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Highlights #1: The Uninsured in America, 1996

Health Insurance Status of the U.S. Civilian Noninstitutionalized Population

By Karen M. Beauregard, Susan K. Drilea, Jessica P. Vistnes


Introduction

The Medical Expenditure Panel Survey (MEPS) collects nationally representative data on health care use, expenditures, source of payment, and insurance coverage for the U.S. civilian noninstitutionalized population. MEPS is cosponsored by the Agency for Health Care Research and Quality (AHRQ) and the National Center for Health Statistics (NCHS). Preliminary data from the MEPS Household Component of the Medical Expenditure Panel Survey (MEPS HC), collected in the first several months of 1996, are shown here. Once time-period and definitional differences are considered, these estimates are consistent with the findings of other recent surveys.

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Briefly Stated

  • Seventeen percent of the U.S. population were uninsured throughout the first half of 1996, on average. This represents almost 44.8 million people who were not covered by insurance, private or public. A revised estimate of the uninsured derived from MEPS first-round data, which will incorporate additional data on payment sources, is expected to be lower than this initial estimate.
  • Over 33 percent of Hispanics and 23 percent of blacks were uninsured throughout the first half of 1996. Less than 14 percent of other race/ethnicity groups (including whites) were uninsured.
  • Nearly 25 percent of all uninsured Americans were under 18 years of age. Nearly 11 million children—more than 15 percent of the Nation's noninstitutionalized children—were uninsured throughout the first half of 1996.
  • Among children most likely to be uninsured throughout the first half of 1996 were Hispanics, children living outside metropolitan statistical areas, and those living in families with adults who had less than a high school education.

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Health Insurance Status

Throughout the first half of 1996, Hispanics represented almost 11 percent of the U.S. population but 21 percent of the uninsured. Blacks represented almost 13 percent of the U.S. population and 17 percent of the uninsured. Other race/ethnicity groups (including whites) represented almost 77 percent of the U.S. population and 62 percent of the uninsured. For details, select Figure 1.

Lack of insurance throughout the first half of 1996 was more common in the South (20 percent of the region's population) and West (19 percent) than in the Northeast (14 percent) or Midwest (14 percent). Of all the uninsured in this country, 41 percent lived in the South. To see the percentages of all uninsured American in the regions, select Figure 2.

About 28 percent of Hispanic children under 18 were uninsured throughout the first half of 1996, compared with 18 percent of black children and 12 percent of children of other race/ethnicity groups (including whites). Hispanic children represented almost 15 percent of the Nation's children but 26 percent of the Nation's uninsured children. For details, select Figure 3.

Over 27 percent of children living in families where adults had less than a high school diploma were uninsured throughout the first half of 1996. In comparison, 19 percent of children living in families where adults had completed 12 years of education and less than 11 percent of children living in families where adults had more than 12 years of education were uninsured. Select Figure 4 for more information.

Children living in families with two or more employed adults were just as likely to be uninsured throughout the first half of 1996 (13 percent) as children living in families with no employed adults (15 percent). Of all children uninsured throughout the first half of 1996, 90 percent lived in families with one or more employed adults, the same proportion as represented in the total population; 46 percent lived in families with two or more employed adults. Select Figure 5 for more information.

MEPS Sample Design and Accuracy of Estimates

The sample selected for the 1996 MEPS is a subsample of the 1995 National Health Interview Survey (NHIS), designed to produce statistically unbiased national estimates that are representative of the civilian noninstitutionalized population of the United States. First-round data were obtained for approximately 9,400 households in MEPS, resulting in a survey response rate of 78 percent, which reflects participation in both NHIS and MEPS.

The statistics presented here are affected by both sampling error and sources of nonsampling error, which include nonresponse bias, respondent reporting errors, interviewer effects, and data processing misspecifications. MEPS person-level estimation weights include nonresponse adjustments and post-stratification adjustments to population estimates derived from the March 1996 Current Population Survey (CPS), based on cross-classifications by region, age, race/ethnicity, and sex.

Tests of statistical significance were used to determine whether the differences between populations existed at specified levels of confidence or whether they occurred by chance. Any comparison made in this Highlights is based on tests using Z-scores having asymptotic normal properties, at the .05 level of significance.

Because of methodological differences, use caution when comparing these data with data from other sources. For example, CPS measures persons who are uninsured for a full year; NHIS measures persons who lack insurance at a given point in time--the month before the interview. CPS is conducted annually, and NHIS collects insurance data on a continuous basis each year. In addition, unlike MEPS, CPS counts military veterans whose source of health care is the Department of Veterans Affairs as insured. CPS also counts children of adults covered by Medicaid as being insured. For these preliminary estimates, MEPS does not consider these children insured unless their families report them as such.

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Figures

Figure 1. Race/Ethnicity and Health Insurance Status:  First Half of 1996
Figure 2. Geographic Region and Health Insurance Status: First Half of 1996
Figure 3. Race/Ethnicity and Health Insurance Status of Children: First Half of 1996
Figure 4. Highest Education of Any Adult Family Member and Health Insurance Status of Children: First Half of 1996
Figure 5. Employment Status of Adult Family Members and Health Insurance Status of Children: First Half of 1996

Figure 1. Race/Ethnicity and Health Insurance Status:  First Half of 1996

Figure 1: Race/Ethnicity and Health Insurance Status: First Half of 1996

  • DATA SOURCE: Medical Expenditure Panel Survey, Household Component.

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Figure 2. Geographic Region and Health Insurance Status: First Half of 1996

Figure 2: Geographic Region and Health Insurance Status: First Half of 1996

  • DATA SOURCE: Medical Expenditure Panel Survey, Household Component.

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Figure 3. Race/Ethnicity and Health Insurance Status of Children: First Half of 1996

Figure 3: Race/Ethnicity and Health Insurance Status of Children: First Half of 1996

  • DATA SOURCE: Medical Expenditure Panel Survey, Household Component.

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Figure 4. Highest Education of Any Adult Family Member and Health Insurance Status of Children: First Half of 1996

Figure 4: Highest Education of Any Adult Family Member and Health Insurance Status of Children: First Half of 1996

  • DATA SOURCE: Medical Expenditure Panel Survey, Household Component.

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Figure 5. Employment Status of Adult Family Members and Health Insurance Status of Children: First Half of 1996

Figure 5: Employment Status of Adult Family Members and Health Insurance Status of Children: First Half of 1996

  • DATA SOURCE: Medical Expenditure Panel Survey, Household Component.

Tables

Table 1. Race/Ethnicity and Health Insurance Status:  First Half of 1996
Table 2. Health insurance status of children: U.S. children under 18 years of age, by selected characteristics, first half of 1996

Table 1. Health insurance status: U.S. civilian noninstitutionalized population, by selected characteristics, first half of 1996

Percent Characteristic Population  Percent distribution of population    Percent uninsured Distribution  of uninsured    population  

Percent (standard error)

Total    263,515,813 100.0     17.0 (0.5) 100.0

Age in Years 

Under 18 71,420,710 27.1 (0.4) 15.4 (0.8) 24.5 (1.0) 
18-64 160,255,618  60.8 (0.4) 20.9 (0.5) 74.9 (1.0)
65 or over 31,839,485 12.1 (0.4) 0.9 (0.2) 0.6 (0.2)

Race/Ethnicity

Hispanic 28,384,339 10.8 (0.5) 33.5 (1.6) 21.2 (1.4)
Black 32,974,563 12.5 (0.7) 23.0 (1.3) 16.9 (1.3)
Other 202,156,911 76.7 (0.8) 13.7 (0.5) 61.9 (1.7)

Sex

Male 128,383,237 48.7 (0.3) 18.7 (0.6) 53.5 (0.8)
Female 135,132,576 51.3 (0.3) 15.4 (0.5) 46.5 (0.8)

Perceived Physical Health Status (1)

Excellent 95,602,424 36.3 (0.5) 16.4 (0.7) 35.1 (1.1)
Very good 78,524,536 29.8 (0.4) 15.2 (0.6) 25.4 (0.9)
Fair 21,320,848 8.1 (0.3) 18.3 (1.0) 8.7 (0.5)
Poor 8,225,956 3.1 (0.2) 14.7 (1.6) 2.7 (0.3)
Unknown(2) -- -- -- --

Census Region

Northeast 51,464,265 19.5 (0.8) 13.7 (0.9) 5.7 (1.0)
Midwest  61,827,772  23.5 (0.9) 13.6 (1.0) 18.8 (1.4)
South 91,854,957  34.9 (1.2) 19.9 (0.8) 40.9 (1.8)
West 58,368,819  22.2 (0.8) 18.9 (1.0) 24.6 (1.2)

(1) Physical health status as perceived by respondent.
(2) Cell size too small for reliable estimates.
Note: Percent distributions may not sum to 100 percent due to rounding.
Source: Center for Financing, Access, and Cost Trends, Agency for Health Care Policy and Research: Medical Expenditure Panel Survey, Household Component, 1996 (Round 1).

Table 2. Health insurance status of children: U.S. children under 18 years of age, by selected characteristics, first half of 1996

Percent Characteristic Population  Percent distribution of children in population    Percent uninsured Distribution  of uninsured    children  

Percent (standard error)

Total  Status (1) 71,420,710 100.0 15.4 (0.8) 100.0

Age in Years 

Under 6 24,099,593 33.7 (0.8) 13.2 (1.0) 28.9 (1.8)
6-12 28,285,339 39.6 (0.7) 15.5 (1.0) 40.0 (1.6)
13-17 19,035,778 26.7 (0.7) 17.9 (1.1) 31.1 (1.5)

Race/Ethnicity

Hispanic 10,373,234 14.5 (0.9) 27.6 (1.9) 26.1 (2.2)
Black 11,285,178 15.8 (1.0) 17.5 (2.0) 18.0 (2.2)
Other 49,762,299 69.7 (1.2) 12.3 (0.8) 55.8 (2.7)

Metropolitan Statistical Area

MSA 56,641,290 79.3 (1.3) 14.0 (0.8) 72.1 (2.9)
Non-MSA 14,779,420 20.7 (1.3) 20.7 (2.2) 27.9 (2.9)

Perceived Physical Health Status (2,3)

Excellent 37,063,155 51.9 (0.9) 14.8 (0.9) 49.9 (2.1)
Very good 20,124,942 28.2 (0.8) 14.1 (1.1) 25.9 (1.5)
Good 11,325,060 15.9 (0.6) 18.6 (1.7) 19.2 (1.6)
Fair/Poor 2,770,053 3.9 (0.3) 15.4 (2.5) 3.9 (0.7)

Family size (3)

2 persons 4,312,903 6.0 (0.4) 18.0 (2.6) 7.1 (1.1)
3 persons 12,978,814 18.2 (0.7) 13.7 (1.2) 16.2 (1.5)
4 or more persons 53,979,583 75.6 (0.8) 15.5 (0.9) 76.4 (1.8)

Census Region

Northeast 13,286,659 18.6 (0.9) 10.9 (1.4) 13.2 (1.6)
Midwest  16,919,711 23.7 (1.2) 13.2 (1.6) 20.4 (2.2)
South 24,446,161 34.2 (1.5) 18.7 (1.4) 41.7 (2.9)
West 16,768,178 23.5 (1.2) 16.2 (1.6) 24.7 (2.2)

Highest education of persons 18 or over in family (3)

Less than 12 years 8,827,971 12.4 (0.8) 27.6 (2.5) 22.2 (2.1)
12 years  22,582,319 31.6 (1.0) 18.9 (1.2) 38.9 (2.2)
More than 12 years 39,823,174 55.8 (1.2) 10.6 (0.9) 38.6 (2.7)

Number of persons 18 or over in family (3)

1 12,502,839 17.5 (0.9) 16.5 (1.8) 18.8 (2.1)
2 or more 58,730,625 82.2 (0.9) 15.1 (0.8) 80.8 (2.1)

Number of employed persons 18 or over in family (3,4)

0 7,211,407 10.1 (0.7) 15.0 (2.0) 9.9 (1.3)
1 25,688,027 36.0 (1.0) 18.5 (1.4) 43.4 (2.5)
2 or more 38,334,029 53.7 (1.1) 13.3 (1.0) 46.4 (2.6)

Age of oldest person in family (3)

18-24 2,558,956 3.6 (0.3) 19.2 (3.8) 4.5 (0.9)
25-34 17,955,536 25.1 (1.0) 14.7 (1.4) 24.0 (2.0)
35-44 33,253,478 46.6 (1.0) 14.6 (1.1) 44.2 (2.3)
45 and over 17,465,493 24.5 (0.9) 16.9 (1.3) 26.9 (2.0)

(1) Includes persons with unknown perceived physical health status and persons living alone or in families with either no adult members or whose adult members have missing information on education. In a reporting unit, families consist of all persons related by blood or marriage.
(2) Physical health status as perceived by respondent.
(3) Percent distributions may not sum to 100 percent. See footnote 1 for details.
(4) Individuals are counted as employed if they are employed at the Round 1 interview date.
Note: Percent distributions may not sum to 100 percent due to rounding.
Source: Center for Financing, Access, and Cost Trends, Agency for Health Care Policy and Research: Medical Expenditure Panel Survey, Household Component, 1996 ( Round 1).

References

For more information on MEPS, call the MEPS information coordinator at AHRQ (301/594-1406) or select "Data: Public Use Data File Index".

For a detailed description of the MEPS survey design, sample design, and methods used to minimize sources of nonsampling error, see:

Cohen S. Sample design of the 1996 Medical Expenditure Panel Survey Household Component. Rockville (MD): Agency for Health Care Policy and Research; 1997. AHRQ Pub. No. 97-0027.

Cohen J. Design and methods of the Medical Expenditure Panel Survey Household Component. Rockville (MD): Agency for Health Care Policy and Research; 1997. AHRQ Pub. No. 97-0026.

For detailed data on which the 1996 numbers in this Highlights were based, a set of two tables ("Medical Expenditure Panel Survey Insurance Status Tables: First Half of 1996") can be accessed (Table 1 & 2). Print versions of the tables (AHRQ Pub No. 97-R052) are available from the AHRQ Clearinghouse(800/358-9295) from AHRQ InstantFAX(301/594-2800).

More detailed information on the uninsured population will be published in:

Vistnes JP, Monheit AC. Health insurance status of the U.S. civilian noninstitutionalized population. Rockville (MD): Agency for Health Care Policy and Research; 1997. MEPS Research Findings No. 1. AHRQ Pub. No. 97-0030.

MEPS Highlights No. 1, AHRQ Pub. No. 97-0025, May 1997.

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Suggested Citation:
Beauregard, K. M., Drilea, S. K., and Vistnes, J. P. Highlights #1: The Uninsured in America, 1996. May 1997. Agency for Healthcare Research and Quality, Rockville, MD. http://www.meps.ahrq.gov /data_files/publications/hl1/hl1.shtml