The working uninsured: who they are, how they have changed, and the consequences of being uninsured--with presidential candidate proposals outlined.

This Issue Brief presents data on workers who do not have health insurance. It offers a description of this population, discusses how this population has changed over time, and reviews the consequences of being uninsured. Also included is a description of the 2000 presidential candidates' proposals to reduce the number of uninsured Americans. The percentage of workers without any form of health insurance has been increasing since at least 1987. In 1998, 18.1 percent of workers were uninsured, up from 14.6 percent in 1987, although most of the increase occurred prior to 1993. Uninsured adult workers made up 56 percent of the uninsured population in 1998. In all, 83.2 percent of the 43.9 million uninsured Americans were in a family with a working family head. The working uninsured are heavily concentrated in certain segments of the population. In 1998, 53 percent of uninsured workers were under age 35, 58 percent were male, 57 percent were white, nearly 90 percent had not received a college diploma, 78 percent worked full time, 20 percent worked in the service industry, 60 percent were employed in small firms or were self-employed, 42 percent earned $7.00 or less per hour, and 99 percent earned less than $50,000 per year. The likelihood of being uninsured increased substantially for certain groups of workers between 1987 and 1998. The highest rates of increase were found among workers ages 55-64 (44 percent), in families at or above 400 percent of the federal poverty level (61 percent), in the public sector (34 percent), in the largest firms (53 percent), with hourly wages of $15.00 or more (50 percent), with annual income between $25,000 and $75,000 (100 percent), and with retirement plans (112 percent). Health insurance makes a difference in health status and access to health care services. Data show that uninsured workers are more likely than insured workers to report that their health status is fair or poor. Compared with insured workers, uninsured workers were more likely to receive health care in a hospital or emergency room, and were less likely to receive it in an office-based setting. Both the major-party presidential candidates, Vice President Al Gore and Texas Gov. George W. Bush, have put forth proposals to reduce the number of uninsured Americans. While both candidates' proposals recognize that the bulk of uninsured Americans are either children or workers employed by small firms, the proposed strategies to deal with these populations are incremental, and are unlikely to have a substantial impact on the number of uninsured Americans.