.3 million were from families with incomes less than
twice the poverty level. Medicaid and other state programs were, in general, no longer expanding and
continued decreases in employer-based coverage, particularly among those with low incomes,
increased the share of the nonelderly population who were uninsured. By 2005, nearly 18% of all the
nonelderly and 33% of those with low incomes were uninsured.
16
14
00
00
Why Doesn't Employer-Sponsored Insurance Cover More Americans?
Employer-sponsored health insurance covered 156 million Americans (61% of the nonelderly population) in
2005. Yet, 37 million people from working families were uninsured in that year because not all businesses
offer health benefits, not all workers qualify for coverage, and many employees cannot afford their share of
the health premium. The strength of the economy and growth rate of health insurance premiums are the
primary factors influencing the proportion of Americans insured through employer-sponsored benefits.
�
Employer-sponsored health insurance is sensitive to sharp changes in health insurance
premiums. Between 1988 and 1993, health insurance premiums grew by at least 8% annually and the
proportion of workers covered by job-based insurance decreased. By 1996, premiums had stabilized,
even dropping below the overall rate of inflation as insurers competed to increase their market share.
Low premium growth combined with the prospering economy very gradually reversed the trend in
employer-sponsored coverage, and the percent of the population covered by employer-sponsored
coverage grew slightly.
�
The economic downturn which began in early 2001, coupled with the return of double-digit
inflation in health insurance premiums, decreased employer-sponsored coverage again. Both
factors also adversely affect the type of health benefits offered and the amount employees are required
to contribute towards their health benefits. Although the growth rate of health insurance premiums has
declined recently, premiums continue to grow more than twice as fast as wage increases, and
employer-sponsored coverage continues to erode.
Figure 15
Average Annual Premium Costs for
Covered Employees, 2000 and 2006
$11,480
Employer Contribution
Worker Contribution
$6,438
$8,508
$4,242
$4,819
$2,471
$334 $2,137
2000
$3,615
$627
$1,619
2006
Single Coverage
2000
$2,973
2006
Family Coverage
Family coverage is defined as health coverage for a family of four.
SOURCE: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2006.
17
15
� In 2006, annual employer-sponsored group premiums cost, on average, $4,242 for individual
coverage and $11,480 for family coverage of four. Total family premiums now exceed the annual
salary of a full-time, minimum-wage worker. The employee’s share of a family premium in 2006
averaged $2,973, increasing by $1,354 since 2000 (Figure 15).28
�
The share of employees who were covered by employer-sponsored insurance (ESI) decreased
markedly between 2001 and 2005, with a corresponding increase in the share who were
uninsured. Decreases in job-based coverage—and increases in the share who were uninsured—
were greatest among low-income workers, those who were already the most likely to be uninsured.
The share of poor employees who had employer-sponsored insurance dropped from 37% in 2001 to
30% by 2005 and among the near-poor dropped from 59% to 52%, while among those with the highest
incomes, employer-sponsored insurance rates stayed at over 92% (Figure 16).29
Figure 16
Changes in Employees’ ESI Coverage and
Uninsured Rates, by Family Income Levels,
2001-2005
Percent with ESI
100%
2001
2005
92.9% 92.2%
82.4%
80%
58.7%
60%
40%
36.8%
78.5%
51.7%
30.4%
20%
0%
<100% FPL
*
100-199% FPL
*
200-399%
*
400%+
Uninsured Rates
46.7%
54.1%
33.9%
39.1%
13.4%
16.0%
3.6%
4.0%
* Statistically significant changes for both ESI and uninsured rates for these groups (p<.05).
SOURCE: Urban Institute analysis of the February 2001 and 2005 Contingent Work Supplement of the
Current Population Survey (CPS) and the March 2001 and 2005 Annual Social and Economic (ASEC)
Supplement of the CPS.
The main reason for this change was that fewer employees worked for employers who sponsored
health benefits. Over 70% of the decline in job-based coverage was due to loss of employer
sponsorship, changes in employees’ eligibility for health benefits, or loss of job-based coverage as a
dependent of another worker. About a quarter of the drop was due to employees not participating in
health benefits offered to them (Figure 17). Declines in employer sponsorship between 2001 and 2005
were deepest among poor and near-poor employees.30
18
16
00
00
Figure 17
Reasons for Decline in ESI
among Employees, 2001- 2005
Employee
Take-up Decline
27%
Employer
Sponsorship
Decline
48%
ESI Dependent
Coverage Decline
11%
Employee
Eligibility
Decline
14%
3.8% Decline in ESI among Employees
(From 81.2% to 77.4%)
SOURCE: Urban Institute analysis of the February 2001 and 2005 Contingent Work Supplement of the
Current Population Survey (CPS) and the March 2001 and 2005 Annual Social and Economic (ASEC)
Supplement of the CPS.
�
Workers from low-income families have less access to job-based insurance, even when benefits
from a spouse’s job are considered. In 2005, 55% of employees from poor families did not have
employer-sponsored insurance available to them, either through their own job or a family member's job,
compared to only 4% of employees from higher income families (Figure 18).31
Figure 18
Employee Access to ESI within the Family
by Family Income, 2005
Covered by Own or Spouse's Employer
Declined offer from Own or Spouse's Employer
Not offered through Own or Spouse's Employer
30%
15%
52%
79%
92%
14%
55%
<100%
35%
100-199%
13%
8%
200-399%
4%
4%
400% +
Poverty Level
Data may not total 100% due to rounding.
SOURCE: Urban Institute analysis of the February 2005 Contingent Work Supplement of the Current Population
Survey (CPS) and the March 2005 Annual Social and Economic (ASEC) Supplement of the CPS.
�
The required employee share of premiums makes employer-sponsored coverage unaffordable
for some, particularly low-wage workers. Poor employees compared to higher-wage workers are
less likely to participate when health benefits are offered (64% participation among poor employees vs.
84% of those with family incomes greater than four times the poverty level).32 Low-wage workers often
19
17
work in firms where employees are required to pay a larger share of the premium. Among businesses
offering health benefits in 2006, employees in lower-wage firms paid 35% of the premium costs for
family coverage compared to 26% paid by employees in higher-wage firms.33
�
Employees of small businesses (less than 100 employees) are less likely than those in larger
firms to have health benefits offered to them. This gap widened between 2001 and 2005, with
employees of the smallest firms (less than 10 employees) experiencing the greatest change. The
share of employees in these small firms who were offered health benefits declined from 54% in 2001 to
50% by 2005.34
�
Health coverage varies both by industry and by type of occupation. Across industries, uninsured
rates range from a high of 35% in agriculture to just 4% in public administration. But even in industries
where health benefits are better than average, the gap in health coverage between blue and white
collar workers is nearly two-fold or greater. Over 80% of uninsured workers are in blue-collar jobs.
Figure 19
Uninsured Rates Among Selected Industry Groups,
White vs. Blue Collar Jobs, 2005
Information/Education/
Communication
(11% of jobs)
Health/Soc Services
(12%)
Mining/Manufacturing
(12%)
6%
11%
18%
7%
18%
6%
Services/Arts
Entertainment (13%)
Wholesale/Retail
(15%)
Blue Collar
White Collar
35%
20%
14%
23%
Uninsured Rate for
All Workers = 19%
White collar workers include all professionals and managers; all other workers classified as blue collar.
SOURCE: KCMU/Urban Institute analysis of March 2006 CPS
20
18
00
00
What is Medicaid's Role?
Medicaid is the nation’s major public health insurance program for low-income Americans, providing health
coverage based not only on income levels, but also eligibility categories. As a federal-state program,
Medicaid's combination of federal rules and state options for coverage has created different eligibility rules
for different groups across the country.
Medicaid covers four main groups of nonelderly, low-income people: children, their parents, pregnant
women, and people with disabilities—with the program playing its broadest role among children. Half of all
Medicaid beneficiaries are children.
�
Federal law requires states to cover children under age 19 who come from poor families. The
threshold is higher (133% of the poverty level) for children under age six and pregnant women, and
states have the option to expand coverage beyond these federal minimum requirements.
�
SCHIP works as a complement to Medicaid by covering low-income children not eligible for
Medicaid. The two programs together aim to cover nearly all low-income children. SCHIP gives
states the option to cover children through their existing Medicaid program or a separate child health
program. Most states cover children up to 200% of the poverty level through Medicaid or SCHIP
(Figure 20).
Figure 20
Medicaid/SCHIP Eligibility Levels for Children,
July 2005
NH
VT
WA
MT
MN
OR
ID
RI
MI
WY
PA
IA
NE
NV
CA
CO
ILIL
OH
IN
WV
MO
KY
NC
TN
OK
AZ
NM
AK
MD
DC
SC
AR
MS
TX
CT
NJ
DE
VA
KS
MA
NY
WI
SD
UT
ME
ND
AL
GA
LA
FL
HI
> 200% FPL (13 states)
200% FPL (28 states including DC)
< 200% FPL (10 states)
SOURCE: Based on a national survey conducted by the Center on Budget and Policy Priorities for KCMU, 2005.
�
Despite broad Medicaid and SCHIP eligibility for low-income children, many eligible children
are not enrolled in the programs. As much as 75% of uninsured children are eligible for Medicaid or
SCHIP but are not enrolled (Figure 21).35 Some families are not aware of the availability of the
programs or may not believe their children are eligible. But, many families face barriers to enrolling
and renewing their children in public programs, and new rules require U.S. citizens to document their
citizenship and identity when applying for Medicaid or renewing their coverage.
21
19
Figure 21
Medicaid and SCHIP Eligibility Status of
Uninsured Children, 2004
Not
Eligible
25%
Medicaid
Eligible
53%
SCHIP
Eligible
22%
Total = 8.1 million uninsured children
SOURCE: Georgetown Center for Children and Families analysis of March 2005 Current Population
Survey using July 2004 eligibility rules.
�
In contrast, the role of Medicaid for nonelderly adults is far more limited. Medicaid covers some
parents and low-income disabled individuals, but most adults without dependent children—regardless
of how poor—are ineligible for Medicaid. Parents of dependent children qualify for Medicaid, though
income eligibility levels are set much lower than congressionally mandated standards for children and
pregnant women. These eligibility restrictions, coupled with barriers to Medicaid enrollment, leave
42% of poor parents under age 65 uninsured (Figure 22).
Figure 22
Health Insurance Coverage of LowIncome Adults and Children, 2005
Employer/Other Private
Poor
Children
(<100% Poverty)
17%
Near-Poor
Poor
Parents
18%
Near-Poor
Poor
(<100% Poverty)
Near-Poor
(100-199% Poverty)
40%
43%
17%
42%
17%
28%
25%
Uninsured
22%
41%
50%
(100-199% Poverty)
Adults
without
children
61%
43%
(100-199% Poverty)
(<100% Poverty)
Medicaid/Other Public
33%
47%
18%
39%
Medicaid also includes SCHIP and other state programs, Medicare and military-related coverage. The federal
poverty level was $19,971 for a family of four in 2005. Data may not total 100% due to rounding.
SOURCE: KCMU/Urban Institute analysis of March 2006 CPS.
22
20
00
00
�
Some states have expanded Medicaid eligibility for low-income parents, but most states
continue to tie income eligibility levels for parents to former welfare assistance levels. Over one
quarter of states have used the flexibility available to them under federal law to extend Medicaid
eligibility for parents to 100% of the poverty level or higher. However, in the remaining states, parents
still must have income below the poverty level in order to qualify for health coverage (Figure 23). As a
result, millions of poor parents are ineligible for Medicaid. For example, a parent in a family of three
working full-time at the minimum wage could not qualify for Medicaid in 25 states in 2005.36
Figure 23
Medicaid Eligibility for Working Parents,
by Income, July 2005
NH
VT
WA
MT
MN
OR
ID
RI
MI
WY
PA
IA
NE
NV
CA
CO
IL
OH
IN
MO
KY
NC
TN
OK
AZ
NM
AK
MD
DC
SC
AR
MS
TX
CT
NJ
DE
WV
VA
KS
MA
NY
WI
SD
UT
ME
ND
AL
GA
LA
FL
HI
National Average = 67% FPL
> 100% FPL* (14 states including DC)
50% - 100% FPL (23 states)
< 50% FPL (14 states)
* Federal Poverty Level (FPL) refers here to HHS Poverty Guidelines, $16,090 for a family of three in 2005.
SOURCE: Center on Budget and Policy Priorities for KCMU, 2005
�
Growth in Medicaid and SCHIP enrollment from 2000 to 2004 contributed to the decrease in the
share of children who were uninsured; however, Medicaid coverage leveled off in 2005. Many
states remain focused on measures to control Medicaid enrollment and spending growth. In 2006, 18
states implemented policies to restrict eligibility. However, improving fiscal conditions are allowing for
more program investments than in previous years. In both their 2006 and 2007 budgets, just over half
of states implemented or adopted policies that would expand eligibility either by raising eligibility levels
or by simplifying application or eligibility processes.37
23
21
�
Medicaid covers the majority of people who are in fair or poor health. Over 50% of people in fair
and poor health are covered by Medicaid, while only 18% are covered by private insurance (Figure 24).
Medicaid beneficiaries are also poorer and more likely to have health conditions that limit work
compared to the low-income privately insured. Most Medicaid beneficiaries do not have access to
private health insurance, and without Medicaid, they would become uninsured.
Figure 24
Health Insurance Coverage of the Low-Income
Nonelderly by Health Status, 2005
Employer/Other Private
Excellent/Very Good
Good
Fair/Poor
Medicaid
38%
28%
18%
Uninsured
30%
34%
32%
38%
55%
27%
Medicaid also includes SCHIP, other state programs, Medicare, and military-related coverage.
Data may not total 100% due to rounding.
SOURCE: KCMU/Urban Institute analysis of March 2006 CPS.
24
22
00
00
What Can Be Done to Decrease the Number of Uninsured?
Public opinion surveys over time show that the majority of Americans believe decreasing the number of
uninsured is an important policy priority. However, there is little agreement on how to achieve this goal.
Policy options that have been proposed to guarantee universal coverage range from a single public plan
that covers all Americans to more targeted strategies that extend employer-based coverage. Some build
on public coverage while others require individuals to purchase coverage directly. Most strategies
recognize the need to subsidize the cost for the lowest income groups.
Many of the recent proposals, however, have taken approaches that combine strategies in order to
expand health insurance coverage incrementally. Building on the nation’s mixed system of public and
private insurance, the strategies being discussed vary not only by the means of insuring more Americans,
but also by who is targeted for coverage. The uninsured population is diverse; therefore, applying different
strategies may be necessary to meet the needs of a growing uninsured population.
Figure 25
The Nonelderly Uninsured,
by Age and Income Groups, 2005
Low-Income
Children
14%
Low-Income
Parents
16%
Other Children
5%
Other Parents
8%
Other Adults
without Children
22%
Low-Income
Adults without
Children
35%
Total = 46.1 million uninsured
Low-income includes those with family incomes less than 200% of the federal poverty level ($39,942 for a family
of four in 2005).
SOURCE: KCMU/Urban Institute analysis of March 2006 CPS.
Components of proposed strategies include:
� Expanding public coverage for the low-income uninsured by building on Medicaid and SCHIP.
With the administrative means to enroll beneficiaries and pay providers already in place, these public
programs currently provide comprehensive benefits with no or minimal cost-sharing to all who qualify.
These programs are explicitly designed to cover those most at risk of being uninsured—low-income
families and the disabled. However, neither program has reached its full enrollment potential.
25
23
With the introduction of SCHIP, several states successfully implemented system-wide changes in order
to improve enrollment and retention efforts in both Medicaid and SCHIP. However, not all of these
efforts could be fully sustained during recent state budget crises. With major budgetary problems now
behind many states, more states are again considering ways of expanding coverage to more of the
low-income population through their public programs.
Increasing federal and state funding to expand public coverage offers the potential (as shown in Figure
25) to reach nearly two-thirds of the uninsured population, if coverage is extended to low-income adults
without children, as well as to more parents.
�
Expanding private group coverage by bolstering the current employer-sponsored system
and/or building new group insurance options. The share of Americans with job-based coverage
has been declining, particularly since 2000. While the majority of Americans obtain their health
insurance through the workplace, over 80% of the uninsured are working themselves or have a
connection to the workforce. Proposals aimed at increasing coverage through the workplace range
from encouraging more job-based coverage with financial incentives for employers, including tax
incentives, to mandating that businesses provide health coverage.
Some federal proposals would set up new group insurance options for individuals or businesses,
sometimes modeled after the Federal Employee Health Benefits Program, that would provide a wide
range of health plans with a large risk pool. Others would make it easier for small employers and the
self-employed to band into larger insurance purchasing pools, potentially giving them large group
negotiating power when buying insurance. Both types of strategies could lower premiums and broaden
the choice of policies available to the uninsured, but many experts believe the government will need to
subsidize the premiums for low-wage workers or some small firms, or at least, provide some form of
federal reinsurance for high cost enrollees to reduce employer premiums.
�
Subsidizing the purchase of private individual health insurance, making coverage more
affordable with tax credits or deductions delivered through the federal income tax system.
Some believe job-based coverage is an outdated approach in a country where workers change
employers several times during their lives and are unable to maintain their health benefits across jobs.
It has also been argued that tax exclusions tied to employer health insurance unfairly benefit only those
who have group coverage through a business.
Letting individuals choose their own health plans and helping with costs through tax credits provides an
alternative to employment-linked coverage. However, the success of these options depends on
whether the individual health insurance market can evolve to meet the needs of people with higher
health needs. Most people with health problems or a chronic condition currently are either excluded
from nongroup insurance or find policies unaffordable. Private nongroup coverage has not grown over
time, still covering just over 5% of the nonelderly population.
Another set of proposals would make it easier for people to take advantage of health savings accounts
(HSAs) if they purchase a high deductible health plan. Contributions and withdrawals to HSAs are
made tax-free and are to be used for paying out-of-pocket medical expenses. While high deductible
plans could potentially make people more cost-conscious, for many, particularly the low-income
uninsured, they are not more affordable than other plans and could attract only healthy people, driving
26
24
00
00
up the cost of coverage for others. HSA-qualified health plans are still relatively rare, with recent
estimates of three million individuals covered in either group or nongroup HSA-qualified HDHPs.38
Proposals that offer tax credits or deductions to individuals vary by whom they would assist. Some
would target tax provisions to the low-income; others would assist all the uninsured. The cost to the
government of tax-based approaches could be high, since those least able to afford insurance would
require substantial financial assistance to pay their premiums. Moreover, such tax credits are likely to
also be used by many who are already insured, providing greater tax equity, but also increasing the
cost of expanding coverage.
Figure 26
Uninsured Rates Among the Nonelderly
by State, 2004-2005
NH
VT
WA
MT
ME
ND
MN
OR
ID
MI
WY
UT
CA
CO
PA
IA
NE
NV
IL
KS
IN
OH
VA
KY
AZ
NM
TN
TX
AL
MD
DC
SC
AR
MS
AK
RI
CT
NJ
DE
WV
MO
NC
OK
MA
NY
WI
SD
GA
LA
FL
HI
National Average = 18%
<13% Uninsured (12 states)
13 to <18% Uninsured (22 states & DC)
>18% Uninsured (17 states)
SOURCE: KCMU and Urban Institute analysis of the March Current Population Survey, 2005 and 2006, twoyear pooled data.
In the absence of national reform and as more state budgets return to healthy balances, more governors
and state legislators are seeking solutions to address their state’s growing number of uninsured—and are
proposing a diverse mix of reforms. The problem differs widely across states, with uninsured rates varying
nearly three-fold, largely due to differences in state economies and employer coverage, the share of
families with low incomes, and the breadth of state Medicaid programs (Figure 26).
Some states are moving toward expanded coverage of children, while others are looking for more
comprehensive solutions. Recent landmark legislation in Massachusetts, designed to provide nearly
universal coverage for its residents, combines several strategies: a Medicaid expansion, an individual
mandate, and required employer participation. Because each state faces different circumstances, the
combination that may work for Massachusetts may not be feasible for others. Moreover, the growing size
and scope of the problem means few states will be able to move towards universal coverage in the
absence of federal assistance and financial support.
27
25
00
TABLES
Table 1: Characteristics of the Nonelderly Uninsured, 2005
Table 2: Characteristics of Uninsured Children, 2005
Table 3: Characteristics of the Low-Income Nonelderly Uninsured, 2005
Table 4: Health Insurance Coverage of the Nonelderly, 2005
Table 5: Health Insurance Coverage of Children, 2005
Table 6: Health Insurance Coverage of the Low-Income Nonelderly, 2005
Table 7: Health Insurance Coverage of the Nonelderly by State, 2004-2005
Table 8: Health Insurance Coverage of Children by State, 2004-2005
Table 9: Health Insurance Coverage of the Low-Income Nonelderly by State, 2004-2005
28
27
Table 1
Characteristics of the Nonelderly Uninsured, 2005
Nonelderly
(millions)
Total - Nonelderlya
Percent of
Nonelderly
257.4
100.0%
Children - Total
77.9
Adults - Total
Adults 19-24
Adults 25-34
Adults 35-44
Adults 45-54
Adults 55-64
179.5
23.9
39.1
42.8
42.7
31.0
Uninsured
(millions)
Percent of
Uninsured
Uninsured
Rate
46.1
100.0%
17.9%
30.3%
9.0
19.6%
11.6%
69.7%
9.3%
15.2%
16.6%
16.6%
12.0%
37.1
7.8
10.4
8.1
6.5
4.2
80.4%
17.0%
22.6%
17.5%
14.1%
9.1%
20.7%
32.8%
26.6%
18.9%
15.3%
13.6%
61.2
53.4
142.9
23.8%
20.7%
55.5%
22.7
13.0
10.5
49.2%
28.1%
22.7%
37.1%
24.3%
7.3%
<100%
100-199%
...100-149%
...150-199%
200-399%
...200-299%
...300-399%
400%+
45.9
44.8
22.2
22.6
74.4
40.5
33.9
92.3
17.8%
17.4%
8.6%
8.8%
28.9%
15.7%
13.2%
35.9%
16.7
13.3
7.2
6.1
10.7
7.2
3.5
5.3
36.3%
28.9%
15.7%
13.2%
23.3%
15.7%
7.7%
11.4%
36.5%
29.8%
32.7%
27.0%
14.4%
17.8%
10.4%
5.7%
Single Adults Living Alone
Single Adults Living Together
Married Adults
19.1
29.7
52.8
7.4%
11.5%
20.5%
3.2
10.5
8.9
6.9%
22.8%
19.4%
16.7%
35.4%
16.9%
1 Parent with childrenc
2 Parents with childrenc
31.9
111.3
12.4%
43.2%
6.2
13.6
13.3%
29.5%
19.3%
12.2%
Multigenerational/Other with childrend
12.7
4.9%
3.7
8.1%
29.2%
2 Full-time
1 Full-time
Only Part-timee
Non-Workers
71.5
137.9
17.7
30.3
27.8%
53.6%
6.9%
11.8%
5.9
26.1
5.2
8.9
12.8%
56.5%
11.4%
19.3%
8.3%
18.9%
29.6%
29.4%
White only (non-Hispanic)
Black only (non-Hispanic)
Hispanic
Asian/S. Pacific Islander only
Am. Indian/Alaska Native
Two or More Races f
166.6
32.6
40.8
11.8
1.5
4.2
64.7%
12.7%
15.8%
4.6%
0.6%
1.6%
22.0
6.8
14.0
2.3
0.5
0.6
47.6%
14.8%
30.3%
5.0%
1.1%
1.3%
13.2%
20.9%
34.3%
19.4%
32.0%
13.9%
225.8
11.0
5.0
15.6
87.7%
4.3%
1.9%
6.1%
34.4
2.4
2.6
6.8
74.5%
5.2%
5.6%
14.7%
15.2%
21.8%
51.3%
43.5%
177.8
58.2
21.5
69.1%
22.6%
8.3%
28.1
13.5
4.4
61.0%
29.3%
9.6%
15.8%
23.3%
20.7%
Age
Annual Family Income
<$20,000
$20,000 - $39,999
$40,000 +
Family Poverty Levelb
Household Type
Family Work Status
Race/Ethnicity
Citizenship
U.S. citizen - native
U.S. citizen - naturalized
Non-U.S. citizen, resident for < 5 years
Non-U.S. citizen, resident for 5+ years
Health Status
Excellent/Very Good
Good
Fair/Poor
28
00
00
Table 2
Characteristics of Uninsured Children, 2005
Children
(millions)
Total - Childreng
Percent of
Children
Uninsured
(millions)
Percent of
Uninsured
Uninsured
Rate
77.9
100.0%
9.0
100.0%
11.6%
<1
1-5
6-18
4.1
20.3
53.5
5.2%
26.1%
68.7%
0.6
2.1
6.4
6.2%
22.8%
71.0%
13.9%
10.1%
12.0%
<$20,000
$20,000 - $39,999
$40,000 +
18.6
14.9
44.4
23.9%
19.1%
57.0%
4.1
2.5
2.4
45.5%
27.8%
26.6%
22.1%
16.9%
5.4%
<100%
100-199%
...100-149%
...150-199%
200-399%
...200-299%
...300-399%
400%+
17.7
15.5
7.8
7.6
22.6
12.8
9.9
22.1
22.7%
19.8%
10.1%
9.8%
29.1%
16.4%
12.7%
28.4%
4.0
2.6
1.5
1.1
1.8
1.3
0.5
0.7
43.8%
28.8%
16.7%
12.1%
19.4%
13.9%
5.5%
8.0%
22.3%
16.8%
19.2%
14.4%
7.7%
9.8%
5.1%
3.3%
1 Parent with childrenc
2 Parents with childrenc
Multigenerational/Other with childrend
19.0
52.7
5.4
24.3%
67.6%
7.0%
2.6
4.8
1.4
28.4%
53.0%
15.0%
13.5%
9.1%
25.0%
2 Full-time
1 Full-time
Only Part-timee
Non-Workers
22.4
41.8
4.4
9.3
28.8%
53.6%
5.7%
11.9%
1.4
4.8
0.7
2.1
16.0%
53.4%
7.5%
23.1%
6.5%
11.5%
15.3%
22.4%
White only (non-Hispanic)
Black only (non-Hispanic)
Hispanic
Asian/S. Pacific Islander only
Am. Indian/Alaska Native
Two or More Racesf
45.3
11.4
15.4
3.1
0.5
2.1
58.2%
14.7%
19.8%
4.0%
0.7%
2.7%
3.4
1.5
3.5
0.4
0.1
0.1
37.8%
16.3%
38.3%
4.4%
1.6%
1.7%
7.5%
12.9%
22.4%
12.8%
27.5%
7.2%
75.1
1.2
1.6
96.4%
1.5%
2.1%
7.9
0.5
0.6
87.8%
5.8%
6.5%
10.6%
44.5%
35.8%
63.1
13.1
1.8
81.0%
16.8%
2.3%
6.8
2.1
0.2
74.7%
23.2%
2.0%
10.7%
16.1%
10.4%
Age
Family Income
Family Poverty Levelb
Household Typeh
Family Work Status
Race/Ethnicity
Citizenship
U.S. Citizen
Non-U.S. citizen, resident for < 5 years
Non-U.S. citizen, resident for 5+ years
Health Status
Excellent/Very Good
Good
Fair/Poor
29
Table 3
Characteristics of the Low-Income Nonelderly Uninsured
(Less than 200% of Poverty), 2005
Low-Income Percent of
Nonelderly Low-Income
(millions)
Nonelderly
Total - Low-Income Nonelderlya
Uninsured
(millions)
Percent of
Uninsured
Uninsured
Rate
90.7
100.0%
30.1
100.0%
33.2%
Children - Total
33.2
36.6%
6.6
21.8%
19.8%
Adults - Total
Adults 19-24
Adults 25-34
Adults 35-44
Adults 45-54
Adults 55-64
57.5
13.8
14.8
11.9
9.6
7.4
63.4%
15.2%
16.3%
13.1%
10.6%
8.2%
23.5
6.1
7.0
4.9
3.6
2.0
78.2%
20.3%
23.1%
16.2%
11.8%
6.8%
40.9%
44.3%
47.0%
41.0%
36.9%
27.6%
<$20,000
$20,000 - $39,999
$40,000 +
61.2
25.6
3.9
67.4%
28.3%
4.3%
22.7
6.8
0.6
75.4%
22.5%
2.1%
37.1%
26.4%
16.2%
<100%
100-199%
...100-149%
...150-199%
45.9
44.8
22.2
22.6
50.6%
49.4%
24.4%
25.0%
16.7
13.3
7.2
6.1
55.7%
44.3%
24.1%
20.3%
36.5%
29.8%
32.7%
27.0%
Single Adults Living Alone
Single Adults Living Together
Married Adults
6.5
15.4
9.9
7.2%
16.9%
11.0%
1.9
7.5
4.1
6.4%
24.8%
13.6%
29.6%
48.6%
41.3%
c
21.2
29.1
8.6
23.4%
32.1%
9.5%
4.9
8.7
3.0
16.4%
28.8%
10.0%
23.3%
29.8%
34.9%
2 Full-time
1 Full-time
e
Only Part-time
Non-Workers
5.9
45.4
12.7
26.6
6.5%
50.1%
14.0%
29.3%
1.7
15.6
4.4
8.4
5.5%
51.9%
14.5%
28.1%
27.8%
34.4%
34.4%
31.7%
White only (non-Hispanic)
Black only (non-Hispanic)
Hispanic
Asian/S. Pacific Islander only
Am. Indian/Alaska Native
f
Two or More Races
42.8
17.8
23.7
3.8
0.9
1.7
47.2%
19.6%
26.1%
4.2%
1.0%
1.9%
12.3
5.1
10.5
1.4
0.4
0.4
40.9%
17.0%
34.8%
4.7%
1.3%
1.3%
28.7%
28.8%
44.3%
37.0%
43.7%
22.3%
U.S. citizen - native
U.S. citizen - naturalized
Non-U.S. citizen, resident for < 5 years
Non-U.S. citizen, resident for 5+ years
75.6
3.4
3.1
8.6
83.4%
3.7%
3.4%
9.4%
21.8
1.4
2.0
5.0
72.4%
4.5%
6.6%
16.5%
28.8%
40.2%
63.5%
58.1%
54.2
24.2
12.3
59.7%
26.7%
13.6%
17.6
9.1
3.4
58.6%
30.3%
11.1%
32.5%
37.6%
27.3%
Age
Annual Family Income
Family Poverty Levelb
Household Type
1 Parent with children
c
2 Parents with children
d
Multigenerational/Other with children
Family Work Status
Race/Ethnicity
Citizenship
Health Status
Excellent/Very Good
Good
Fair/Poor
30
00
00
Table 4
Health Insurance Coverage of the Nonelderly, 2005
Nonelderly
Percent Distribution by Coverage Type
Uninsured
Private
Public
(millions)
Employer
Individual
Medicaid
Otheri
257.4
60.8%
5.4%
13.5%
2.4%
17.9%
Children - Total
77.9
56.4%
4.4%
26.1%
1.4%
11.6%
Adults - Total
Adults 19-24
Adults 25-34
Adults 35-44
Adults 45-54
Adults 55-64
179.5
23.9
39.1
42.8
42.7
31.0
62.7%
43.6%
58.9%
67.5%
70.0%
65.3%
5.8%
10.6%
4.2%
4.6%
5.3%
6.6%
8.0%
11.3%
8.8%
7.3%
6.7%
7.6%
2.8%
1.7%
1.5%
1.8%
2.8%
6.8%
20.7%
32.8%
26.6%
18.9%
15.3%
13.6%
61.2
53.4
142.9
18.4%
51.4%
82.4%
6.7%
5.9%
4.7%
33.8%
15.7%
4.0%
4.0%
2.8%
1.6%
37.1%
24.3%
7.3%
<100%
100-199%
...100-149%
...150-199%
200-399%
...200-299%
...300-399%
400%+
45.9
44.8
22.2
22.6
74.4
40.5
33.9
92.3
14.2%
38.6%
30.2%
46.8%
71.0%
64.9%
78.3%
86.4%
6.2%
6.0%
6.0%
6.1%
5.6%
6.1%
5.0%
4.6%
39.8%
22.0%
27.3%
16.9%
6.6%
8.6%
4.1%
1.9%
3.3%
3.6%
3.9%
3.3%
2.4%
2.6%
2.1%
1.4%
36.5%
29.8%
32.7%
27.0%
14.4%
17.8%
10.4%
5.7%
Single Adults Living Alone
Single Adults Living Together
Married Adults
19.1
29.7
52.8
60.2%
43.7%
69.1%
8.9%
8.5%
5.5%
9.5%
9.7%
4.7%
4.7%
2.8%
3.8%
16.7%
35.4%
16.9%
1 Parent with childrenc
2 Parents with childrenc
Multigenerational/Other with childrend
31.9
111.3
12.7
37.9%
70.9%
35.7%
4.9%
4.2%
3.9%
36.6%
11.1%
28.6%
1.3%
1.5%
2.5%
19.3%
12.2%
29.2%
2 Full-time
1 Full-time
Only Part-timee
Non-Workers
71.5
137.9
17.7
30.3
83.1%
63.2%
29.9%
15.0%
3.1%
5.5%
12.2%
6.6%
4.5%
10.8%
25.1%
40.4%
1.1%
1.6%
3.2%
8.5%
8.3%
18.9%
29.6%
29.4%
White only (non-Hispanic)
Black only (non-Hispanic)
Hispanic
Asian/S. Pacific Islander only
Am. Indian/Alaska Native
Two or More Races f
166.6
32.6
40.8
11.8
1.5
4.2
68.7%
47.5%
39.5%
63.4%
42.9%
55.1%
6.3%
3.2%
3.1%
6.9%
2.4%
5.1%
9.3%
-0.4%
21.6%
8.6%
19.7%
22.4%
2.5%
3.2%
1.6%
1.7%
3.0%
3.6%
13.2%
20.9%
34.3%
19.4%
32.0%
13.9%
225.8
11.0
5.0
15.6
62.8%
62.3%
32.0%
40.2%
5.5%
6.3%
5.5%
3.8%
14.0%
7.7%
10.5%
11.2%
2.5%
1.9%
0.8%
1.3%
15.2%
21.8%
51.3%
43.5%
177.8
58.2
21.5
66.0%
53.8%
36.3%
5.9%
4.5%
3.6%
10.8%
16.1%
29.3%
1.4%
2.4%
10.2%
15.8%
23.3%
20.7%
Total - Nonelderlya
Age
Annual Family Income
<$20,000
$20,000 - $39,999
$40,000 +
Family Poverty Levelb
Household Type
Family Work Status
Race/Ethnicity
Citizenship
U.S. citizen - native
U.S. citizen - naturalized
Non-U.S. citizen, resident for < 5 years
Non-U.S. citizen, resident for 5+ years
Health Status
Excellent/Very Good
Good
Fair/Poor
( ) = Estimate has a large 95% confidence interval of +/- 5.0 - 7.9 percentage points. Estimates with larger margins of error are not provided.
31
Table 5
Health Insurance Coverage of Children, 2005
Percent Distribution by Coverage Type
Uninsured
Private
Public
Children
(millions)
Total - Childreng
Employer
Individual
Medicaid
Otheri
77.9
56.4%
4.4%
26.1%
1.4%
11.6%
<1
1-5
6-18
4.1
20.3
53.5
48.5%
53.7%
58.0%
2.6%
3.3%
5.0%
33.5%
31.1%
23.7%
1.5%
1.7%
1.3%
13.9%
10.1%
12.0%
<$20,000
$20,000 - $39,999
$40,000 +
18.6
14.9
44.4
13.9%
39.4%
79.9%
3.6%
4.6%
4.7%
58.9%
37.5%
8.6%
1.5%
1.5%
1.4%
22.1%
16.9%
5.4%
<100%
100-199%
...100-149%
...150-199%
200-399%
...200-299%
...300-399%
400%+
17.7
15.5
7.8
7.6
22.6
12.8
9.9
22.1
13.3%
38.2%
29.1%
47.6%
72.2%
65.6%
80.6%
87.5%
3.3%
4.4%
4.0%
4.9%
5.2%
5.4%
4.8%
4.6%
59.5%
39.0%
46.1%
31.5%
13.1%
17.3%
7.7%
3.7%
1.5%
1.6%
1.6%
1.7%
1.8%
1.8%
1.8%
0.9%
22.3%
16.8%
19.2%
14.4%
7.7%
9.8%
5.1%
3.3%
1 Parent with childrenc
c
2 Parents with children
d
Multigenerational/Other with children
19.0
52.7
5.4
35.1%
68.0%
24.0%
4.4%
4.3%
3.6%
46.0%
17.0%
46.1%
1.0%
1.6%
1.3%
13.5%
9.1%
25.0%
2 Full-time
1 Full-time
Only Part-timee
Non-Workers
22.4
41.8
4.4
9.3
79.0%
57.8%
21.6%
12.1%
3.0%
5.0%
7.6%
3.8%
10.4%
24.1%
54.5%
59.7%
1.1%
1.6%
1.0%
2.0%
6.5%
11.5%
15.3%
22.4%
White only (non-Hispanic)
Black only (non-Hispanic)
Hispanic
Asian/S. Pacific Islander only
Am. Indian/Alaska Native
Two or More Racesf
45.3
11.4
15.4
3.1
0.5
2.1
67.7%
39.1%
35.5%
64.9%
----54.0%
5.8%
2.3%
2.2%
4.9%
2.8%
4.4%
17.7%
44.1%
38.7%
16.0%
----31.2%
1.4%
1.7%
1.2%
1.5%
0.4%
3.3%
7.5%
12.9%
22.4%
12.8%
(27.5%)
7.2%
U.S. citizen
Non-U.S. citizen, resident for < 5 years
Non-U.S. citizen, resident for 5+ years
75.1
1.2
1.6
57.3%
28.7%
34.5%
4.5%
4.0%
2.6%
26.2%
21.8%
26.3%
1.5%
1.0%
0.8%
10.6%
(44.5%)
35.8%
63.1
13.1
1.8
60.8%
39.2%
27.7%
4.8%
3.0%
2.0%
22.3%
40.4%
58.1%
1.5%
1.3%
1.8%
10.7%
16.1%
10.4%
Age
Annual Family Income
Family Poverty Levelb
Household Typeh
Family Work Status
Race/Ethnicity
Citizenship
Health Status
Excellent/Very Good
Good
Fair/Poor
( ) = Estimate has a large 95% confidence interval of +/- 5.0 - 7.9 percentage points. Estimates with larger margins of error are not provided.
32
00
00
Table 6
Health Insurance Coverage of the Low-Income Nonelderly, 2005
(Less than 200% of Poverty)
Percent Distribution by Coverage Type
Public
Private
Uninsured
Low-Income
Nonelderly
(millions)
Total - Low-Income Nonelderly
a
Employer
Individual
Medicaid
Other
i
90.7
26.2%
6.1%
31.0%
3.4%
33.2%
Children - Total
33.2
24.9%
3.8%
49.9%
1.6%
19.8%
Adults - Total
Adults 19-24
Adults 25-34
Adults 35-44
Adults 45-54
Adults 55-64
57.5
13.8
14.8
11.9
9.6
7.4
27.0%
25.5%
26.7%
29.6%
26.7%
26.8%
7.4%
12.1%
4.7%
5.2%
6.4%
8.9%
20.1%
16.4%
19.5%
20.8%
23.4%
23.0%
4.5%
1.6%
2.1%
3.4%
6.6%
13.7%
40.9%
44.3%
47.0%
41.0%
36.9%
27.6%
61.2
25.6
3.9
18.4%
40.3%
56.8%
6.7%
4.8%
5.1%
33.8%
26.2%
19.9%
4.0%
2.3%
2.1%
37.1%
26.4%
16.2%
<100%
100-199%
...100-149%
...150-199%
45.9
44.8
22.2
22.6
14.2%
38.6%
30.2%
46.8%
6.2%
6.0%
6.0%
6.1%
39.8%
22.0%
27.3%
16.9%
3.3%
3.6%
3.9%
3.3%
36.5%
29.8%
32.7%
27.0%
Single Adults Living Alone
Single Adults Living Together
Married Adults
6.5
15.4
9.9
25.3%
19.9%
29.3%
11.8%
10.8%
7.9%
24.2%
16.6%
14.8%
9.3%
4.1%
6.7%
29.6%
48.6%
41.3%
1 Parent with childrenc
21.2
21.8%
3.3%
50.0%
1.5%
23.3%
2 Parents with childrenc
29.1
33.7%
4.4%
29.8%
2.2%
29.8%
Multigenerational/Other with childrend
8.6
20.4%
4.0%
38.1%
2.7%
34.9%
2 Full-time
1 Full-time
Only Part-timee
Non-Workers
5.9
45.4
12.7
26.6
42.4%
34.9%
20.0%
10.8%
4.7%
5.0%
11.0%
6.0%
23.3%
24.1%
32.3%
44.0%
1.7%
1.6%
2.3%
7.5%
27.8%
34.4%
34.4%
31.7%
White only (non-Hispanic)
Black only (non-Hispanic)
Hispanic
Asian/S. Pacific Islander only
Am. Indian/Alaska Native
Two or More Racesf
42.8
17.8
23.7
3.8
0.9
1.7
30.7%
23.0%
20.0%
31.8%
(19.9%)
24.4%
8.9%
3.5%
2.7%
9.6%
1.2%
4.6%
27.3%
40.9%
31.3%
19.4%
(31.1%)
44.8%
4.4%
3.7%
1.7%
2.2%
4.1%
3.9%
28.7%
28.8%
44.3%
37.0%
(44.5%)
22.3%
75.6
3.4
3.1
8.6
27.2%
31.0%
16.2%
20.0%
6.4%
6.8%
5.7%
3.5%
33.9%
19.0%
13.6%
16.9%
3.8%
2.8%
1.0%
1.5%
28.8%
40.2%
63.5%
58.1%
54.2
24.2
12.3
30.3%
23.3%
14.3%
7.6%
4.2%
3.2%
27.8%
31.8%
43.8%
1.8%
3.0%
11.5%
32.5%
37.6%
27.3%
Age
Annual Family Income
<$20,000
$20,000 - $39,999
$40,000 +
b
Family Poverty Level
Household Type
Family Work Status
Race/Ethnicity
Citizenship
U.S. citizen - native
U.S. citizen - naturalized
Non-U.S. citizen, resident for < 5 years
Non-U.S. citizen, resident for 5+ years
Health Status
Excellent/Very Good
Good
Fair/Poor
( ) = Estimate has a large 95% confidence interval of +/- 5.0 - 7.9 percentage points. Estimates with larger margins of error are not provided.
33
Table 7
Health Insurance Coverage of the Nonelderly
by State, 2004-2005
Nonelderly
United States
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Percent Distribution by Coverage Type
Private
Public
(thousands)a
Employer
Individual
Medicaid
Other
256,260
3,962
601
5,131
2,369
31,896
4,146
3,030
723
479
14,773
8,050
1,058
1,269
11,064
5,497
2,521
2,331
3,550
3,687
1,125
4,883
5,608
8,788
4,519
2,500
4,937
787
1,524
2,122
1,134
7,627
1,667
16,539
7,450
538
9,891
2,960
3,128
10,445
926
3,613
654
5,062
20,208
2,267
538
6,538
5,435
1,522
4,751
439
60.9%
60.6%
55.4%
53.2%
53.4%
53.5%
63.7%
69.8%
67.4%
55.8%
55.3%
57.9%
69.8%
60.3%
66.6%
64.7%
68.4%
67.4%
61.4%
55.8%
59.1%
68.0%
67.1%
67.0%
71.4%
52.6%
63.4%
53.5%
65.8%
65.0%
75.5%
71.0%
49.6%
60.4%
59.8%
64.4%
67.7%
55.7%
60.4%
67.6%
63.4%
57.9%
59.5%
56.4%
53.4%
63.3%
59.4%
67.5%
63.0%
58.3%
67.6%
60.6%
5.5%
3.6%
4.4%
5.8%
6.3%
7.5%
7.8%
4.5%
3.5%
6.2%
5.6%
4.5%
3.4%
8.4%
4.9%
4.5%
8.1%
7.1%
4.1%
5.4%
4.7%
4.6%
4.4%
4.5%
8.3%
4.4%
5.9%
9.0%
8.2%
4.6%
4.6%
3.0%
5.0%
4.4%
5.5%
10.7%
4.1%
4.6%
6.8%
6.0%
4.4%
4.5%
10.7%
6.0%
4.5%
7.9%
4.9%
4.6%
6.0%
2.5%
6.4%
8.1%
13.6%
15.9%
15.9%
17.4%
16.3%
16.5%
7.4%
11.2%
11.2%
22.2%
11.6%
14.5%
10.9%
12.7%
10.9%
12.8%
11.8%
10.6%
15.3%
16.0%
21.5%
9.1%
14.9%
14.1%
9.2%
20.3%
14.4%
12.1%
10.9%
7.0%
6.0%
8.0%
18.3%
19.0%
13.2%
8.7%
12.8%
13.7%
12.5%
12.2%
17.4%
15.5%
12.1%
17.4%
12.5%
10.6%
20.7%
7.8%
12.4%
15.4%
12.8%
11.0%
2.3%
3.6%
5.6%
2.3%
4.1%
1.5%
2.7%
1.5%
2.5%
1.3%
3.4%
3.3%
5.3%
1.5%
1.7%
2.1%
1.3%
2.4%
3.8%
2.5%
2.8%
2.4%
1.5%
1.4%
1.4%
3.4%
2.1%
4.1%
2.2%
3.1%
2.0%
1.3%
3.4%
1.1%
3.9%
2.9%
1.8%
3.8%
1.5%
1.4%
2.0%
3.4%
3.7%
4.1%
2.5%
1.5%
2.1%
4.6%
3.5%
3.8%
1.7%
3.5%
Uninsured
i
17.7%
16.3%
18.6%
21.3%
19.8%
21.0%
18.4%
12.9%
15.4%
14.5%
24.1%
19.9%
10.7%
17.1%
15.9%
15.9%
10.4%
12.4%
15.4%
20.2%
12.0%
15.9%
12.1%
13.0%
9.7%
19.3%
14.1%
21.4%
13.0%
20.3%
11.9%
16.5%
23.6%
15.1%
17.7%
13.3%
13.5%
22.1%
18.8%
12.9%
12.8%
18.6%
14.0%
16.1%
27.2%
16.7%
12.9%
15.5%
15.2%
20.0%
11.5%
16.8%
( ) = Estimate has a large 95% confidence interval of +/- 5.0 - 7.9 percentage points. Estimates with larger margins of
error are not provided.
34
00
00
Table 8
Health Insurance Coverage of Children
by State, 2004-2005
Percent Distribution by Coverage Type
Public
Private
Children
g
Employer
Individual
Medicaid
77,836
1,153
195
1,659
719
10,157
1,234
880
207
119
4,250
2,467
311
413
3,442
1,680
728
722
1,041
1,168
304
1,448
1,588
2,686
1,315
810
1,476
228
462
662
320
2,296
524
4,831
2,299
154
2,927
899
918
3,002
268
1,072
200
1,490
6,706
806
144
1,935
1,602
410
1,383
125
56.4%
56.4%
49.3%
47.7%
45.8%
49.1%
62.0%
68.8%
63.2%
(44.1%)
51.7%
50.2%
64.0%
54.7%
63.1%
59.7%
64.0%
63.0%
56.4%
50.8%
54.1%
64.1%
67.7%
63.4%
70.1%
41.9%
56.7%
52.4%
63.0%
65.8%
74.0%
70.1%
40.7%
56.4%
55.5%
60.6%
63.6%
47.2%
57.0%
62.3%
57.4%
52.2%
53.1%
54.7%
47.3%
61.4%
50.5%
65.8%
57.3%
54.5%
63.6%
57.0%
4.5%
2.8%
3.7%
4.9%
5.2%
6.2%
6.5%
3.2%
2.8%
3.1%
4.7%
3.4%
2.1%
9.3%
4.5%
3.4%
6.4%
6.1%
3.3%
5.2%
3.9%
4.0%
3.8%
3.5%
6.6%
3.9%
5.8%
5.9%
5.7%
3.3%
3.8%
2.5%
2.0%
3.3%
4.8%
8.4%
3.5%
4.1%
7.5%
4.7%
4.1%
3.7%
8.9%
4.2%
3.5%
6.5%
3.5%
3.5%
4.5%
2.4%
4.4%
5.1%
26.3%
33.4%
30.8%
29.8%
38.6%
30.1%
14.8%
19.3%
20.1%
(45.2%)
24.5%
32.0%
21.6%
24.4%
20.7%
26.8%
22.7%
22.6%
30.3%
34.7%
33.1%
20.7%
22.5%
26.7%
16.3%
39.2%
28.3%
24.8%
24.0%
13.6%
15.3%
16.2%
37.9%
31.9%
24.6%
18.2%
23.9%
31.5%
24.5%
23.0%
29.5%
32.7%
25.9%
29.4%
27.2%
19.3%
39.0%
17.1%
26.6%
32.8%
24.6%
24.4%
(thousands)
United States
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Other
Uninsured
i
1.4%
1.3%
7.1%
1.3%
1.0%
1.0%
2.4%
0.5%
2.0%
0.1%
1.9%
2.5%
6.7%
0.7%
0.6%
0.6%
0.8%
1.4%
2.2%
0.8%
1.8%
1.7%
0.5%
0.5%
0.5%
1.9%
0.8%
1.6%
1.2%
1.6%
0.7%
0.2%
1.5%
0.5%
3.5%
3.1%
0.7%
2.6%
0.1%
0.7%
1.5%
2.0%
3.0%
2.0%
1.7%
0.9%
1.1%
4.7%
3.6%
1.7%
0.8%
2.6%
11.4%
6.1%
9.2%
16.3%
9.4%
13.6%
14.3%
8.2%
11.9%
7.6%
17.2%
11.9%
5.6%
10.9%
11.2%
9.6%
6.1%
6.9%
7.9%
8.7%
7.2%
9.5%
5.5%
5.9%
6.5%
13.1%
8.4%
15.4%
6.1%
15.8%
6.3%
10.9%
17.9%
8.0%
11.6%
9.6%
8.3%
14.5%
10.9%
9.4%
7.6%
9.5%
9.0%
9.7%
20.4%
11.9%
5.9%
8.8%
8.0%
8.7%
6.7%
10.9%
( ) = Estimate has a large 95% confidence interval of +/- 5.0 - 7.9 percentage points. Estimates with larger
margins of error are not provided.
35
Table 9
Health Insurance Coverage of the Low-Income Nonelderly
(Less than 200% of Poverty) by State, 2004-2005
Low-Income
% of
Nonelderly
Nonelderly with
(thousands)
United States
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
a
90,251
1,582
181
2,100
1,000
12,673
1,229
771
221
196
5,285
3,020
333
452
3,495
1,815
738
785
1,387
1,636
364
1,348
1,551
2,887
1,029
1,155
1,637
320
456
751
231
1,917
736
6,050
2,726
163
3,176
1,165
1,159
3,361
294
1,403
212
1,956
8,628
781
141
1,891
1,664
616
1,450
130
Low Incomes
35.2%
39.9%
30.2%
40.9%
42.2%
39.7%
29.7%
25.4%
30.6%
-0.4%
35.8%
37.5%
31.5%
35.6%
31.6%
33.0%
29.3%
33.7%
39.1%
44.4%
32.4%
27.6%
27.7%
32.8%
22.8%
46.2%
33.2%
40.6%
29.9%
35.4%
20.4%
25.1%
44.2%
36.6%
36.6%
30.2%
32.1%
39.4%
37.1%
32.2%
31.7%
38.8%
32.4%
38.6%
42.7%
34.4%
26.3%
28.9%
30.6%
40.5%
30.5%
29.6%
b
Percent Distribution by Coverage Type
Public
Private
Employer
26.4%
25.3%
19.4%
23.1%
25.2%
21.7%
28.3%
27.6%
30.7%
22.0%
26.0%
25.9%
40.5%
29.8%
28.5%
30.5%
28.7%
34.6%
28.4%
25.4%
20.2%
29.3%
25.0%
31.4%
29.4%
22.8%
26.4%
26.9%
30.9%
37.3%
35.4%
31.0%
19.7%
26.0%
25.3%
31.7%
30.2%
26.5%
26.2%
31.4%
26.4%
24.7%
25.6%
22.5%
23.1%
33.5%
19.7%
33.9%
25.0%
26.4%
33.0%
25.5%
Individual
6.1%
5.2%
4.2%
6.3%
6.8%
6.7%
8.9%
5.8%
4.6%
6.2%
4.9%
5.0%
4.1%
7.8%
6.2%
4.3%
11.9%
9.3%
5.2%
5.6%
5.6%
5.9%
6.4%
5.1%
13.9%
5.0%
6.9%
9.2%
9.6%
4.6%
8.8%
4.5%
4.6%
5.4%
6.3%
15.9%
5.6%
4.6%
8.1%
9.2%
5.6%
5.0%
12.1%
6.4%
4.2%
11.7%
7.2%
5.6%
8.3%
2.6%
8.5%
8.8%
Medicaid
31.3%
35.1%
38.6%
32.8%
30.4%
33.9%
19.7%
34.9%
30.1%
47.5%
24.0%
31.0%
28.7%
30.8%
29.2%
32.8%
32.2%
26.6%
33.1%
31.2%
50.9%
26.1%
41.3%
35.6%
30.3%
38.2%
35.5%
25.2%
29.6%
16.3%
19.8%
24.9%
33.9%
40.7%
30.5%
21.9%
33.9%
28.1%
29.1%
29.8%
40.9%
33.6%
31.4%
37.7%
24.6%
24.1%
48.2%
22.2%
32.2%
32.6%
32.3%
30.6%
Other
Uninsured
i
3.4%
6.4%
6.1%
2.7%
5.7%
2.0%
3.6%
3.5%
4.8%
2.1%
3.8%
4.5%
6.0%
2.1%
3.3%
3.8%
2.6%
3.6%
5.9%
3.7%
3.3%
4.3%
2.8%
2.6%
2.3%
4.5%
3.8%
4.6%
2.7%
4.8%
5.1%
2.9%
3.9%
1.6%
5.1%
4.6%
3.1%
4.8%
2.3%
3.2%
3.4%
5.0%
4.8%
5.8%
3.2%
1.8%
4.2%
6.1%
4.6%
5.9%
3.4%
4.4%
32.7%
28.1%
31.7%
35.2%
31.9%
35.7%
39.5%
28.3%
29.8%
22.2%
41.3%
33.6%
20.6%
29.5%
32.9%
28.6%
24.6%
25.9%
27.3%
34.1%
19.9%
34.4%
24.5%
25.3%
24.2%
29.5%
27.4%
34.0%
27.2%
37.0%
30.9%
36.6%
38.0%
26.3%
32.8%
25.8%
27.2%
36.0%
34.3%
26.4%
23.7%
31.7%
26.1%
27.6%
44.9%
29.0%
20.8%
32.2%
29.9%
32.6%
23.0%
30.8%
( ) = Estimate has a large 95% confidence interval of +/- 5.0 - 7.9 percentage points. Estimates with larger margins of error are not provided.
36
00
00
Table Endnotes
The term family as used in family income, family poverty levels, and family work status, is
defined as a health insurance unit (those who are eligible as a group for "family" coverage
in a health plan) throughout this report.
a
Nonelderly includes all individuals under age 65.
b
The 2005 federal poverty level for a family of four was $19,971.
c
Parent includes any person with a dependent child.
d
Multigenerational/other families with children include families with at least three generations
in a household, plus families in which adults are caring for children other than their own
(e.g., a niece living with her aunt).
e
Part-time workers were defined as working < 35 hours per week.
f
For the first time in 2003, respondents could identify themselves in more than one racial group.
Since there is no way of knowing how people who reported more than one race in 2003
previously reported their race, comparisons in health insurance coverage by race/ethnicity
cannot be made with earlier years.
g
Children includes all individuals under age 19.
h
Approximately 1% of children live in households with no adult, three-quarters of whom are 17-18 years old.
i
Other includes other public insurance (mostly Medicare and military-related).
SCHIP is included in Medicaid.
37
Data Notes
Much of the health insurance coverage information in this primer (including data in the tables) is based on a
collaborative analysis of the Census Bureau’s March Current Population Survey (CPS; Annual Social and
Economic Supplement) by analysts at the Kaiser Commission on Medicaid and the Uninsured and the
Urban Institute. The CPS supplement is the primary source of annual health insurance coverage
information in the United States.
While other ongoing national surveys may be able to more precisely determine health coverage over a
specific time period, the CPS remains the most frequently cited national survey on health insurance
coverage. Since the CPS began asking questions about health insurance in 1980, its design has been
changed a number of times so that better estimates of the number of people with health coverage could be
obtained. Despite these changes, the CPS remains the best survey for trending changes in health
insurance from year to year.
29
38
00
00
Endnotes
Kaiser Family Foundation and Health Research and Educational Trust. 2006. Employer Health Benefits
2006 Annual Survey. (#7527; September).
1
2
Kaiser Family Foundation and Health Research and Educational Trust. 2006.
Collins S, et al. 2006. Squeezed: Why Rising Exposure to Health Care Costs Threatens the Health and
Financial Well-being of American Families. The Commonwealth Fund. (September).
3
Georgetown Center for Children and Families analysis of FY 2003 Medicaid Statistical Information System
(MSIS) and SCHIP enrollment data.
4
Holahan J and A Cook. 2005. Are Immigrants Responsible for Most of the Growth of the Uninsured?
Kaiser Commission on Medicaid and the Uninsured paper (#7411; October).
5
Davidoff AJ and G Kenney. 2005. Uninsured Americans with Chronic Health Conditions: Key Findings
from the National Health Interview Survey. Available at: http://www.urban.org/publications/411161.html.
6
7
Kaiser Family Foundation. 2004. Kaiser 2003 Health Insurance Survey. (#7204; October).
Kaiser Commission on Medicaid and the Uninsured. 2003. Access to Care for the Uninsured: An Update.
(# 4142; September).
8
9
Kaiser Commission on Medicaid and the Uninsured. 2003.
10
NewsHour with Jim Lehrer/Kaiser Family Foundation National Survey on the Uninsured. March 2003.
11
Institute of Medicine. 2002. Health Insurance is a Family Matter. Washington, DC.
Haley J and S Zuckerman. 2003. Is Lack of Coverage a Short-Term or Chronic Condition? Kaiser
Commission on Medicaid and the Uninsured report (#4120; June).
12
Kasper J, T Giovannini, C Hoffman. 2000. “Gaining and Losing Health Insurance: Strengthening the
Evidence for Efforts on Access to Care and Health Outcomes.” MCRR. 57(3): 298-318.
13
14
Hadley J. 2003. “Sicker and Poorer – The Consequences of Being Uninsured.” MCRR. 60(2): 3-76.
15
Institute of Medicine. 2002. Care Without Coverage, Too Little, Too Late. Washington, DC. P. 161-65.
Hadley J and J Holahan. 2004. The Cost of Care for the Uninsured: What Do We Spend, Who Pays, and
What Would Full Coverage Add to Medical Spending? Kaiser Commission on Medicaid and the Uninsured.
Issue Update (# 7084; May). Hadley J and J Holahan. 2003. Who Pays and How Much? The Cost of
Caring for the Uninsured. Kaiser Commission on Medicaid and the Uninsured (# 4088; February).
16
17
Kaiser Commission on Medicaid and the Uninsured. 2003.
18
Kaiser Commission on Medicaid and the Uninsured. 2003.
30
39
Asplin B, et al. 2005. “Insurance Status and Access to Urgent Ambulatory Care Follow-up
Appointments”. JAMA 294(10):1248-54.
19
20
Anderson G. “Price Discrimination in Hospitals.” Forthcoming paper submitted for publication, July 2006.
Kaiser Commission on Medicaid and the Uninsured, 2005 Low-Income Coverage and Access Survey.
Unpublished Data.
21
22
Hadley J and J Holahan, 2004.
Hadley J, M Cravens, T Coughlin, J Holahan. 2005. Federal Spending on the Health Care Safety Net
from 2001-2004: Has Spending Kept Pace with the Growth in the Uninsured? Kaiser Commission on
Medicaid and the Uninsured (#7425; November).
23
24
Hadley J and J Holahan. 2003.
Cunningham PJ and JH May. 2006. “A Growing Hole in the Safety Net: Physician Charity Care Declines
Again.” Center for Studying Health Systems Change Tracking Report.
25
Holahan J and MB Pohl. 2002. “Changes in Insurance Coverage: 1994-2000 and Beyond.” Health
Affairs. Web Exclusive: April 2002.
26
Holahan J and A Cook. 2005. “Changes in Economic Conditions and Health Insurance Coverage, 20002004.” Health Affairs. W5-498-508.
27
28
Kaiser Family Foundation and Health Research and Educational Trust. 2006.
Clemans-Cope L and B Garrett. Changes in Employer-Sponsored Health Insurance Sponsorship,
Eligibility, and Participation: 2001 – 2005. Kaiser Commission on Medicaid and the Uninsured,
Forthcoming October, 2006. (#7570)
29
30
Clemans-Cope L and B Garrett. 2006.
31
Clemans-Cope L and B Garrett. 2006.
32
Clemans-Cope L and B Garrett. 2006.
33
Kaiser Family Foundation and Health Research and Educational Trust, 2006.
34
Clemans-Cope L and B Garrett. 2006.
Georgetown Center for Children and Families analysis of March 2005 Current Population Survey using
July 2004 eligibility rules, unpublished data.
35
Cohen Ross D and L Cox. 2005. In a Time of Growing Need: State Choices Influence Health Coverage
Access for Children and Families. Kaiser Commission on Medicaid and the Uninsured report (# 7393;
October).
36
31
40
00
00
Smith V, K Gifford, E Ellis, A Wiles, R Rudowitz, M O’Malley, and C Marks. 2006. Low Spending Growth
Amid Rebounding State Revenues: Results from a 50-State Medicaid Budget Survey, State Fiscal Years
2006 and 2007. Kaiser Commission on Medicaid and the Uninsured report (October).
37
America’s Health Insurance Plans. 2006. “Over 3 Million Enrolled in High-Deductible/HSA Plans.” Press
Release, January 26, 2006. Obtained on Feb. 14, 2006 from http://www.ahip.org/content/pressrelease.
38
32
41
Select Publications from the
Kaiser Commission on Medicaid and the Uninsured
Available at www.kff.org
Reports/Data Books
Why Did the Number of Uninsured Continue to Increase in 2005?, October 2006 (#7571)
Who are the Uninsured? A Consistent Profile Across National Surveys, August 2006 (#7553)
Changes in Employees’ Health Insurance Coverage, 2001-2005, October 2006 (#7570)
Health Savings Accounts and High Deductible Health Plans: Are They An Option for Low-Income Families?, October
2006 (#7568)
Health Coverage for Low-Income Americans: An Evidence-Based Approach to Public Policy, November 2006
Opening Doorways to Health Care for Children: 10 Steps to Ensure Eligible but Uninsured Children Get Health
Insurance, May 2006 (#7506)
Federal Spending on the Health Care Safety Net: 2001-2004: Has Spending Kept Pace with the Growth in the
Uninsured? November 2005 (#7425)
Are Immigrants Responsible for Most of the Growth of the Uninsured? October 2005 (#7411)
In a Time of Growing Need: State Choices Influence Health Coverage Access for Children and Families, October 2005
(#7393)
Low Medicaid Spending Growth Amid Rebounding State Revenues: Results from a 50-State Medicaid Budget Survey
State Fiscal Years 2006 and 2007, October 2006 (#7569)
What is the Current Population Survey Telling Us About the Number of Uninsured? August 2005 (#7384)
The Economic Downturn and Changes in Health Insurance Coverage, 2000-2003, September 2004 (#7174)
At the Edge: Near-Elderly Americans Talk About Health Insurance, July 2004 (#7127)
Health Insurance Coverage of the Near Elderly, July 2004 (#7114)
The Cost of Care for the Uninsured: What Do We Spend, Who Pays, and What Would Full Coverage Add to Medical
Spending, May 2004 (#7084)
Challenges and Tradeoffs in Low-Income Family Budgets: Implications for Health Coverage, April 2004 (#4147)
Fact Sheets
The Uninsured and Their Access to Health Care, October 2006 (#1420-08)
The Medicaid Program at a Glance, May 2006 (#7235)
Health Coverage for Low-Income Children, September 2004 (#2144-04)
Uninsured Workers in America, July 2004 (#7117)
Kaiser Family Foundation Publication
Employer Health Benefits 2006 Annual Survey, September 2006 (#7527)
42
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