Insurance—Those With and Those Without - Who Was Uninsured In 2002 And 2003?

Not surprisingly, the poor were the income group most likely to be without insurance coverage. In 2002, 30.4% of the nation's poor went without insurance. (See Table 6.2.) Across every demographic category—age, race, citizenship status, education, and work experience—higher proportions of the nation's poor were uninsured in 2002.

According to the U.S. Census Bureau 2002 and 2003 annual social and economic supplements to the Current Population Survey, almost eighty-two million people in the United States, or one in three people under age sixty-five, had no health insurance for at least one month during the past two years. Nearly two-thirds of the uninsured were without coverage for at least six months during 2002 and 2003, and just over half went without benefits for at least nine months.

The same U.S. Census data revealed that the proportion of people who did not have health insurance ranged from about 8.0% in Minnesota, Rhode Island, Wisconsin, and Iowa to 24.1% in Texas, based on three-year averages. New Mexico was the only state where the proportion of people without health coverage fell. In 2003 California had the greatest number of people without health insurance—11.9 million. Texas came in second with 8.5 million, followed by New York with 5.6 million.

Gender, Age, and Race/Ethnicity

More males than females lacked insurance in 2002—16.7% of males lacked insurance, compared to 13.9% of

FIGURE 6.1

females. (See Table 6.1.) As would be expected, those age sixty-five and over were most likely to be covered by insurance, since almost all of them qualified for Medicare. (Some older adults also qualified for Medicaid.) Less than 1% of those over sixty-five went without health insurance in 2002. Persons eighteen to twenty-four years of age were the least likely to have insurance coverage—29.6% of Americans in that age group lacked health insurance in 2002. Persons who were foreign-born were more likely than those born in the United States to be uninsured (33.4 versus 12.8%), and among persons who were foreignborn, those who were not citizens were most likely to be uninsured (43.3%).

Effects of Education Level, Income, and Employment

Education levels and health coverage are closely related. Generally, the better educated a person, the more

FIGURE 6.2

likely he or she is to have a job that offers health insurance and other benefits. In 2002 those who had not completed high school were more than three times as likely to be uninsured as those who held a bachelor's or higher degree (28% versus 8.4%). (See Table 6.1.)

As household income increases, the chances of being uninsured drop dramatically. Table 6.1 shows the 2002 percentages of uninsured persons according to income level and other selected characteristics. While only 8.2% of individuals with an income of $75,000 or more lacked insurance, 23.5% of those with incomes under $25,000 were uninsured. The same was true in 1999—only 7% of high-income individuals were uninsured, while 23.2% of Americans in the lowest income bracket went without insurance.

Not surprisingly, persons who worked full-time were most likely to have health insurance. In 2002 about 17% of full-time workers were uninsured, compared to 23.5% of part-time workers and 25.7% of those who did not work. (See Table 6.1.)

About 55.2% of workers age eighteen to sixty-four had insurance coverage through their employers. Large companies were more likely to provide health insurance

TABLE 6.1

People without health insurance for the entire year, by selected characteristics, 2001 and 2002
(Numbers in thousands)
	2001			2002			Change 2002 less 2001*
		Uninsured			Uninsured		Uninsured
Characteristic	Total	Number	Percent*	Total	Number	Percent	Number	Percent
— Represents zero or rounds to zero.
*Details may not sum to totals because of rounding.
SOURCE: Robert J. Mills and Shailes Bhanderi, "Table 1. People without Health Insurance for the Entire Year by Selected Characteristics: 2001 and 2002," in Health Insurance Coverage in the United States: 2002, U.S. Census Bureau, September 2003, http://www.census.gov/prod/2003pubs/p60-223.pdf (accessed July 10, 2004)
People
Total	282,082	41,207	14.6	28,593	43,574	15.2	2,367	0.6
Sex
Male	137,871	21,722	15.8	139,876	23,327	16.7	1,606	0.9
Female	144,211	19,485	13.5	146,057	20,246	13.9	761	0.4
Age
Under 18 years	72,628	8,509	11.7	73,312	8,531	11.6	22	−0.1
18 to 24 years	27,312	7,673	28.1	27,438	8,128	29.6	456	1.5
25 to 34 years	38,670	9,051	23.4	39,243	9,769	24.9	718	1.5
35 to 44 years	44,284	7,131	16.1	44,074	7,781	17.7	650	1.6
45 to 64 years	65,419	8,571	13.1	67,633	9,106	13.5	535	0.4
65 years and over	33,769	272	0.8	34,234	258	0.8	−14	−0.1
Nativity
Native	249,629	30,364	12.2	252,463	32,388	12.8	2,023	0.7
Foreign born	32,453	10,843	33.4	33,471	11,186	33.4	343	—
Naturalized citizen	11,962	2,060	17.2	12,837	2,251	17.5	191	0.3
Not a citizen	20,491	8,782	42.9	20,634	8,935	43.3	153	0.4
Region
Northeast	53,300	6,399	12.0	54,139	7,057	13.0	658	1.0
Midwest	63,779	6,840	10.7	64,581	7,533	11.7	694	0.9
South	100,652	16,712	16.6	101,800	17,773	17.5	1,061	0.9
West	64,351	11,257	17.5	65,413	11,210	17.1	46	−0.4
Household income
Less than $25,000	62,209	14,474	23.3	62,979	14,776	23.5	302	0.2
$25,000 to $49,999	76,226	13,516	17.7	75,927	14,638	19.3	1,122	1.5
$50,000 to $74,999	58,114	6,595	11.3	58,622	6,904	11.8	309	0.4
$75,000 or more	85,532	6,623	7.7	88,406	7,256	8.2	633	0.5
Education
(18 years and older)
Total	209,454	32,698	15.6	0.2	212,622	35,042	2,344	0.9
No high school diploma	35,423	9,776	27.6	0.7	34,829	9,768	−8	0.4
High school graduate only	66,682	11,618	17.4	0.3	67,512	12,671	1,053	1.3
Some college, no degree	40,282	5,815	14.4	0.5	41,319	6,214	398	0.6
Associate degree	16,183	1,754	10.8	0.7	16,350	1,981	226	1.3
Bachelor's degree or higher	50,884	3,734	7.3	0.3	52,612	4,408	674	1.0
Work experience
(18 to 64 years old)
Total	175,685	32,426	18.5	0.3	178,388	34,785	2,359	1.0
Worked during year	142,474	24,230	17.0	0.3	142,918	25,679	1,449	1.0
Worked full-time	118,776	19,014	16.0	0.3	118,411	19,911	897	0.8
Worked part-time	23,698	5,216	22.0	0.7	24,506	5,767	552	1.5
Did not work	33,211	8,197	24.7	0.7	35,470	9,106	909	1.0

coverage than were smaller firms. Employees of firms with one thousand or more workers were more than twice as likely to receive health insurance benefits as those in firms with twenty-five or fewer employees (68.7 and 30.8%, respectively). (See Figure 6.3.) Many small firms cannot afford health insurance for their employees. Insurers charge higher premiums for small firms because of the higher per person administrative costs of small groups.

The Consequences and Impact of Uninsured Americans

A report prepared for the Kaiser Commission on Medicaid and the Uninsured, "Sicker and Poorer: The Consequences of Being Uninsured" (Jack Hadley, The

TABLE 6.2

People in poverty without health insurance for the entire year, by selected characteristics, 2001 and 2002
(Numbers in thousands.)
	2001			2002			Change 2002 less 2001*
		Uninsured			Uninsured		Uninsured
Characteristic	Total	Number	Percent*	Total	Number	Percent	Number	Percent
— Represents zero or rounds to zero.
*Details may not sum to totals because of rounding.
SOURCE: Robert J. Mills and Shailesh Bhanderi, "Table 2. People in Poverty without Health Insurance for the Entire Year by Selected Characteristics: 2001 and 2002," in Health Insurance Coverage in the United States: 2002, U.S. Census Bureau, September 2003, http://www.census.gov/prod/2003pubs/p60-223.pdf (accessed July 10, 2004)
People
Total	32,907	10,093	30.7	34,570	10,492	30.4	399	−0.3
Sex
Male	14,327	4,854	33.9	15,162	5,042	33.3	188	−0.6
Female	18,580	5,239	28.2	19,408	5,450	28.1	211	−0.1
Age
Under 18 years	11,733	2,497	21.3	12,133	2,434	20.1	−62	−1.2
18 to 24 years	4,449	2,025	45.5	4,536	1,991	43.9	−34	−1.6
25 to 34 years	4,255	2,108	49.5	4,674	2,273	48.6	165	−0.9
35 to 44 years	3,822	1,703	44.6	4,087	1,882	46.0	178	1.5
45 to 64 years	5,234	1,669	31.9	5,564	1,844	33.1	175	1.2
65 years and over	3,414	91	2.7	3,576	67	1.9	−23	−0.8
Nativity
Native	27,698	7,223	26.1	29,012	7,418	25.6	196	−0.5
Foreign born	5,209	2,870	55.1	5,558	3,074	55.3	204	0.2
Naturalized citizen	1,186	377	31.8	1,285	449	35.0	72	3.2
Not a citizen	4,023	2,493	62.0	4,273	2,625	61.4	132	−0.5
Region
Northeast	5,687	1,504	26.4	5,871	1,394	23.7	−110	−2.7
Midwest	5,966	1,546	25.9	6,616	1,798	27.2	252	1.3
South	13,515	4,366	32.3	14,019	4,617	32.9	252	0.6
West	7,739	2,677	34.6	8,064	2,682	33.3	5	−1.3
Education
(18 years and older)
Total	21,174	7,596	35.9	22,437	8,058	35.9	461	—
No high school diploma	8,033	2,992	37.2	8,221	3,113	37.9	122	0.6
High school graduate only	7,029	2,523	35.9	7,487	2,728	36.4	205	0.5
Some college, no degree	3,392	1,194	35.2	3,678	1,231	33.5	37	−1.7
Associate degree	886	314	35.4	929	301	32.3	−13	−3.1
Bachelor's degree or higher	1,832	574	31.3	2,122	684	32.3	−13	−3.1
Work experience
(18 to 64 years old)
Total	17,760	7,506	42.3	18,861	7,990	42.4	485	0.1
Worked during year	8,172	3,978	48.7	8,608	4,080	47.4	102	−1.3
Worked full-time	5,121	2,575	50.3	5,277	2,603	49.3	28	−1.0
Worked part-time	3,051	1,403	46.0	3,331	1,477	44.4	74	−1.6
Did not work	9,588	3,528	36.8	10,253	3,910	38.1	382	1.3

Cost of Not Covering the Uninsured Project, Washington, DC: The Urban Institute, May 2002, updated May 2003), contained an exhaustive review of the literature detailing the major findings of more than twenty-five years of health services research on the effects of health insurance. The report found that the uninsured receive less preventive care, are diagnosed at more advanced stages of disease, and receive less treatment as measured in terms of pharmaceutical and surgical interventions.

In addition to receiving less medical care and treatment, uninsured persons often pay more for medical care. In a June 25, 2004, article, "Uninsured Patients Pay Far More for Care," (Associated Press, http//www.CNN.com), Lara Jakes Jordan reported that hospitals routinely overcharge persons without health insurance—as much as four times more than insured hospital patients are charged. The overcharging is attributed to hospitals' efforts to recoup the costs of providing care to persons who are indigent.

The Kaiser Commission report also concluded that if the uninsured were provided with health insurance, their mortality rates would be reduced by between 10 and 15%. The reduction in mortality would largely result from improved access to timely and appropriate care. This finding supports the Institute of Medicine (IOM) estimate that eighteen thousand

FIGURE 6.3

Americans die each year because they lack health insurance. Further, better health would enable uninsured persons to improve their annual earnings by 10 to 30% and would also act to increase their educational attainment.