Ascension Health
Advocacy Environmental Assessment
Health Status and Needs of the Poor:
Policy Update
Sara Rosenbaum*
Harold and Jane Hirsh Professor, Health Law and Policy
Director, Center for Health Services Research and Policy
The George Washington University Medical Center
School of Public Health and Health Services
September, 2001
* With thanks to Dylan Roby for assistance with the preparation of the figures shown
in this analysis, as well as the Henry J. Kaiser Family Foundation for allowing
reproduction of figures contained in its reports.
Figure 1: Poverty Rate by Age: 1959-1999
Source: U.S. Census Bureau Poverty Statistics, 2000
Figure 2: Poverty Rate by Race and Hispanic
Origin: 1959-1999
Source: U.S. Census Bureau Poverty Statistics, 2000
Figure 3: Poverty Rates of People in Families by
Family Type and Presence of Workers: 1959-1999
Source: U.S. Census Bureau Poverty Statistics, 2000
Figure 4: Three-Year Average Poverty Rates by
State, 1997-1999
Source: U.S. Census Bureau Poverty Statistics, 2000
Figure 5: Growth in the Number of Uninsured
Americans: 1988-1999
Millions of Nonelderly Uninsured
45
40
35
33.6
34.3
35.6
1988
1989
1990
36.3
1991
38.3
39.3
39.4
1992
1993
1994
40.3
41.4
1995
1996
43.1
43.9
42.1
1997
1998
1999
30
25
20
15
10
5
0
Source: Kaiser Commission on Medicaid and the Uninsured, The Uninsured: A Primer,
2001 from an analysis of the March 1989-2000 CPS by the Employee Benefits Research
Institute, 2000.
Figure 6: The Nonelderly Uninsured by Poverty
Level and Work Status, 1999
300% of
FPL and
Above
20%
<100%
FPL
36%
200-299%
FPL
15%
2 or More
Full-Time
Workers
16%
Part-time
Workers
12%
No
Workers
18%
100-199%
FPL
29%
Poverty Level
1 FullTime
Worker
54%
Family Work Status
Total: 42 Million Uninsured
Source: Kaiser Commission on Medicaid and the Uninsured, The
Uninsured: A Primer, 2001 with analysis of the March 2000 CPS by the
Urban Institute.
Figure 7: Access to Employer-Based Coverage
for Low and High Wage Workers, 1996
4%
6%
Access
55%
45%
Not Offered
13%
Access
96%
90%
Covered by
Employer
42%
Low-Wage Workers
(Wage $7 per hour or less)
Declined
High-Wage Workers
(Wage $15 per hour or more)
Source: Kaiser Commission on Medicaid and the Uninsured, The Uninsured: A Primer,
2001 from an analysis of the 1996 MEPS and 1987 NMES by Cooper and Schone,
1997.
Figure 8: The Uninsured Population, 1999
Total = 42 Million
Low-Income*
Children
18%
Other Children
7%
Other Adults
28%
Low-Income*
Adults with
Children
22%
* Low Income is defined
as less than 200% of FPL,
or $26,580 for a family of
three in 1999.
Low-Income*
Adults without
Children
25%
Source: Kaiser Commission on Medicaid and the Uninsured, The Uninsured: A Primer,
2001 from an analysis of the March 2000 CPS by the Urban Institute.
Figure 9: The Nonelderly Uninsured by Citizenship,
1999
Non-Citizens,
Residents <6
years
6%
Non-Citizens,
Residents 6+
years
12%
Naturalized
Citizens
4%
Native Citizens
78%
Total = 42 Million
Source: Kaiser Commission on Medicaid and the Uninsured, Health Insurance
Coverage in America, 1999 Data Update. December, 2000.
Figure 10: Sources of Health Insurance Coverage
Among Nonelderly Persons, by Age, Sex and Family
Income, 1999
Children (0-18)
Low-Income
Children
66%
36%
Women (19-64)
Low-Income
Women
0%
40%
75%
43%
14%
24%
8%
21%
18%
Private/
Other
Medicaid
36%
Uninsured
Men (19-64)
Low-Income
Men
20%
75%
43%
20%
4%
13%
40%
21%
44%
60%
80%
100%
Source: Kaiser Commission on Medicaid and the Uninsured, Health Insurance
Coverage in America, 1999 Data Update. December, 2000.
Figure 11: Sources of Health Insurance
Coverage Among Nonelderly Persons by
Citizenship and Family Income Status, 1999
Private/ Other
Medicaid
Uninsured
Non-U.S. Citizen, resident 6 years or more
10%
48%
28%
Low-Income Non-U.S. Citizen, resident 6 or more years
Non-U.S. Citizen, resident <6 years
23%
56%
16%
8%
42%
Low-Income Non-U.S. Citizen, resident <6 years
42%
51%
67%
11%
U.S. Citizen Naturalized
6%
72%
41%
Low-Income U.S. Citizen Naturalized
U.S Citizen Native
44%
15%
11%
74%
42%
Low-Income U.S. Citizen Native
0%
10%
20%
40%
50%
60%
15%
30%
28%
30%
22%
70%
80%
Source: Kaiser Commission on Medicaid and the Uninsured, Health Insurance
Coverage in America, 1999 Data Update. December, 2000.
90% 100%
Figure 12: Sources of Prescription Drug Coverage for
Medicare Beneficiaries, 1998
No drug
coverage
(10.2 million)
27%
Other *
33%
Employersponsored
3%
12%
15%
10%
Medicaid
Medicare
HMO
Medigap
Total = 38.1 million Medicare beneficiaries
*Includes those receiving coverage from other public programs and those in non-risk HMOs.
Note: Data are based on the non-institutionalized population.
Source: Poisal, J.A., and L. Murray. Health Affairs, March/April 2001.
Figure 13: Medicare Beneficiaries without
Prescription Drug Coverage, by Poverty Level,
1998
Less than 100%
of poverty
(2.0 million)
20%
More than
175% of
poverty
(5.2 million)
50%
16%
100-135%
of poverty
(1.6 million)
14%
135-175%
of poverty
(1.4 million)
Total = 10.2 million beneficiaries, 1998
Source: Poisal, J.A., and L. Murray. Health Affairs, March/April 2001.
Note: The federal poverty level was $8,050 for individuals and $10,850 for couples
in 1998.
Figure 14: Problems Obtaining Needed Care Among
Nonelderly Adults, Uninsured vs. Insured, 2000
Did Not Get
Medical Care for a
Serious Condition
Postponed Needed
Medical Care for a
Serious Condition
Did Not Fill
Prescription Due to
Cost
Skipped a
Recommended
Medical Test or
Treatment
3%
20%
5%
28%
Insured
Uninsured
12%
30%
13%
39%
Source: Kaiser Commission on Medicaid and the Uninsured, The Uninsured: A Primer, 2001.
Data from the National Survey on the Uninsured, 2000.
Major diagnostic group
Figure 15: Eligibility Pathway for Medicaid
Beneficiaries with Chronic or Disabling Conditions,
by Major Diagnostic Group, Children
All
Infectious
Cancer
Cardiovascular
Cerebrovascular
Nervous System
Diabetes
Developmental
Eye
Genital
Gastrointestinal
Hematological
Metabolic
Psychiatric
Substance Abuse
Pulmonary
Renal
Skeletal and
Skin
14.6
8.9
16.1
34.6
26.5
14.4
7.2
7.2
19.3
24.3
29.9
17.2
10.2
7.5
13.5
13.8
6.6
0%
45.1
48.5
44.0
45.4
30.5
38.0
48.4
64.7
37.8
47.0
46.1
40.0
32.8
41.2
42.2
52.4
44.4
43.9
54.3
25%
50%
23.6
40.3
42.6
34.8
39.9
31.0
35.6
37.2
9.3
26.0
42.9
45.9
46.7
35.7
37.2
41.6
47.6
40.1
42.1
42.3
39.1
75%
Entered Medicaid
through SSI eligibility
AFDC eligibility
Other eligibility
100%
Percent of Medicaid beneficiaries with special needs
Source: Faces of Medicaid, Center for Healthcare Strategies, 2000
Mathematica Policy Research analysis of HCFA data from the State Medicaid
Research Files for California, Georgia, New Jersey, and Kansas, 1995.
Figure 16: Eligibility Pathway for Medicaid
Beneficiaries with Chronic or Disabling Conditions;
by Major Diagnostic Group, Adults
Major diagnostic group
All
Infectious Disease
Cancer
Cardiovascular
Cerebrovascular
Nervous System
Diabetes
Developmental Disability
Eye
Genital
Gastrointestinal
Hematological
Metabolic
Psychiatric
Substance Abuse
Pulmonary
Renal
Skeletal and Connective
Skin
0%
21.9
51.5
60.6
58.3
58.8
72.0
58.5
61.6
86.9
69.6
54.4
50.3
64.5
67.4
56.2
51.7
47.2
50.7
50.9
52.9
25%
50%
28.3
20.2
19.5
24.9
9.3
24.9
22.4
20.2
19.2
22.2
16.4
18.7
16.7
16.0
0.8 12.3
15.0
15.4
23.7
31.4
18.3
18.5
17.0
18.6
14.0
27.7
16.2
34.7
13.6
33.6
19.2
30.2
19.1
31.3
17.7
29.2
17.9
75%
Entered Medicaid
through SSI eligibility
AFDC eligibility
Other eligibility
100%
Percent of Medicaid beneficiaries with special needs
Source: Faces of Medicaid, Center for Healthcare Strategies, 2000
Mathematica Policy Research analysis of HCFA data from the State Medicaid
Research Files for California, Georgia, New Jersey, and Kansas, 1995.