Sources of health insurance and characteristics of the uninsured: analysis of the March 1998 Current Population Survey.

This Issue Brief provides summary data on the insured and uninsured populations in the nation and in each state. It discusses the characteristics most closely related to individuals' health insurance status. Based on EBRI analysis of the March 1998 Current Population Survey, it represents 1997 data--the most recent data available. In 1997, private or public health insurance, or both, covered 81.7 percent of Americans (193.1 million) at some point. Seventy-one percent of the nonelderly population had private insurance, 64.2 percent through an employment-based plan. Almost 15 percent of the nonelderly had public health insurance. In 1997, 18.3 percent of the nonelderly population was uninsured, compared with 14.8 percent a decade earlier, in 1987. The percentage of uninsured Americans has been increasing since at least 1987. While the increase in the uninsured between 1987 and 1993 can be attributed to the erosion of employment-based health benefits, the portion of Americans covered by employment-based health insurance increased between 1993 (63.5 percent) and 1997 (64.2 percent). The decline in public sources of health insurance would mostly explain the recent increase in the uninsured population. For example, between 1994 and 1996 the percentage of nonelderly Americans covered by CHAMPUS/CHAMPVA declined from 3.8 percent to 2.9 percent, in large part due to downsizing in the military. Similarly, between 1996 and 1997, the percentage of nonelderly Americans covered by Medicaid (the federal-state insurance program for the poor) declined from 12.1 percent to 11.0 percent as people left welfare for the private sector. This follows a decline in Medicaid participation between 1995 and 1996. Between 1996 and 1997 the percentage of nonelderly Americans without health insurance coverage increased from 17.7 percent to 18.3 percent. Further examination indicates that adults ages 18-64 accounted for almost all of this increase. In 1996, 14.8 percent of children and 18.9 percent of persons ages 18-64 were uninsured, compared with 15.0 percent of children and 19.7 percent of persons ages 18-64 in 1997. The decline in Medicaid coverage among nonworking and working adults appears to account for the overall increase in the uninsured. Employment and income play a dominant role in determining an individual's likelihood of having health insurance. In addition, age, gender, firm size, hours of work, and industry are all important determinants of an individual's likelihood of having coverage; however, these variables are also closely linked to employment status and income. Some of the widest variations involve factors that are not always examined in traditional demographic assessments, such as citizenship. However, variations by race, ethnicity, and citizenship are also closely linked to employment status and income.