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Research Findings #14: Health Insurance Status of the Civilian Noninstitutionalized Population, 1999

by Jeffrey A. Rhoades, Ph.D., and May C. Chu, B.A., Agency for Healthcare Research and Quality



Abstract

This report from the 1999 Medical Expenditure Panel Survey (MEPS) provides preliminary estimates of the health insurance status of the civilian noninstitutionalized U.S. population during the first half of 1999, including the size and characteristics of the population with private health insurance, with public insurance only, and without any health care coverage. During this period, 84.2 percent of all Americans were covered by private or public health insurance, leaving 15.8 percent of the population, some 42.8 million people, uninsured. Among the non-elderly population, 82.1 percent of Americans had either private or public coverage only and 17.9 percent of the population (42.6 million people) lacked health care coverage. Among the elderly population, there was a significant drop from 1998 to 1999 in private health insurance coverage and a corresponding significant increase in coverage by public health insurance only. The probability that an individual would be uninsured during this period was especially high for young adults ages 1924 and members of racial and ethnic minorities (especially Hispanics). Public health insurance continues to play an important role in ensuring that children, black Americans, and Hispanic Americans obtain health care coverage.

Introduction

This report is the fourth in a series of reports on the health insurance status of the U.S. population. Previous reports have presented health insurance estimates for the first part of 1996 (Vistnes and Monheit, 1997), 1997 (Vistnes and Zuvekas, 1999), and 1998 (Rhoades, Brown and Vistnes, 2000).

The health insurance status of the U.S. population, especially the size and composition of the uninsured population, has become an issue of perennial public policy concern for several reasons. First, health insurance is viewed as essential to ensure that individuals obtain timely access to medical care and protection against the risk of expensive and unanticipated medical events. Compared to people without health care coverage, insured individuals are more likely to have a usual source of medical care, to spend less out of pocket on health services, and to experience different treatment patterns, quality, and continuity in their health care (Lefkowitz and Monheit, 1991; U.S. Congress, Office of Technology Assessment, 1992).

Second, concern over the population's health insurance status reflects a variety of equity and efficiency considerations. These include the magnitude and appropriate mix of private and public sector responsibility for financing health care, the impact of health insurance on the efficient use of health care, and the manner in which health insurance affects the distribution of health care among the general population and across groups of specific policy interest.

Third, timely and reliable estimates of the population's health insurance status are essential to evaluate the costs and expected impact of public policy interventions to expand coverage or to alter the manner in which private and public insurance is financed. Identification of how individual and household demographic characteristics, health status, and economic circumstances are associated with the population's health insurance status is of critical importance in developing efficient and targeted policy interventions. This is especially relevant given the current emphasis on incremental health care reform that is focused on particular health care markets and population groups.

Finally, comparisons of the characteristics of insured and uninsured populations over time provide information on whether greater equity has been achieved in the ability of specific population groups to obtain health insurance or whether serious gaps remain. In this regard, estimates of the population's health insurance status from the Medical Expenditure Panel Survey (MEPS), which is conducted annually, provide critical data for evaluating the health insurance implications of recent legislative initiatives: the 1996 Health Insurance Portability and Accountability Act (HIPAA), Public Law 104–191; welfare reform under the 1996 Personal Responsibility and Work Opportunity Reconciliation Act, Public Law 104–193; and the 1997 State Children's Health Insurance Program (SCHIP). A primary goal of HIPAA is to reduce the impact of preexisting health conditions on the continuity of health insurance during employment transitions. Under welfare reform, mandated work requirements and time limitations governing the receipt of public assistance may have consequences for a recipient's health insurance status. The goal of the SCHIP program is to provide health insurance coverage to low-income children who are not eligible for Medicaid.

This report presents preliminary estimates of the number and characteristics of people with private and public health insurance at any time during the first half of 1999, on average. Particular emphasis is directed toward estimating the size of the population that was uninsured throughout the first half of 1999 and identifying groups especially at risk of lacking health insurance.

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Overview

During the first half of 1999, on average, 84.2 percent of all Americans in the civilian noninstitutionalized population had some type of private or public health insurance coverage (Table 1). About 68 percent of Americans obtained health insurance from private sources. Another 16.1 percent had only public sources of coverage, primarily Medicare and Medicaid. (Throughout this report, the public health insurance category includes only people who had no coverage except public health insurance.) The remaining 15.8 percent of Americans, 42.8 million people, were without health insurance throughout the first half of 1999. Among the non-elderly population, 70.4 percent were covered by private insurance and 11.7 percent by public insurance. Among the non-elderly population, an estimated 42.6 million individuals (17.9 percent) were uninsured. Table 2 gives more detailed information on the health insurance status of the non-elderly population.

Overall these health insurance estimates do not differ significantly from the 1998 MEPS figures for the non-elderly population, as reported in Rhoades, Brown, and Vistnes (2000). However, there were differences between the two years for the elderly population. These differences are discussed below.

Tables 1-3 provide estimates of the population's health insurance status according to selected demographic characteristics, perceived health status, employment status, and residential location. Table 4 provides estimates of the distribution of the uninsured population by selected characteristics. Table A in the technical appendix provides estimates of the number of people by health insurance status. Some of the key findings and relationships revealed by these data are discussed below.

Age

MEPS data reveal that, in general, children are more likely than non-elderly adults to have health insurance coverage. The main findings among age groups are described below.

Children

There has been considerable interest in the health insurance status of children. This interest stems from the role health care coverage plays in ensuring that children obtain the medical care appropriate to their specific stage of development. To help ensure such coverage, Congress passed the State Children's Health Insurance Program in 1997, allocating approximately $24 billion over 5 years to provide health insurance coverage to low-income children who are not eligible for Medicaid. The SCHIP program follows on Medicaid expansions beginning in the late 1980s that focused attention on the role of the public and private sectors in financing health care for low-income children.

MEPS data indicate that public health insurance covered a substantial proportion of children in the first half of 1999: 28.1 percent of children under age 4, one in four children ages 4–6 (24.0), and one in five children ages 7–12 (19.2) had public coverage, primarily through Medicaid. As a result, the proportion uninsured among children under age 18 (13.6 percent) was lower than the proportion among non-elderly adults in general (19.7 percent for ages 18–64). Despite this finding, about 9.8 million children lacked health care coverage.

Adults

Young adults ages 19–24 were the age group most likely to lack health insurance. Nearly a third of young adults (32.2 percent) were uninsured, twice the rate at which all Americans lacked coverage.

Slightly more than half of elderly Americans (50.8 percent) were covered by private health insurance. Slightly less than half of elderly Americans (48.6 percent) held public coverage only (Medicare alone or in conjunction with Medicaid). These estimates differ significantly from estimates for 1998, when 55.3 percent of the elderly were covered by private health insurance and 43.8 percent were covered by public health insurance. This continues a trend first observed between 1997 and 1998, when the percent of the elderly covered by private health insurance declined from 60.5 percent to 55.3 percent (Rhoades, Brown, and Vistnes, 2000).

There are several possible reasons for the observed drop in private health insurance coverage among the elderly. Increases in Medicare health maintenance organization enrollment may have prompted people to drop private health insurance; people may have elected to drop Medigap health insurance policies as premiums have risen; and former employers may have opted to discontinue private health insurance coverage for retirees or have become unable to provide such coverage. However, there are currently insufficient data to determine definitively why these changes have occurred over the 3-year period.

Employment Status

Since most private health insurance in the United States is provided through the workplace, employment status is an important indicator of access to private health insurance. MEPS data reveal the following for the population ages 16–64 (Table 2):

  • Almost four-fifths (79.9 percent) of workers were covered by private health insurance, compared to half (51.2 percent) of individuals who were not employed.
  • People who were not employed were more likely than those who were employed to be covered by public insurance (21.8 and 3.4 percent, respectively).
  • Workers were less likely than people who were not employed to be uninsured (16.8 and 27.0 percent, respectively).

Race/Ethnicity

MEPS data indicate that significant disparities exist in the rate at which racial and ethnic minorities are covered by private and public health insurance compared to white Americans (Table 1). For example:

  • Less than half of all Hispanic Americans (45.5 percent) and slightly more than half of black Americans (53.0 percent) were covered by private health insurance, compared to three-quarters of whites (75.0 percent). Over a third of Hispanics (34.2 percent) and almost a fifth of blacks (19.2 percent) were uninsured. In contrast, 12.1 percent of white Americans were uninsured.
  • Hispanic and black Americans were more likely than white Americans to be covered by public health insurance (20.3 percent and 27.8 percent, respectively, compared to 12.9 percent for white Americans).

Marital Status

Widowed people were less likely to have private health insurance coverage in 1999 (43.6 percent) than in 1998 (50.7 percent) and more likely to have public insurance only (49.6 percent and 43.1 percent, respectively) (Rhoades, Brown, and Vistnes, 2000). These changes in health insurance coverage for widowed people can be attributed to similar changes observed among the elderly population, many of whom are widowed, for the two years (data not shown). Among adults under age 65, married people were more likely to have private health insurance (82.0 percent) and less likely to have public insurance (4.7 percent) or be uninsured (13.3 percent) than unmarried people were (Table 2). Of people ages 16–64 who were not married at the time of the survey:

  • Over one-quarter of widowed people were uninsured (26.4 percent).
  • Almost one-quarter of all divorced people were uninsured (24.6 percent). The proportion of divorced people covered by public insurance declined from 13.8 percent in 1998 (Rhoades, Brown, and Vistnes, 2000) to 9.5 percent in 1999.
  • Almost one-third of Americans who were separated were uninsured (32.8 percent).
  • More than one-quarter of Americans who never married were uninsured (26.8 percent).

Residential Location

The type of health care coverage obtained by Americans and the likelihood of being uninsured also varied by region and whether or not they lived in a metropolitan statistical area (MSA). Table 1 shows that:

  • People living outside MSAs were less likely than those living within MSAs to be covered by private health insurance (64.5 percent vs. 68.9 percent).
  • People living in the West were less likely than residents of the Northeast and Midwest to have private health insurance (62.6 percent in the West compared to 69.9 percent in the Northeast and 73.5 percent in the Midwest). Nearly one out of five people in the West and South were uninsured (18.9 percent and 17.5 percent, respectively), compared to 12.8 percent in the Northeast and 12.7 percent in the Midwest.

Health Status

There is considerable public policy interest in determining whether people with health problems are able to obtain health insurance and, if so, the source of such coverage. MEPS respondents were asked to rate their health and family members' health as excellent, very good, good, fair, or poor. The data in Table 3 reveal the relationships described below between health status and insurance coverage.

Non-Elderly People

More than one in five non-elderly Americans in good health (21.4 percent) or fair health (20.9 percent) were uninsured throughout the first half of 1999. Among the non-elderly:

  • People in fair or poor health were less likely than those in better health to have private health insurance. Only 42.2 percent of those in poor health and 54.8 percent of those in fair health had any private coverage.
  • Public insurance helped to reduce the health-related disparities in coverage. Almost one-quarter (24.2 percent) of people in fair health and 4 in 10 (40.9 percent) of the people in poor health had public coverage. Nevertheless, those in good or fair health were more likely than people in very good or excellent health to be uninsured.

Elderly People

Elderly Americans in fair or poor health were less likely to have private coverage than those in good or better health. As a result, those in fair or poor health were more likely to be covered by insurance from public sources only (64.1 percent and 57.9 percent, respectively) than other elderly Americans. Medicare, either alone or with Medicaid, was the main public source of coverage. There were significant differences between the 1999 and 1998 estimates for elderly people in fair health: a significant decrease in the percent covered by private health insurance (34.5 percent in 1999 vs. 49.0 percent in 1998) and a corresponding significant increase in the percent covered by public health insurance only (64.1 percent in 1999 vs. 50.7 percent in 1998). Presently there are insufficient data to determine why these changes have occurred between the two years.

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Characteristics of Uninsured Americans

Previous sections of this report have described the health insurance status of Americans by focusing on demographic, health status, and geographic characteristics associated with the likelihood that particular groups obtained private or public health insurance or were more at risk of being uninsured. To put this discussion in perspective, data displayed in Table 4 characterize the uninsured population by considering the representation of specific groups in the general population of non-elderly Americans relative to their representation among the uninsured population. In this way, one can assess whether certain population groups are disproportionately represented among the uninsured. Such information can be useful in formulating targeted policy interventions on behalf of people without health insurance.

Age

Children under the age of 18 comprised slightly less than one-quarter (23.0 percent) of the uninsured population. Young adults ages 19–24 composed 8.4 percent of the non-elderly population but 15.1 percent of the uninsured population. Among all age groups, young adults had the greatest risk of being uninsured.

For individuals ages 30–34 and 55–64, there was a significant change in the percent distribution of the uninsured population between 1998 and 1999. The proportion of the uninsured population represented by ages 30–34 declined from 10.0 percent in 1998 to 8.3 percent in 1999, while the proportion ages 55–64 increased from 6.8 percent in 1998 to 9.2 percent in 1999. These changes reflect a shift in the age distribution of the population between 1998 and 1999 rather than a change in risk for being uninsured.

Sex

While males comprised slightly less than half of the non-elderly population, they represented 53.4 percent of the uninsured population.

Race/Ethnicity

Racial and ethnic minorities were more at risk of lacking health insurance than white Americans were. As a result, minority representation among the uninsured exceeded their representation among the general population. For example, Table 4 shows that:

  • Hispanics represented only 12.6 percent of all non-elderly Americans but 25.2 percent of the uninsured population. Hispanics were the racial/ethnic group most likely to be uninsured (35.9 percent).
  • Although almost 7 out of 10 non-elderly Americans were white (69.6 percent), whites accounted for less than 6 out of 10 uninsured persons (54.6 percent).
  • When the uninsured are categorized by race/ethnicity and sex, white males and females represent the largest proportions of the uninsured population: 28.9 and 25.7 percent, respectively.

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Conclusions

Preliminary estimates from the 1999 MEPS reveal that, during the first half of 1999, 68.1 percent of Americans obtained health insurance from private sources, 16.1 percent obtained coverage through public programs, and 15.8 percent of the population (42.8 million people) lacked any health care coverage. Among the non-elderly population, over one person in six was uninsured.

In general, there was no difference between the 1998 and 1999 estimates for the non-elderly population. However, among the elderly population there was a significant drop in the rate of private health insurance coverage and a corresponding significant increase in public health insurance coverage only, a trend that continues from 1997.

The tabulations presented in this report indicate that the health insurance status of the U.S. population is strongly associated with specific demographic characteristics, health status, and employment status. Important disparities in health care coverage exist for particular groups. Among the groups especially at risk of lacking health care coverage are young adults ages 19–24 and members of racial and ethnic minorities (especially Hispanic Americans). Public health insurance continues to play an important role in insuring children, black Americans, and Hispanic Americans. Disparities in the proportion with insurance coverage also exist by health status, with non-elderly people in good or fair health more likely than people in better health to be uninsured.

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References

Cohen J, Monheit A, Beauregard K, et al. The Medical Expenditure Panel Survey: a national health information resource. Inquiry 1996;33:373–89.

Cohen S. Sample design of the 1996 Medical Expenditure Panel Survey Household Component. Rockville (MD): Agency for Health Care Policy and Research; 1997. MEPS Methodology Report No. 2. AHCPR Pub. No. 97–0027.

Lefkowitz D, Monheit A. Health insurance, use of health services, and health care expenditures. Rockville (MD): Agency for Health Care Policy and Research; 1991. National Medical Expenditure Survey Research Findings 14. AHCPR Pub. No. 92–0017.

Rhoades J, Brown E, Vistnes J. Health insurance status of the civilian noninstitutionalized population: 1998. Rockville (MD): Agency for Healthcare Research and Quality; 2000. MEPS Research Findings No. 11. AHRQ Pub. No. 00–0023.

U.S. Congress, Office of Technology Assessment. Does health insurance make a difference? Background paper. Washington: U.S. Government Printing Office; 1992. Report No. OTA-BP-H-99.

Vistnes J, Monheit A. Health insurance status of the civilian noninstitutionalized population: 1996. Rockville (MD): Agency for Health Care Policy and Research; 1997. MEPS Research Findings No. 1. AHCPR Pub. No. 97–0030.

Vistnes J, Zuvekas S. Health insurance status of the civilian noninstitutionalized population: 1997. Rockville (MD): Agency for Health Care Policy and Research; 1999. MEPS Research Findings No. 8. AHCPR Pub. No. 99–0030.

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Tables

1. Health insurance coverage and population characteristics - all ages
2. Health insurance coverage and population characteristics - under age 65
3. Health insurance coverage and perceived health status—all ages
4. Population characteristics: total population and the uninsured—under age 65

Table 1. Health insurance coverage and population characteristics - all ages

Table 1. Health insurance coverage and population characteristics - all ages, continued

a Includes persons with unknown employment status and marital status.
b For individuals age 16 and over.

* Relative standard error is greater than or equal to 30 percent.

Note: Percents may not add to 100 because of rounding.

Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component, 1999.

Table 2. Health insurance coverage and population characteristics - under age 65

Table 2. Health insurance coverage and population characteristics - under age 65, continued

a Includes persons with unknown employment status and marital status.
b For individuals age 16 and over.

Note: Percents may not add to 100 because of rounding.

Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component, 1999.

Table 3. Health insurance coverage and perceived health status, all ages

a Total includes persons with unknown perceived health status.

* Relative standard error is greater than or equal to 30 percent.

Note: Percents may not add to 100 because of rounding.

Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component, 1999.

Table 4. Population characteristics: total population and the uninsured—under age 65

Table 4. Population characteristics: total population and the uninsured, under age 65, continued

a Total includes persons with unknown perceived health status and marital status.
b For individuals age 16 and over. Excludes unknown marital status. As a result, percents do not sum to 100.

- Sample size too small to produce reliable estimates.

Note: Percent distributions may not add to 100 because of rounding.

Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component, 1999.

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Technical Appendix

Derivation of Insurance Status Information   Health Insurance Edits
Population Characteristics Sample Design and Accuracy of Estimates
Rounding Comparisons With Other Data Sources
Population and Standard Error Tables

This data in this report were obtained in the first round of interviews for the Household Component (HC) of the 1999 Medical Expenditure Panel Survey (MEPS). MEPS is cosponsored by the Agency for Healthcare Research and Quality (AHRQ) and the National Center for Health Statistics (NCHS). The MEPS HC is a nationally representative survey of the U.S. civilian noninstitutionalized population that collects medical expenditure data at both the person and household levels. The focus of the MEPS HC is to collect detailed data on demographic characteristics, health conditions, health status, use of medical care services, charges and payments, access to care, satisfaction with care, health insurance coverage, income, and employment. In other components of MEPS, data are collected on the use, charges, and payments reported by providers; residents of licensed or certified nursing homes; and the supply side of the health insurance market.

The sample for the MEPS HC was selected from respondents to the National Health Interview Survey (NHIS), which was conducted by NCHS. NHIS provides a nationally representative sample of the U.S. civilian noninstitutionalized population and reflects an oversampling of Hispanics and blacks. The MEPS HC collects data through an overlapping panel design. In this design, data are collected through a precontact interview that is followed by a series of five rounds of interviews over 2 1/2 years. Two calendar years of medical expenditure and utilization data are collected from each household and captured using computer-assisted personal interviewing (CAPI). This series of data collection rounds is launched again each subsequent year on a new sample of households to provide overlapping panels of survey data which, when combined with other ongoing panels, will provide continuous and current estimates of health care expenditures. The reference period for Round 1 of the 1999 MEPS HC (Panel 4) was from January 1, 1999, to the date of the Round 1 interview. Interviews for Panel 4 (Round 1) were conducted from March to July 1999.

Derivation of Insurance Status Information

The household respondent was asked if during the interview period anyone in the family was covered by any of the sources of public and private health insurance coverage discussed in the following paragraphs. Coverage by Medicare and TRICARE, formerly known as CHAMPUS/CHAMPVA, was measured at the time of the interview. (CHAMPUS and CHAMPVA were the Civilian Health and Medical Programs for the Uniformed Services and Veterans' Affairs.) All other sources of insurance were measured for any time between January 1999 and the interview date. Persons counted as uninsured were uninsured throughout this time period.

Public Coverage

For this report, individuals were considered to have public coverage only if they met both of the following criteria:

  • They were not covered by private insurance.
  • They were covered by one of the public programs discussed below.

Medicare

Medicare is a federally financed health insurance plan for the elderly, persons receiving Social Security disability payments, and most persons with end-stage renal disease. Medicare Part A, which provides hospital insurance, is automatically given to those who are eligible for Social Security. Medicare Part B provides supplementary medical insurance that pays for medical expenses and can be purchased for a monthly premium.

Tricare

TRICARE covers active-duty and retired members of the Uniformed Services and the spouses and children of active-duty, retired, and deceased members. Spouses and children of veterans who died from a service-connected disability, or who are permanently disabled and are not eligible for Medicare, are covered by TRICARE. In this report, TRICARE coverage is considered to be public coverage. When persons covered by TRICARE reach age 65, their coverage generally ends and enrollees are eligible for Medicare.

Medicaid and State Children's Health Insurance Program

Medicaid and the State Children's Health Insurance Program (SCHIP) are means-tested government programs jointly financed by Federal and State funds that provide health care to those who are eligible. Eligibility criteria vary significantly by State. Medicaid is designed to provide health insurance coverage to families and individuals who are unable to afford necessary medical care, while SCHIP is designed to provide health insurance coverage for uninsured low-income children. Respondents who did not report Medicaid or SCHIP coverage were asked if they were covered by any other public hospital/physician coverage. These questions were asked in an attempt to identify Medicaid or SCHIP recipients who might not have recognized their coverage as Medicaid or SCHIP. In this report, all coverage reported in this manner is considered public coverage.

Private Health Insurance

Private health insurance was defined for this report as insurance that provides coverage for hospital and physician care (including Medigap coverage). Insurance that provides coverage for a single service only, such as dental or vision coverage, was not counted. Private health insurance could have been obtained through an employer, union, self-employed business, directly from an insurance company or a health maintenance organization (HMO), through a group or association, or from someone outside the household.

Uninsured

The uninsured were defined as persons not covered by Medicare, TRICARE, Medicaid, other public hospital/physician programs, or private hospital/physician insurance (including Medigap coverage) during the period from January 1999 through the time of the interview. Individuals covered only by noncomprehensive State-specific programs (e.g., Maryland Kidney Disease Program) or private single-service plans (e.g., coverage for dental or vision care only, coverage for accidents or specific diseases) were not considered to be insured.

Health Insurance Edits

For the Round 1 (Panel 4) sample, minimal editing was performed on sources of public coverage and no edits were performed on the private coverage variables. Health insurance data were edited as described below.

Medicare

Medicare coverage was edited for persons age 65 and over but not for persons under age 65. Persons age 65 and over were assigned Medicare coverage if they met one of the following criteria:

  • They answered "yes" to a follow-up question on whether they had received Social Security benefits.
  • They were covered by Medicaid, other public hospital/physician coverage, or Medigap coverage.
  • Their spouse was age 65 or over and covered by Medicare.
  • They were covered by TRICARE.

Medicaid

This report does not distinguish among sources of public insurance. Medicaid or other public hospital/physician coverage was included when considering whether an individual was covered only by public insurance.

Tricare

Respondents age 65 and over who reported TRICARE coverage were instead classified as covered by Medicare.

Private Health Insurance

Private insurance coverage was unedited and unimputed for Round 1 (Panel 4). Individuals were considered to be covered by private insurance if the insurance provided coverage for hospital/physician care. Medigap plans were included. Individuals covered by single-service plans only (e.g., dental, vision, or drug plans) were not considered to be privately insured. Sources of insurance with missing information regarding the type of coverage were assumed to contain hospital/physician coverage.

Population Characteristics

Place of Residence

Individuals were identified as residing either inside or outside a metropolitan statistical area (MSA) as designated by the U.S. Office of Management and Budget (OMB), which applied 1990 standards using population counts from the 1990 U.S. census. An MSA is a large population nucleus combined with adjacent communities that have a high degree of economic and social integration within the nucleus. Each MSA has one or more central counties containing the area's main population concentration. In New England, metropolitan areas consist of cities and towns rather than whole counties. Regions of residence are in accordance with the U.S. Bureau of the Census definition.

Race/Ethnicity

Classification by race and ethnicity was based on information reported for each household member. Respondents were asked if their race was best described as American Indian, Alaska Native, Asian or Pacific Islander, black, white, or other. They were also asked if their main national origin or ancestry was Puerto Rican; Cuban; Mexican, Mexicano, Mexican American, or Chicano; other Latin American; or other Spanish. All persons who claimed main national origin or ancestry in one of these Hispanic groups, regardless of racial background, were classified as Hispanic. Since the Hispanic grouping can include black Hispanic, white Hispanic, and other Hispanic, the race categories of black, white, and other do not include Hispanic.

Employment Status

Persons were considered to be employed if they were age 16 and over, and had a job for pay, owned a business, or worked without pay in a family business at the time of the Round 1 interview.

Sample Design and Accuracy of Estimates

MEPS is designed to produce estimates at the national and regional level over time for the civilian noninstitutionalized population of the United States and some subpopulations of interest. Each MEPS panel collects data covering a 2-year period, with the first four MEPS panels spanning 1996–97, 1997–98, 1998–99, and 1999–2000. The data in this report are from the first round of data collection for the MEPS Panel 4 sample.

The statistics presented in this report are affected by both sampling error and sources of nonsampling error, which include nonresponse bias, respondent reporting errors, interviewer effects, and data processing misspecifications. For a detailed description of the MEPS survey design, the adopted sample design, and methods used to minimize sources of nonsampling error, see Cohen (1997) and Cohen, Monheit, Beauregard, et al. (1996). The MEPS person-level estimation weights include nonresponse adjustments and poststratification adjustments to population estimates derived from the March 1999 Current Population Survey (CPS) based on cross-classifications by region, MSA status, age, race/ethnicity, and sex.

Tests of statistical significance were used to determine whether the differences between populations exist at specified levels of confidence or whether they occurred by chance. Differences were tested using Z-scores having asymptotic normal properties at the 0.05 level of significance. Unless otherwise noted, only statistical differences between estimates are discussed in the text.

At its beginning in 1999, MEPS Panel 4 consisted of a sample of 6,875 households, a nationally representative subsample of the households responding to the 1998 National Health Interview Survey. Like earlier MEPS panels, the Panel 4 sample reflects the oversampling of Hispanic and black households resulting from the NHIS sample design.

The overall MEPS Panel 4 response rate at the end of Round 1 (which collects data for the first part of 1999) was 73.0 percent. This overall rate reflects response to both the 1998 NHIS interview and the MEPS Round 1 interview.

Rounding

Estimates presented in the tables were rounded to the nearest 0.1 percent. Standard errors, presented in Tables B–E, were rounded to the nearest 0.01, while for Table F they were rounded to the nearest whole number. Population estimates in Tables 1–4 and Table A were rounded to the nearest thousand. Therefore, some of the estimates presented in the tables for population totals of subgroups will not add exactly to the overall estimated population total.

Comparisons With Other Data Sources

Because of methodological differences, caution should be used 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. The CPS interview that contains information on the health insurance status of the population is conducted annually, and NHIS collects insurance data on a continuous basis each year. In addition, unlike MEPS, CPS counts as insured military veterans whose source of health care is the Department of Veterans Affairs. CPS also counts children of adults covered by Medicaid as insured. For these preliminary estimates, MEPS did not consider these children insured unless their families reported them as such.

Table A: Health insurance coverage of the civilian noninstitutionalized population: Population estimates  by type of coverage and selected population characteristics, U.S., first half of 1999.

a Includes persons with unknown employment status and marital status.
b For individuals age 16 and over.

- Sample size too small to produce reliable estimates.

Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component, 1999.

Table B: Health insurance coverage of the civilian noninstitutionalized population: Standard errors by type of coverage and selected population characteristics, U.S., first half of 1999. Corresponds to Table 1.

Table B: Health insurance coverage of the civilian noninstitutionalized population: Standard errors by type of coverage and selected population characteristics, U.S., first half of 1999. Corresponds to Table 1, continued.

a Includes persons with unknown employment status and marital status.
b For individuals age 16 and over.

* Relative standard error is greater than or equal to 30 percent.

Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component, 1999.

Table C: Health insurance coverage of the civilian noninstitutionalized population under age 65: Standard errors by type of coverage and selected population characteristics, U.S., first half of 1999. Corresponds to Table 2.

a Includes persons with unknown employment status and marital status.
b For individuals age 16 and over.

Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component, 1999.

Table D: Health insurance coverage of the civilian noninstitutionalized population: Standard errors by type of coverage and perceived health status, U.S., first half of 1999. Corresponds to Table 3.

a Includes persons with unknown perceived health status.

* Relative standard error is greater than or equal to 30 percent.

Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component, 1999.

Table E: Total population and uninsured persons under age 65: Standard errors by selected population characteristics, U.S., first half of 1999. Corresponds to Table 4.

Table E: Total population and uninsured persons under age 65: Standard errors by selected population characteristics, U.S., first half of 1999. Corresponds to Table 4, continued.

a Total includes persons with unknown perceived health status and marital status.
b Not applicable.
c For individuals age 16 and over.

- Sample size too small to produce reliable estimates.

Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component, 1999.

Table F: Health insurance coverage of the civilian noninstitutionalized population: Population estimates  by type of coverage and selected population characteristics, U.S., first half of 1999. Corresponds to Table A.

a Includes persons with unknown employment status and marital status.
b For individuals age 16 and over.

- Sample size too small to produce reliable estimates.

Source: Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component, 1999.

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Suggested Citation:
Rhoades, J. A. and Chu, M. C. Research Findings #14: Health Insurance Status of the Civilian Noninstitutionalized Population: 1999. December 2000. Agency for Healthcare Research and Quality, Rockville, MD. http://www.meps.ahrq.gov/data_files/publications/rf14/rf14.shtml