Highlights
#5: Job-Based Health Insurance, 1987 and 1996
Estimates for the U.S.
Civilian Noninstitutionalized Population
Introduction
Two national medical expenditure surveys
reveal that an increasing number of workers are turning down
job-based health insurance coverage. Although the number of workers
offered health insurance grew from 1987 to 1996, the number of
workers who declined this coverage increased even more. Data
from the 1987 National Medical Expenditure Survey and the 1996
Medical Expenditure Panel Survey (MEPS) also show that while
access to job-based insurance--through a worker's own job or
that of a family member--remained stable over time, the rate
at which workers took advantage of this coverage fell from 93
percent in 1987 to 89 percent in 1996 (Figure
1). Overall, the number of workers with access to job-based
coverage who declined it grew from 2.6 million in 1987 to 6.3
million in 1996.
In addition to not having access to health
insurance, there are likely to be many factors associated with
workers' decisions to decline coverage when it is offered. Health
insurance premiums have increased much more than wages, and workers
are also facing higher employee contributions to health insurance.
Aside from cost, other factors that may have contributed to declining
rates of job-based insurance coverage include a change in the
generosity of insurance plans over time and the possibility that
expansions to the Medicaid program may have encouraged some workers
to rely on Medicaid instead of job-based coverage.
The data indicate that increasing proportions
of workers without job-based health insurance had access to it (Figure
2). For example, of uninsured workers, only 16 percent had
access to job-based coverage in 1987, compared to 29 percent
in 1996. Of workers who had health coverage under public insurance,
only 8 percent had access to job-based coverage in 1987, compared
to 26 percent in 1996.
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Briefly
Stated
- The rate at which
workers were offered health insurance through their job increased
slightly from 1987 to 1996, but a growing proportion of workers
turned down the coverage. The proportion of workers with access
to any job-based health insurance (through their own or a family
member's job) did not change.
- Some workers--notably
Hispanics, workers under age 25, and low-wage workers--faced
declines in access to job-based coverage. These groups also
were more likely to turn it down if it was available and to
be uninsured.
- From 1987 to 1996,
the number of workers who turned down job-based health insurance
jumped from 2.6 million to 6.3 million, an increase of 140
percent.
- Of the 6.3 million
workers who declined job-based health insurance in 1996, 4.6
million were uninsured.
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Who
Is Affected?
There is substantial variation in access
rates and take-up rates across population subgroups. For example,
workers earning $7.00 or less per hour had significantly lower
take-up rates than other wage earners in both 1987 and 1996 (Figure
3). Low-wage earners have also become increasingly likely
to turn down available coverage: In 1987, 89 percent of the
lowest wage workers with access to job-based coverage were
covered by it; in 1996, this number fell 13 percentage points
to 76 percent. In contrast, comparable rates for those earning
more than $15.00 per hour remained unchanged. In both 1987
and 1996, workers earning $10.00 or less per hour, particularly
those earning $7.00 or less per hour, were less likely to have
access to job-based health insurance than better paid workers.
Access rates for workers earning $7.00 or less per hour declined
from 60 percent in 1987 to 55 percent in 1996.
Workers under age 25 faced lower access
rates than other age groups and were less likely to take up
available coverage (Figure 4).
For example, workers under age 25 faced an 8 percentage point
decline in their access rate to job-based insurance from 1987
to 1996, while access rates for workers ages 25 and over were
stable or increased slightly. Similarly, the take-up rates
for these young workers fell by 13 percentage points, compared
to only 3 percentage points for workers ages 35-54.
Racial and ethnic minorities, particularly
Hispanics, also were more likely to lack access to job-based
coverage and to turn it down when it was available. The rate
of access to job-based insurance for Hispanic workers fell
from 71 percent in 1987 to 67 percent in 1996, although it
remained stable for other groups. Take-up rates declined from
1987 to 1996 for all racial/ethnic groups, and take-up rates
for Hispanic workers were significantly lower than those of
white workers in both years.
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About MEPS and NMES
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.
MEPS' precursor, the National Medical Expenditure Survey (NMES),
was a longitudinal survey conducted in four rounds covering January
1 through December 31, 1987. This Highlights shows information
from samples drawn from the first round of data collection of
both the 1996 MEPS Household Component and NMES Household Survey,
which consisted of persons ages 21-64 who were employed but not
self-employed
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Definitions
Offer rate: The
proportion of workers offered health insurance by their primary
employer. Take-up rate: The proportion of workers offered health
insurance by their primary employer who took the coverage. Access
rate: The proportion of workers who could have obtained health
insurance either through their own job or a family member's job.
Family take-up rate: The proportion of workers with access to
job-based health insurance coverage who were covered by such
a plan.
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Figures
Figure
1.
Offer, access, and take-up rates for job-based health insurance:
1987 and 1996
- Although the rate at
which employees were offered health insurance grew slightly
from 1987 to 1996, access to job-based coverage remained stable.
Declines in job-based coverage primarily result from workers
turning down available coverage.
DATA
SOURCE: 1987 National Medical Expenditure Survey and
1996 Medical Expenditure Panel Survey Household Component.
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Figure 2. Access
rates for workers without job-based health insurance coverage
by actual insurance status: 1987 and 1996
- Increasing proportions
of workers without job-based health insurance had access to--but
were not covered by--such insurance.
DATA SOURCE: 1987
National Medical Expenditure Survey and 1996 Medical Expenditure
Panel Survey Household
Component.
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Figure 3. Rates
of job-based health insurance by wage:1 1987 and 1996
- Low-wage workers
were less likely than higher wage workers to have access
to job-based health insurance
and more likely to turn it down.
1 All wages
are measured in 1996 dollars. DATA
SOURCE: 1987 National Medical Expenditure Survey
and 1996 Medical Expenditure Panel Survey Household Component.
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Figure 4. Rates
of job-based health insurance by age group: 1987 and 1996
- Workers ages 35-54
were the most likely to have access to job-based health insurance
in both 1987 and 1996. The youngest workers were the least
likely to have access to coverage.
DATA
SOURCE: Job-Based
Health Insurance--1987 and 1996
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References
For more information
on MEPS, call the MEPS information coordinator at AHRQ (301/594-1406)
or visit the MEPS
section of the AHRQ Web site at http://www.ahrq.gov/
For a detailed description of the MEPS survey
design, sample design, and methods used to minimize sources of
nonsampling error, see the following publications:
Cohen J. Design and methods of the Medical
Expenditure Panel Survey Household Component. Rockville (MD):
Agency for Health Care Policy and Research; 1997. MEPS Methodology
Report No. 1. AHRQ Pub. No. 97-0026.
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. AHRQ Pub. No. 97-0027.
For more information about the NMES survey
design, see the following publication:
Edwards W, Berlin M. Questionnaires and data
collection methods for the Household Survey and the Survey of
American Indians and Alaska Natives. Rockville (MD): Public Health
Service; 1989. DHHS Pub. No. 89-3450.
The estimates in this highlights
are drawn from the following publication:
Cooper PF, Schone BS. More offers, fewer takers
for job-based health insurance: 1987 and 1996. Health Affairs
1997;16(6):142-149. AHRQ Pub. No. 98-R008.
MEPS Highlights No. 5, AHRQ Pub No. 98-0032,
May 1998.
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Suggested Citation:
Highlights #5: Job-Based Health Insurance, 1987 and 1996. May 1998. Agency for Healthcare Research and Quality, Rockville, MD. http://www.meps.ahrq.gov/data_files/publications/hl5/hl5.shtml
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