Alan C. Monheit, Ph.D., Jessica P.Vistnes,
Ph.D., and Samuel H. Zuvekas, Ph.D., Agency for Healthcare Research
and Quality.
Initiatives to expand health
insurance coverage have focused not only on the size of the
uninsured population but also on the stability and
continuity of coverage. This report from the Agency for
Healthcare Research and Quality (AHRQ) describes the health
insurance experience of the U.S. population during 1996,
using data from the 1996 Medical Expenditure Panel Survey
(MEPS). It provides alternative estimates of the uninsured
population and the prevalence of full-year and part-year
coverage. It also examines the extent to which people
insured at the beginning of a calendar year become uninsured
and the likelihood that those uninsured at the beginning of
the year will acquire coverage. The findings point to the
importance of public insurance as a means through which many
disadvantaged Americans acquire coverage but also reveal
that public coverage is less stable than private health
insurance. Only a small proportion of people uninsured at
the beginning of 1996 acquired health insurance during the
year.
The estimates in this report are based on the most recent
data available at the time the report was writ-ten. However, selected
elements of MEPS data may be revised on the basis of
additional analyses, which could result in slightly different
estimates from those shown here. Please check the MEPS Web
site for the most current file releases.
Size
of Uninsured Population for Different Time Periods
Estimates
of the uninsured population from various household surveys
reflect differences
in the time period studied as well as differences in questionnaire
design, sample design, and estimation procedures (Lewis, Ellwood,
and Czajka, 1998; Monheit, 1994; Swartz, 1986; Swartz and
Purcell, 1989). MEPS data permit construction of a variety
of health insurance status measures to examine the relationship
between the time period considered and the size of the
uninsured population for a given sample design and questionnaire
content. Table 1 presents four estimates
of the size of the uninsured population:
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Annual Estimates of
Insurance Status
Table 2 presents more
detailed estimates of the full-year health insurance status
of non-elderly Americans during calendar year 1996 by selected
demographic characteristics. It focuses on three mutually
exclusive groups: insured by private and/or public coverage
throughout 1996; insured for part of 1996; and uninsured throughout
1996. As noted above, a substantial percentage of non-elderly
Americans lacked coverage at some point during 1996 (27.1
percent, or 62 million individuals), with a fairly even split
between those who were continuously uninsured during the year
and those who were without coverage for part of the year.
Table 2 shows that
individuals who were, on average, the most at risk of lacking
coverage during the first half of 1996 (discussed in Vistnes
and Monheit, 1997) were also the most at risk of lacking coverage
all year. Most prominent among this population were young
adults and racial/ethnic minorities. For example, only half
of all people 18-24 years of age (54.5 percent) were insured
throughout the year.3 In
contrast, over three-quarters of adults 35-54 years of age
and 82.1 percent of adults 55-64 years of age were insured
all year. Only about half of all Hispanics were insured for
the full year and nearly 29 percent were uninsured all year.
Less than two-thirds (64.1 percent) of black Americans were
insured all year and 17.4 percent were uninsured all year.
In comparison, nearly four out of five white Americans (77.9
percent) were insured all year and only 10.5 percent lacked
coverage for the entire year. Of all racial/ethnic groups,
Hispanic males were the most at risk, as one out of three
Hispanic males were uninsured throughout the year.
Annual health insurance status was also
related to marital status, health status, and family income.4 Compared
to people in the other all-year marital status categories
in Table 2, people who were married
throughout 1996 were most likely to have full-year coverage
and least likely to be uninsured all year.5 People
married all year were also more likely to have full-year coverage
than people who changed marital status during the year.
With regard to health status, people reported
as being in fair or poor health status for either the whole
year or part of the year were less likely than others to have
full-year coverage and more likely to lack coverage throughout
the year.
Family income exhibited a strong association
with continuous insurance coverage during 1996. People who
were poor, near-poor, or low income (incomes less than or
equal to 200 percent of the Federal poverty line) were nearly
five times as likely to be uninsured all year and two to three
times more likely to be insured only part of the year than
high-income people (incomes over 400 percent of the poverty
line). Near-poor persons (100 to 125 percent of poverty) had
the lowest rate of full-year coverage and also exhibited the
highest rate of part-year coverage, a finding that may reflect
their inability to pay for continuous private coverage or
to remain eligible for public coverage, given periodic reviews
of asset and income levels over the year. While middle-income
individuals (200 to 400 percent of poverty) had more stable
coverage than those in lower income households, they still
experienced important gaps in coverage compared to high-income
families. For example, 75.7 percent of middle-income individuals
were insured all year, compared to 86.7 percent of high-income
individuals.
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Acquisition of
Insurance by Uninsured Americans
An important prerequisite for developing
strategies to expand health insurance coverage is understanding
the extent to which uninsured individuals are able to acquire
coverage through the present systems of private and public
insurance. Toward that end, the health insurance experience
of a specific cohort of non-elderly individuals who were without
coverage in January 1996 is examined. This cohort, consisting
of 45.2 million uninsured people, represents a snapshot of
the uninsured population at a point in time. By examining
the experience of this group over the year, the characteristics
of the uninsured that are associated with the acquisition
of coverage, as well as the characteristics of those who may
be chronically uninsured, can be examined.
A
minority of the uninsured—only
30.0 percent of the 45.2 million people uninsured in January
1996—obtained coverage during the year (Table
3). The data in Table 3 also reveal
several important demographic correlates of coverage acquisition
during 1996. Over two-fifths (41.9 percent) of children under
age 7 obtained coverage. Over half of the children under age
7 who obtained coverage were enrolled in public insurance.
This result may reflect the fact that, in contrast to other
age groups, young children have been targeted for eligibility
in public insurance programs.
Older children had a lower likelihood of
obtaining any coverage, and when they did obtain coverage
it was more likely to be private than public coverage. Adults
were also more likely to obtain private than public coverage,
which reflects the fact that there are generally few avenues
for adults without serious health problems to obtain public
coverage.
The findings
for children show that, despite efforts to expand children’s
access to public coverage through the Medicaid program in
the late 1980s and early 1990s, in
1996 nearly two-thirds of children under age 18 in the uninsured
cohort experienced lengthy periods (at least a year) without
coverage. Only 41.9 percent of uninsured children under age
7 and 32.1 percent of uninsured children ages 7-17 obtained
insurance during the course of the year.
The data on health
insurance acquisition also reveal some interesting contrasts
with more static analyses
when the experience of adults is considered.
For example, while young adults had the
highest likelihood of lacking coverage all year (Table
2), about one-third of those ages 18-24 were able to obtain
coverage (mostly private health insurance) during 1996 (Table
3). This contrasts sharply with the experience of older
adults ages 55-64. Although people ages 55-64 were the group
least likely to lack coverage at any time during the year
(Table 2), this high propensity for
full-year coverage did not translate into a high probability
of acquiring coverage when people this age were uninsured
(Table 3). The data suggest that, among
the uninsured cohort, older adults may face considerably more
difficulty than younger persons in acquiring coverage. In
particular, older adults ages 55-64 were half as likely as
young adults to obtain private coverage.
Among racial and ethnic groups, Hispanics
were less likely than blacks or whites to obtain health insurance,
especially private coverage.6 These
disparities largely reflect the experience
of Hispanic males, who exhibited the lowest coverage acquisition
rate, at least
10 percentage points below any other racial/ethnic group except
the group categorized as "other" (not white, black
or Hispanic). Hispanic males were only about half as likely
as other males to obtain private coverage, yet another indication
of the poor health insurance prospects of Hispanic males described
in Table 2 (and in many other reports).
The failure of Hispanic males to acquire coverage also reflects
their worsening access to private coverage compared to other
groups. For example, Hispanic males were the only racial/ethnic
group of working Americans to experience a decline in offers
of employment-related health insurance over the last decade
(Monheit and Vistnes, 2000). While there was no difference
in the likelihood or type of coverage obtained by black and
white males, the data indicate that minority females were
more likely than white females to acquire public coverage.
In addition, Hispanic females were less likely than white
females to obtain private coverage.
While uninsured people in fair or poor health
and those in excellent, very good, or good health were equally
likely to acquire coverage, there were differences in the
type of coverage obtained. Uninsured people in fair or poor
health throughout the year were more than twice as likely
as those in better health to obtain public coverage. Uninsured
people in better health, in turn, were twice as likely as
those in fair or poor health throughout the year to obtain
private coverage. These findings suggest that uninsured people
with health problems may face difficulties enrolling in private
health insurance and point to the important role of public
coverage as a component of the social safety net. Whether
these differences by health status reflect issues related
to affordability, different access to the kinds of jobs that
provide coverage, or the ability to work the hours required
for eligibility, or are a result of exclusions based on health
conditions, remains an important issue for research.
The likelihood of acquiring health insurance
and the type of coverage obtained also displayed some variation
according to employment status.7 People
not employed during 1996 were less likely than those employed
all year to obtain coverage. People employed all
year were far more likely to obtain private coverage than
those with part-year or no employment experience during 1996.
When the nonworking uninsured did obtain coverage, they were
nearly six times as likely as those employed all year to obtain
public coverage.
There was little variation by income in
the likelihood of obtaining insurance except that people in
the highest income group (over 400 percent of poverty) were
less likely to remain uninsured than those with lower incomes.
The sources of coverage also varied by income, with higher
income levels strongly associated with the acquisition of
private coverage. For example, people with the highest family
income were two to three times more likely to enroll in private
coverage than people who were poor or near-poor (up to 125
percent of poverty).
Similarly, the likelihood of obtaining public
insurance increased markedly as family income declined. In
this regard, it is important to recognize that public coverage
played an important role in ensuring that lower income groups
(up to 125 percent of poverty) were as likely to leave an
uninsured state as all but those in the highest income group.
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Stability
of Private Insurance Coverage
Ensuring the
stability of private health insurance has been an important
focus of past and recently
enacted health reform measures. In particular, provisions
of the 1985 COBRA legislation were designed to provide workers
and their dependents with continued access to their employment-based
coverage if change in a worker’s employment circumstances
triggers a specific COBRA qualifying event.8 In
addition, HIPAA legislation promotes health insurance portability
by limiting the use of pre-existing health conditions to deny
people changing jobs access to health insurance.
The estimates in Table
4 provide information on the degree of coverage stability
for non-elderly people who were privately insured in January
1996. People with private insurance at the beginning of
the year exhibited a high rate of stable coverage, with
92.0 percent of them retaining their private coverage throughout
the year. Of those who lost their private insurance after
January, almost all became uninsured for some or all of
the rest of 1996. These data reveal little evidence that
individuals switched from private insurance in the beginning
of the year to public coverage later in the year.
The relatively high degree of stability
in private health insurance masks several important differences
among population subgroups. For example, while the stability
of coverage did not vary among children of different ages,
it declined for young adults and increased substantially as
adults aged. Nearly 1 out of 5 young adults ages 18-24 lost
private insurance coverage during the year (17 percent) compared
to about 1 in 20 adults ages 35-54 and 55-64.
There were smaller disparities across racial/ethnic
groups for the privately insured than were observed in the
earlier tables. Of the population that was privately insured
in January, 87.0 percent of blacks and 88.9 percent of Hispanics
had full-year private coverage, compared to 92.7 percent of
whites. In addition, Hispanic males, the group most at risk
of lacking health insurance, do not emerge as a group especially
at risk of losing private coverage. In fact, private health
insurance coverage stability was equivalent for men and women
within each racial/ethnic group (data not presented). Thus,
the data point to an interesting contrast in the health insurance
status of minority groups: While wide disparities in all-year
uninsured rates and coverage acquisition rates between whites
and minority groups are found, the health insurance experience
of these groups is similar once they hold private coverage.
Whether this result reflects a greater congruence of demographic
characteristics and economic status for those with private
coverage and a greater disparity in these factors among the
uninsured remains a question for further research.
In contrast to earlier findings that revealed
that people in fair or poor health had reduced probabilities
of full-year coverage (Table 2), there
was little evidence that such people had greater instability
in their private health insurance coverage than those in better
health. Thus, the data suggest that health problems do not
interfere with the ability to maintain private coverage. However,
it cannot be determined from the data in this report whether
the health problems of those already holding private coverage
are less severe from the perspective of an insurer or reflect
the impact of reform measures (particularly at the State level)
that have improved portability and reduced the impact of pre-existing
health conditions.
Given the importance of the workplace as
the primary source of private coverage, there is strong evidence
that changes in employment status had a large effect on the
stability of private coverage. Of people employed part of
the year (Table 4), only 79.9 percent
retained private coverage throughout the year, with most of
the remainder of the group becoming uninsured. In contrast,
93.8 percent of those employed throughout the year retained
their private coverage. People who were not employed at all
during the year were as likely to retain their private insurance
(92.2 percent) as those employed all year, a finding that
probably reflects the role of dependency coverage, which affords
access to stable health insurance coverage for many nonworkers.
Particularly compelling is the strong relationship
among family income, the stability of private coverage, and
the likelihood of becoming uninsured should private coverage
end. About 95 percent of high-income people (over 400 percent
of the Federal poverty line) held private coverage all year,
as did 92 percent of people in middle-income families (over
200 percent to 400 percent of poverty). In contrast, people
who were poor or near-poor were at a significantly greater
risk of losing their private coverage: Only 77.7 percent of
those below the poverty line and 73.6 percent between 100
and 125 percent of the poverty line retained private coverage
for the entire year. About 18 percent of privately insured
poor people and a quarter of privately insured near-poor people
became uninsured, and these rates greatly exceeded the rates
for privately insured people in middle- or high-income families.
Note also that public coverage played a relatively small role
in filling the gap in coverage for these lower income privately
insured cohorts. These data may reflect issues of affordability
of coverage for lower income households and/or the possibility
of less stable employment among members of such households.
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Stability of
Public Insurance Coverage
Public programs that provide health insurance
are an important source of coverage, especially for vulnerable
populations such as the disabled, low-income children, and
pregnant women. Since such groups are likely to have greater
health care needs than the general non-elderly population,
it is important to assess whether this component of the public
safety net provides a stable source of coverage or whether
such populations are likely to experience gaps in coverage
during the year. Such assessments are likely to increase in
importance as more children
enroll in the State Children’s
Health Insurance Program (SCHIP) and as former welfare clients
make the transition to the labor market. Moreover, since periodic
reviews of income and assets are made to determine also important to assess the extent to which
those who leave public coverage are able to obtain alternative
sources of coverage.
Table 5 presents estimates
of the full-year health insurance status of non-elderly people
with public insurance coverage as their only source of coverage
in January 1996. In contrast to the cohort covered by private
health insurance in January 1996, those enrolled in public
insurance had substantially less stability in their coverage.
In particular, three-quarters (75.1 percent) of people publicly
insured in January retained such coverage throughout the year
and about one-fifth (19.1 percent) became uninsured at some
point during 1996. Only a relatively small proportion (7.3
percent) of people who began the year with public coverage
obtained private coverage at some point in calendar year 1996.
Children and adults were equally likely
to retain public coverage during 1996, with about three-quarters
of each group covered throughout the year (aggregate data
not shown). There was no variation in rates of full-year public
coverage among children of different ages, and nearly a fifth
of children at all ages became uninsured (18.3 percent, data
not shown). Such gaps in coverage for children enrolled in
public health insurance can have serious implications for
the quality and continuity of the care that they receive (Berman,
Bondy, Lezotte, et al., 1999). Contrary to the experience
of children, rates of full-year coverage did vary by age among
adults.
For example, only 61.7 percent
of young adults ages 18-24 retained coverage all year and
about a third (33.0 percent) became uninsured at some point
during the year. In contrast, 79.4 percent and 85.0 percent
of people ages 35-54 and 55-64, respectively, who had public
coverage in January 1996 were covered by public insurance
all year.
People
who were married all year and those who never married were
equally likely to retain
public coverage, but divorced people were significantly more
likely (86.3 percent) to retain public coverage all year.
Rates of full-year retention of public coverage were not statistically
different across most racial/ethnic groups. The only exception
was higher rates of full-year public coverage for people in
the "other" racial/ethnic group than for whites
and Hispanics. When comparisons are made by race/ethnicity
and gender, black males’ higher rate of full-year public coverage
is the only full-year estimate to differ significantly from
their white counterparts (83.6 vs. 73.4 percent). This difference
mainly reflects white males’ higher likelihood of obtaining
private coverage. For both males and females, whites were
also more likely than Hispanics to obtain private coverage.
Transitions from public coverage to no coverage showed little
statistical difference among racial/ethnic groups.
Public health insurance appears
to have provided a more stable source of coverage for people
who were in fair or poor health (either throughout the year
or ever during the year) than for those in better health in
1996. Rates of full-year coverage for individuals consistently
in fair or poor health were 88.2 percent, higher than the
71.7 percent for those in better health all year and comparable
to full-year coverage rates of their privately insured counterparts
(91.4 percent from Table 4). However,
private coverage for people who were ever in fair or poor
health during 1996 was still substantially more stable (91.0
percent from Table 4) than public coverage
(83.9 percent from Table 5). This latter
result may reflect the fact that people whose health status
improved from fair or poor to better health during 1996 might
have lost public coverage because of periodic reviews for
eligibility. Employment status was also associated with the
stability of public coverage. Approximately 87 percent of
people publicly insured in January 1996 who were not employed
all year retained their public coverage throughout the year.
Publicly insured people who were employed either all year
or part of the year had substantially lower rates of
stable coverage (51.5 percent and 64.8 percent, respectively).
Because employment is tied directly to key eligibility requirements
for many public insurance programs, this result is not surprising.
Note also that publicly insured people employed at any time
during 1996 also exhibited low rates of transition to private
health insurance (16.6 percent for those employed all year
and 6.5 percent for part year), especially when compared to
the rate at which these individuals became uninsured (34.0
percent for those employed all year and 31.9 percent for part
year). Whether this reflects the inability to find jobs that
make coverage available or whether limits on employment activity
associated with public coverage affect eligibility for private
insurance is an important research issue and especially relevant
given welfare reform.
Family income is also tied
directly to eligibility requirements for many Federal and
State public insurance programs. Approximately 82 percent
of publicly insured individuals in poor families retained
their public coverage all year, compared to only 60 to 70
percent of those who were near-poor, low income, or middle
income. Publicly insured people in poor families were less
likely than their near-poor or low-income counterparts to
become uninsured during the year but less likely than their
low-income counterparts to acquire private coverage.9 Because
of small sample sizes, the 9-percentage-point difference in
the rates of stable public coverage between high-income individuals
and poor individuals is not statistically significant, although
the high-income group was significantly more likely to acquire
private coverage.
In sum, MEPS data reveal that
populations of particular policy interest, such as the poor,
those not employed, and those in fair or poor health, experience
greater stability in public coverage than other groups do.
In fact, for individuals consistently in fair or poor health,
public coverage provides the same stability in full-year coverage
as private insurance. Poor people have greater stability in
their public coverage than any other income group except high
income. However, poor people (either publicly or privately
insured) have less stable coverage than the average for all
privately insured persons. Coverage for most other income
groups is less stable for individuals beginning the year with
public coverage than for those with private coverage.
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Conclusions
This analysis
of MEPS monthly health insurance data for 1996 provides
a number of perspectives on the measurement
of health insurance status and on the population’s experience
with health care coverage. First, a variety of time-dependent
measures of health insurance status are available for use,
and care must be exercised as to how such data are applied
to describe the extent of the uninsured problem. For example,
the more static, point-in-time uninsured estimates and the
full-year uninsured estimates provide similar assessments
of groups at risk of lacking coverage (such as young adults,
racial/ethnic minorities, those in fair/poor health, and people
with low income). This suggests that the time period studied
is not likely to bias conclusions regarding the characteristics of
the uninsured population.
However, full-year estimates of the number
of people ever uninsured may be more appropriate than
point-in-time estimates for assessing the program costs required
to provide coverage for the uninsured.
Next, the data
point to the importance of public coverage as a means through
which many disadvantaged
Americans are able to acquire health insurance. At the same
time, the data reveal that the population’s experience with
health insurance depends crucially on the type of coverage
held. While public health insurance does provide stable coverage
for certain disadvantaged groups (e.g., those in fair/poor
health), privately insured people, on average, have far greater
stability in their health insurance status. These differences
suggest that institutional and administrative rules and procedures
designed to allocate scarce resources to targeted populations
may threaten the continuity of public coverage when changes
in assets or income jeopardize eligibility. This is an especially
relevant issue because people who lose public coverage frequently
become uninsured, suggesting that they lack access to or are
unable to afford alternative private coverage.
The data also point to existing inequities
in the health insurance experience of some population groups,
especially with regard to their full-year insurance status,
their ability to maintain continuous coverage, and their ability
to acquire coverage when uninsured. Young adults, racial and
ethnic minorities, people in fair or poor health, and those
in low-income households were especially at risk of lacking
coverage for all or part of 1996. In addition, young adults,
people employed for part of the year, and people with poor,
near-poor, or low family incomes were the most likely to experience
instability in their private health insurance in 1996, suggesting
that the affordability of such coverage may be an issue for
many lower income households. Public coverage was most stable
for the poor, those not employed, and those in fair or poor
health.
Finally, only a relatively small proportion
of people (30.0 percent) who were uninsured at the beginning
of 1996 acquired coverage, with most obtaining private insurance.
The relatively small likelihood that the uninsured will acquire
coverage suggests that a variety of factors may hinder the
transition from uninsured to insured status. Such factors
include lack of available information on eligibility for public
programs and unwillingness of potentially eligible people
to apply for coverage, limited access to sources of private
coverage, and difficulties in affording such coverage when
it is made available. Understanding how these potential barriers
prevent the uninsured from obtaining coverage and whether
steps can be taken to eliminate these impediments constitute
an important challenge to public policy.
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References
Berman S, Bondy J, Lezotte D, et al. The
influence of having an assigned Medicaid primary care physician
on utilization of otitis media-related services. Pediatrics
1999 Nov; 104(5):1192-7.
Cohen J. Design and methods of the Medical
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Agency for Health Care Policy and Research; 1997. MEPS Methodology
Report No. 1. AHCPR Pub. No. 97-0026.
Cohen JW, Monheit AC, Beauregard
KM, 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.
Congressional Research Service. Health insurance
and the uninsured: background data and analysis.
Washington: U.S. Government Printing Office;
1988.
Lewis K, Ellwood M, Czajka JL. Counting
the uninsured: a review of the literature. Washington: Mathematica
Policy Research and the Urban Institute, Assessing the New
Federalism; 1998. Occasional Paper Number 8.
Monheit AC. Underinsured Americans: a review.
Annual Review of Public Health 1994; 15:461-85.
Monheit AC, Vistnes J. Race/ethnicity and
health insurance status: 1987-1996. Medical Care Research
and Review 2000; 57 Suppl:11-35.
Short P. Estimates of the uninsured population,
calendar year 1987. Rockville (MD): Agency for Health Care
Policy and Research;1990. National Medical Expenditure Survey
Data Summary 2. DHHS Pub. No. (PHS) 90-3469.
Swartz K. Interpreting the estimates from
four national surveys of the number of people without health
insurance. Journal of Economic and Social Measurement 1986;
14:233-56.
Swartz K, Purcell PJ. Counting uninsured
Americans. Health Affairs 1989; 8:193-7.
Vistnes J, Monheit AC. 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.
Walden DC, Wilensky DR, Kasper JA. Changes
in health insurance status: full-year and part-year coverage.
National Center for Health Services Research and Health Care
Technology Assessment; 1985. Data Preview 21, National Health
Care Expenditure Study. DHHS Pub. No. (PHS) 85-337.
1In
comparison, data from the Current Population Survey (CPS)
yield an estimate of 41.4 million non-elderly Americans (17.6
percent) who lacked health insurance during the entire 1996
calendar year. However, CPS estimates of the uninsured most
closely resemble those obtained at a point in time or for
reference periods much shorter than a year. As a result, most
analysts regard CPS estimates of the uninsured as hybrids
of point-in-time and annual estimates. See Lewis, Ellwood,
and Czajka (1998), Monheit (1994), Swartz (1986), and Swartz
and Purcell (1989) for a discussion.
2Analyses
of data from the 1987 National Medical Expenditure Survey
reveal that half (51.2 percent) of the 47.8 million non-elderly
Americans ever uninsured in 1987 were uninsured for the entire
year (Short, 1990). Estimates from the 1977 National Medical
Care Expenditure Survey indicate that just over half (53 percent)
of the 34.6 million persons ever uninsured in 1977 were uninsured
for the entire year (Walden, Wilensky, and Kasper, 1985).
3The
low rates of coverage for young adults reflect a number of
factors, including insurance carrier rules that limit dependency
coverage for people 18-24 years of age to full-time students;
transitions from full-time student status to more transient
part-time and part-year employment patterns that may limit
eligibility for employment-based coverage; and a preference
for wage income over nonpecuniary fringe benefits by some
young adults who expect to have small health care expenses.
4Full-year
marital status and health status were constructed from information
available at three points in time in 1996: the interview dates
for the first two rounds of MEPS and December 31, 1996.
5In
contrast to people who are widowed, divorced, or separated,
married people can have access to private coverage through
their own employment and/or that of their spouse. Moreover,
married couples generally have greater household income than
unmarried individuals, so they are better able to afford private
coverage.
6The
difference between Hispanics and groups categorized as "other" was
not statistically significant because of small sample sizes
for the "other" group.
7In
this study, workers are considered to have worked throughout
1996 if they were working at three points in time in 1996:
each of the interview dates for the first two rounds of MEPS
and December 31, 1996. Part-year workers were defined as individuals
who were working on one or two of those dates, and those not
employed were individuals not employed on any of those dates.
8For
employees, COBRA qualifying events include job loss (other
than for gross misconduct) and a reduction in hours. For dependents,
qualifying events include employee termination, death, divorce
or legal separation, employee eligibility for Medicare, and
dependent children who no longer meet plan definitions of
dependents. Continuation coverage extends for 18 months in
the case of a job loss or hours reduction and 36 months for
other qualifying events, and premiums under COBRA can be as
high as 102 percent of the costs for an employer’s active
employees (Congressional Research Service, 1988).
9The
rates of becoming uninsured for poor and near-poor publicly
insured people differed at the 10-percent significance level.
^top
Tables
Table 1. Alternative
estimates of the uninsured population under age 65 from
the 1996 Medical Expenditure Panel Survey
Definition |
Number of uninsured
in thousands |
Percent of non-elderly
population |
|
|
|
Without coverage
on December 31,1996 |
47,119 |
20.5 |
Without coverage throughout
the first half of 1996 (first round of interview) |
42,298 |
18.4 |
Without coverage
the entire year |
31,613 |
13.8 |
Without coverage
for part of the year only (1 to 11 months) |
30,406 |
13.3 |
|
Note:
The estimates in this table cover the civilian noninstitutionalized
population under age 65 who were resident for the entire
year (229.3 million individuals).
Source: Center
for Financing, Access, and Cost Trends, Agency for
Healthcare Research and Quality: Medical Expenditure
Panel Survey, 1996. |
Table 2. Full-year
health insurance status of the population under age 65:
United States,1996
Population
characteristic |
Population in
thousands |
Insured
all year |
Insured part
of year |
Uninsured
all year |
|
|
Percent
distribution
|
Totala |
229,325 |
73.0 |
13.3 |
13.8 |
Age in years |
Less than 7 |
24,229 |
76.9 |
14.7 |
8.4 |
7-17 |
43,340 |
75.5 |
13.1 |
11.4 |
18-24 |
24,798 |
54.5 |
22.8 |
22.7 |
25-34 |
39,587 |
65.2 |
17.8 |
17.0 |
35-54 |
76,769 |
77.8 |
9.1 |
13.0 |
55-64 |
20,602 |
82.1 |
7.2 |
10.8 |
Race/ethnicity |
Total Hispanic |
27,202 |
53.5 |
17.8 |
28.7 |
Total black |
29,924 |
64.1 |
18.5 |
17.4 |
Total white |
162,084 |
77.9 |
11.6 |
10.5 |
Total other |
10,114 |
71.8 |
11.6 |
16.6 |
Hispanic male |
14,002 |
50.2 |
16.0 |
33.8 |
Black male |
14,150 |
62.5 |
18.2 |
19.3 |
White male |
80,778 |
77.3 |
11.3 |
11.4 |
Hispanic female |
13,200 |
57.0 |
19.7 |
23.3 |
Black female |
15,774 |
65.6 |
18.8 |
15.6 |
White female |
81,306 |
78.5 |
11.9 |
9.6 |
Marital
statusb |
Married all year |
86,758 |
80.9 |
9.3 |
9.8 |
Widowed all year |
2,293 |
73.4 |
8.4 |
18.2 |
Divorced all year |
11,459 |
68.4 |
13.4 |
18.2 |
Separated all year |
3,574 |
55.9 |
19.6 |
24.6 |
Never married all year |
49,925 |
60.8 |
17.6 |
21.7 |
Changed marital status |
13,007 |
60.2 |
19.3 |
20.4 |
Perceived health status |
Excellent,very good,or good
all year |
201,195 |
73.8 |
13.1 |
13.1 |
Fair or poor all year |
10,889 |
67.4 |
14.3 |
18.3 |
Ever fair or poor during
year |
27,786 |
66.5 |
14.5 |
18.9 |
Employment
statusb |
Employed all year |
114,545 |
76.5 |
11.1 |
12.4 |
Employed part year |
25,437 |
53.2 |
22.9 |
23.9 |
Not employed all year |
26,286 |
70.8 |
11.6 |
17.5 |
Incomec |
Poor |
30,489 |
55.2 |
20.3 |
24.5 |
Near-poor |
9,203 |
45.2 |
27.6 |
27.3 |
Low income |
30,826 |
55.8 |
19.1 |
25.1 |
Middle income |
76,619 |
75.7 |
12.1 |
12.3 |
High income |
81,637 |
86.7 |
7.8 |
5.5 |
|
aIncludes
persons with unknown marital status, health status,
employment status, and income.
bFor individuals
ages 16 and over.
cPoor refers
to incomes below the Federal poverty line; near-poor,
over the poverty line through 125 percent of the poverty
line; low income, over 125 percent through 200 percent
of the poverty line; middle income, over 200 percent
to 400 percent of the poverty line; and high income,
over 400 percent of the poverty line.
Note: The
estimates in this table cover the civilian noninstitutionalized
population under age 65 who were resident for the entire
year. 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,
1996. |
Table 3. Full-year
health insurance status of persons under age 65 who were
uninsured in January 1996: United States
Population
characteristic |
Population in
thousands |
Obtained insurance |
|
|
Total |
Private |
Public |
|
|
Percent
|
Totala |
45,184 |
30.0 |
21.6 |
8.4 |
Age in years |
Less than 7 |
3,501 |
41.9 |
18.4 |
23.5 |
7-17 |
7,309 |
32.1 |
21.2 |
11.0 |
18-24 |
8,299 |
32.1 |
24.4 |
7.7 |
25-34 |
9,901 |
31.9 |
25.5 |
6.4 |
35-54 |
13,399 |
25.2 |
20.2 |
5.0 |
55-64 |
2,774 |
19.9 |
11.7 |
8.2 |
Race/ethnicity |
Total Hispanic |
10,221 |
23.7 |
13.3 |
10.4 |
Total black |
7,889 |
34.2 |
22.6 |
11.6 |
Total white |
24,763 |
31.6 |
24.9 |
6.7 |
Total other |
2,310 |
27.5 |
20.3 |
7.2 |
Hispanic male |
5,887 |
19.7 |
12.0 |
7.7 |
Black male |
4,103 |
33.5 |
23.9 |
9.6 |
White male |
13,036 |
29.6 |
23.5 |
6.1 |
Hispanic female |
4,335 |
29.1 |
15.1 |
14.0 |
Black female |
3,786 |
34.9 |
21.1 |
13.8 |
White female |
11,727 |
33.8 |
26.4 |
7.4 |
Marital
statusb |
Married all year |
12,017 |
29.4 |
24.0 |
5.4 |
Widowed,divorced,or separated
all year |
4,504 |
24.9 |
17.5 |
7.4 |
Never married all year |
15,098 |
28.4 |
21.9 |
6.5 |
Changed marital status |
3,816 |
30.4 |
21.9 |
8.5 |
Perceived health status |
Excellent,very good,or good
all year |
37,818 |
30.5 |
23.2 |
7.3 |
Fair or poor all year |
2,884 |
31.0 |
11.7 |
19.3 |
Ever fair or poor during
year |
7,295 |
27.9 |
13.5 |
14.4 |
Employment
statusb |
Employed all year |
20,511 |
30.6 |
27.8 |
2.8 |
Employed part year |
8,285 |
26.5 |
17.8 |
8.7 |
Not employed all year |
6,119 |
24.7 |
8.5 |
16.2 |
Incomec |
Poor |
10,368 |
28.0 |
11.2 |
16.8 |
Near-poor |
3,594 |
30.2 |
16.8 |
13.3 |
Low income |
10,592 |
27.0 |
20.7 |
6.3 |
Middle income |
13,445 |
30.2 |
25.0 |
5.2 |
High income |
7,081 |
36.7 |
34.1 |
2.6 |
|
aIncludes
persons with unknown marital status, health status,
employment status, and income.
bFor individuals
ages 16 and over.
cPoor refers
to incomes below the Federal poverty line; near-poor,
over the poverty line through 125 percent of the poverty
line; low income, over 125 percent through 200 percent
of the poverty line; middle income, over 200 percent
to 400 percent of the poverty line; and high income,
over 400 percent of the poverty line.
Note: The
estimates in this table cover the civilian noninstitutionalized
population under age 65 who were resident for the entire
year. For "Obtained insurance," percents may
not add to total because of rounding.
Source: Center
for Financing, Access, and Cost Trends, Agency for Healthcare
Research and Quality: Medical Expenditure Panel Survey,
1996. |
Table 4. Full-year
health insurance status of persons under age 65 who were
privately insured in January 1996: United States
Population
characteristic |
Population in
thousands |
Private
all year |
Ever
uninsured |
Ever public
coverage |
|
|
Percent
|
Totala |
159,998 |
92.0 |
7.6 |
0.7 |
Age in years |
Less than 7 |
15,096 |
92.1 |
6.8 |
1.7 |
7-17 |
28,648 |
92.6 |
6.9 |
0.9 |
18-24 |
14,396 |
83.1 |
16.0 |
1.8 |
25-34 |
26,843 |
87.5 |
12.1 |
0.6 |
35-54 |
58,851 |
94.9 |
4.9 |
0.2 |
55-64 |
16,164 |
95.1 |
4.6 |
0.6 |
Race/ethnicity |
Total Hispanic |
11,626 |
88.9 |
9.9 |
2.0 |
Total black |
15,006 |
87.0 |
11.5 |
2.0 |
Total white |
126,788 |
92.7 |
7.1 |
0.5 |
Total other |
6,578 |
94.6 |
5.4 |
0.0 |
Marital
statusb |
Married all year |
71,676 |
94.3 |
5.5 |
0.3 |
Widowed all year |
1,487 |
97.2 |
2.6 |
0.2 |
Divorced all year |
7,325 |
90.2 |
9.2 |
0.9 |
Separated all year |
1,645 |
88.2 |
11.4 |
1.5 |
Never married all year |
29,785 |
87.7 |
11.7 |
0.9 |
Changed marital status |
7,903 |
87.0 |
12.9 |
1.1 |
Perceived health status |
Excellent,very good,or good
all year |
145,912 |
92.1 |
7.6 |
0.6 |
Fair or poor all year |
4,634 |
91.4 |
7.5 |
1.8 |
Ever fair or poor during
year |
13,857 |
91.0 |
7.9 |
2.1 |
Employment
statusb |
Employed all year |
91,788 |
93.8 |
6.2 |
0.1 |
Employed part year |
14,518 |
79.9 |
19.2 |
2.2 |
Not employed all year |
13,384 |
92.2 |
6.2 |
2.3 |
Incomec |
Poor |
6,174 |
77.7 |
17.9 |
6.8 |
Near-poor |
3,147 |
73.6 |
25.6 |
2.9 |
Low income |
15,965 |
86.9 |
12.0 |
1.8 |
Middle income |
60,905 |
92.0 |
7.7 |
0.6 |
High income |
73,398 |
95.1 |
4.9 |
0.1 |
|
aIncludes
persons with unknown marital status, health status,
employment status, and income.
bFor individuals
ages 16 and over.
cPoor refers
to incomes below the Federal poverty line; near-poor,
over the poverty line through 125 percent of the poverty
line; low income, over 125 percent through 200 percent
of the poverty line; middle income, over 200 percent
to 400 percent of the poverty line; and high income,
over 400 percent of the poverty line.
Note: The
estimates in this table cover the civilian noninstitutionalized
population under age 65 who were resident for the entire
year. The categories shown in the last two columns of
this table, people ever uninsured and people ever publicly
covered, are not mutually exclusive.
Source: Center
for Financing, Access, and Cost Trends, Agency for Healthcare
Research and Quality: Medical Expenditure Panel Survey,
1996. |
Table 5. Full-year
health insurance status of persons under age 65 who were
publicly insured in January 1996: United States
Population
characteristic |
Population
in thousands |
Public
all year |
Ever
uninsured |
Ever private
coverage |
|
|
Percent
|
Totala |
24,143 |
75.1 |
19.1 |
7.3 |
Age in years |
Less than 7 |
5,632 |
74.8 |
18.8 |
8.0 |
7-17 |
7,383 |
75.5 |
17.9 |
8.6 |
18-24 |
2,104 |
61.7 |
33.0 |
5.4 |
25-34 |
2,843 |
71.6 |
21.9 |
9.2 |
35-54 |
4,518 |
79.4 |
16.4 |
5.1 |
55-64 |
1,664 |
85.0 |
10.8 |
4.3 |
Race/ethnicity |
Total Hispanic |
5,354 |
73.8 |
23.6 |
3.1 |
Total black |
7,029 |
79.5 |
16.0 |
5.5 |
Total white |
10,533 |
71.6 |
19.4 |
11.5 |
Total other |
1,226 |
85.1 |
14.9 |
0.0 |
Hispanic male |
2,200 |
75.3 |
21.8 |
3.3 |
Black male |
2,903 |
83.6 |
13.7 |
3.0 |
White male |
5,032 |
73.4 |
17.9 |
11.2 |
Hispanic female |
3,155 |
72.8 |
24.9 |
2.9 |
Black female |
4,126 |
76.6 |
17.6 |
7.3 |
White female |
5,501 |
69.9 |
20.9 |
11.7 |
Marital
statusb |
Married all year |
3,065 |
74.7 |
19.4 |
6.5 |
Widowed or separated all
year |
1,022 |
68.3 |
24.0 |
10.0 |
Divorced all year |
1,344 |
86.3 |
11.6 |
3.2 |
Never married all year |
5,042 |
76.8 |
19.5 |
4.8 |
Changed marital status |
1,288 |
64.9 |
26.3 |
10.1 |
Perceived health status |
Excellent,very good,or good
all year |
17,465 |
71.7 |
21.2 |
8.6 |
Fair or poor all year |
3,371 |
88.2 |
9.3 |
3.0 |
Ever fair or poor during
year |
6,633 |
83.9 |
13.6 |
3.8 |
Employment
statusb |
Employed all year |
2,246 |
51.5 |
34.0 |
16.6 |
Employed part year |
2,634 |
64.8 |
31.9 |
6.5 |
Not employed |
6,784 |
87.1 |
10.5 |
2.4 |
Incomec |
Poor |
13,947 |
82.1 |
15.6 |
2.9 |
Near-poor |
2,462 |
67.6 |
26.3 |
8.6 |
Low income |
4,269 |
59.6 |
25.9 |
18.5 |
Middle income |
2,269 |
69.7 |
21.8 |
10.6 |
High income |
1,159 |
73.3 |
16.4 |
10.3 |
|
aIncludes
persons with unknown marital status, health status,
employment status, and income.
bFor individuals
ages 16 and over.
cPoor refers
to incomes below the Federal poverty line; near-poor,
over the poverty line through 125 percent of the poverty
line; low income, over 125 percent through 200 percent
of the poverty line; middle income, over 200 percent
to 400 percent of the poverty line; and high income,
over 400 percent of the poverty line.
Note: The
estimates in this table cover the civilian noninstitutionalized
population under age 65 who were resident for the entire
year. The categories shown in the last two columns of
this table, people ever uninsured and people ever privately
covered, are not mutually exclusive.
Source: Center
for Financing, Access, and Cost Trends, Agency for Healthcare
Research and Quality: Medical Expenditure Panel Survey,
1996. |
^top
Technical Appendix
The data in this report were obtained in
the first three rounds of interviews for the Household Component
(HC) of the 1996 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 collects detailed data on demographic
characteristics, health conditions, health status, use of
medical care services, charges and payments for those services,
access to care, health insurance coverage, income, and employment
of the U.S. civilian noninstitutionalized population. In other
components of MEPS, data are collected on the use, charges,
and payments reported by providers (Medical Provider Component),
residents of licensed or certified nursing homes (Nursing
Home Component), and the supply side of the insurance market
(Insurance Component).
Survey Design
The sample for the MEPS HC was selected
from respondents to the 1995 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 a period of 21/2 years. Interviews
are conducted with one member of each family, who reports
on the health care experiences of the entire family. Two calendar
years of data are collected in each household and captured
using computer-assisted personal interviewing (CAPI).
The reference period for Round 1 of the
MEPS HC was from January 1, 1996, to the date of the first
interview, which occurred during the period from March through
August 1996. The reference period for Round 2 of the MEPS
HC was from the date of the first interview (March-August
1996) to the date of the second interview, which took place
during the period from August through December 1996. While
the reference period for Round 3 was from the date of the
second interview (August-December 1996) to the date of the
third interview (February-July 1997), only data from the 1996
portion of the Round 3 interview are included in the estimates
contained in this report.
Health Insurance
Status
Individuals under age 65 were classified
into the following insurance categories based on household
responses to health insurance status questions administered
during Rounds 1-3 of the MEPS HC.
- Insured all year -
Individuals who were insured by private and/or public
coverage during
all of calendar year 1996.
- Insured part year -
Individuals who were without coverage for at least 1 month
but not all 12 months of the 1996 calendar year.
- Uninsured all year -
Individuals who did not have any coverage during the entire
1996 calendar
year.
- Obtained private insurance -
Individuals who were uninsured in January 1996 but obtained
private
health insurance at some point during calendar year 1996.
- Obtained public insurance -
Individuals who were uninsured in January 1996 but obtained
public
coverage only at some point during calendar year 1996.
- Private coverage all year -
Persons with a full 12 months of private insurance coverage
during
calender year 1996.
- Public coverage all year -
Persons with only public coverage in January 1996 who
retained
such coverage throughout the year.
- Ever public coverage -
Individuals who began the year with private coverage and
switched
to only public coverage at some point during calendar
year 1996.
- Ever private coverage -
Individuals who began the year with only public coverage
and obtained
private coverage at some point during calendar year 1996.
- Ever uninsured -
Individuals who had health insurance coverage in January
1996 and became
uninsured at some point during 1996.
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 may be purchased for a
monthly premium.
Medicaid
Medicaid is a means-tested government program
jointly financed by Federal and State funds that provides
health care to those who are eligible. Program eligibility
criteria vary significantly by State, but the program is designed
to provide health coverage to families and individuals who
are unable to afford necessary medical care.
Other Public Hospital/Physician Coverage
Respondents who did not report Medicaid
coverage were asked if they were covered by any other public
hospital/physician coverage. These questions were asked in
an attempt to identify Medicaid recipients who might not have
recognized their coverage as Medicaid. 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. Insurance that provides coverage for a
single service only, such as dental or vision coverage, was
not counted. For the purpose of this analysis, CHAMPUS/CHAMPVA
(now known as TRICARE) coverage is combined with private coverage.
CHAMPUS covers retired members of the Uniformed
Services and the spouses and children of active-duty, retired, and
deceased members. CHAMPVA covers spouses and children of veterans
who died from a service-connected disability or are permanently
disabled and not eligible for CHAMPUS or Medicare.
Population Characteristics
Age
The respondent
was asked to report the age of each family member as of
the date of each interview for
Rounds 1, 2, and 3. In this report, age is based on the sample
person’s age as of December 31, 1996.
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.
Marital Status
Full-year marital status was constructed
from information available at three points in time during
1996: the interview dates for the first two rounds of MEPS
and December 31, 1996.
If there were discrepancies between the
marital status of two individuals within a family, other person-level
variables were reviewed to determine the edited marital status
for each individual. Thus, when one spouse was reported as
married and the other spouse reported as widowed, the data
were reviewed to determine if one partner should be coded
as widowed in the specific round.
Perceived Health Status
Full-year health status was
constructed from information available at three points in
time during 1996: the interview dates for the first two rounds
of MEPS and December 31, 1996. The MEPS respondent was asked
to rate the health of each person in the family at the time
of the interview according to the following categories: excellent,
very good, good, fair, and poor. In the tables in this report,
the health status categories were collapsed into the following
three broad categories: (1) excellent, very good, or good
health all year , (2) fair or poor health all year, and (3)
ever in fair or poor health during the year.
Employment Status
Full-year employment status was constructed
from information available at three points in time during
1996: the interview dates for the first two rounds of MEPS
and December 31, 1996. At each point in time, persons were
considered to be employed if they were age 16 and over, had
a job for pay, owned a business, or worked without pay in
a family business at the time of the interview.
Income
Each sample person
was classified according to the total 1996 income of his
or her family. Within a household,
all individuals related by blood, marriage, or adoption were
considered to be a family. Personal income from all family
members was summed to create family income. Possible sources
of income included annual earnings from wages, salaries, bonuses,
tips, and commissions; business and farm gains and losses;
unemployment and Worker’s Compensation; interest and dividends;
alimony, child support, and other private cash transfers;
private pensions, individual retirement account (IRA) withdrawals,
Social Security, and Department of Veterans Affairs payments;
Supplemental Security Income and cash welfare payments from
public assistance, Aid to Families with Dependent Children,
and Aid to Dependent Children; gains or losses from estates,
trusts, partnerships, S corporations, rent, and royalties;
and a small amount of "other" income.
Poverty status
is the ratio of family income to the 1996 Federal poverty
thresholds, which control for family size and age of the head of family.
Income categories are defined as follows:
- Poor - Includes
persons in families with income less than or equal to
the poverty line and those
who reported negative income.
- Near-poor - Includes
persons in families with income over the poverty line
through 125 percent
of the poverty line.
- Low income - Includes
persons in families with income over 125 percent through
200 percent
of the poverty line.
- Middle income - Includes
persons in families with income over 200 percent through
400 percent
of the poverty line.
- High income - Includes
persons in families with income over 400 percent of the
poverty
line.
Sample Design and
Accuracy of Estimates
The sample selected for the 1996 MEPS, a
subsample of the 1995 NHIS, was designed to produce national
estimates that are representative of the civilian noninstitutionalized
population of the United States. Round 1 data were obtained
for approximately 9,400 households in MEPS, resulting in a
survey response rate of 78 percent. This figure reflects participation
in both NHIS and MEPS. For Round 2, the response rate was
95 percent, resulting in a response rate of 74 percent overall
from the NHIS interview through Round 2 of MEPS. For Round
3, the response rate was 95 percent, resulting in a full-year
response rate of 70 percent.
The
statistics presented in this report are affected by both
sampling error and sources
of nonsampling error, which include nonresponse bias, respondent
reporting errors, and interviewer effects. For a detailed
description of the MEPS survey design, the adopted sample
design, and methods used to minimize sources of nonsampling
error, see J. Cohen (1997), S. Cohen (1997), and Cohen, Monheit,
Beauregard, et al. (1996). The MEPS person-level estimation
weights include nonresponse adjustments and poststratification
adjustments to population totals obtained from the March 1997
Current Population Survey (CPS) to reflect Census Bureau estimated
population distributions as of December 1996. The person-level
poststratification incorporated the following variables: income,
marital status, race/ethnicity, sex,
and age. The weighting process also included poststratification
to population totals obtained from the 1996 Medicare Current
Beneficiary Survey (MCBS) for the number of deaths among Medicare
beneficiaries in 1996. Overall, the weighted population estimate
for the civilian noninstitutionalized population as of December
31, 1996, is 265,439,511. The inclusion of people who were
in scope at some time in 1996 but were out of scope (deceased,
institutionalized, active-duty military, or out of the country)
as of December 31, 1996 (not included in this report), brings
the estimated total number of people represented by MEPS respondents
over the course of the year up to 268,905,490. 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 statistically
significant differences between estimates are discussed in
the text.
Rounding
Estimates presented in the tables were rounded
to the nearest 0.1 percent. Standard errors, presented in Tables
A-E, were rounded to the nearest 0.01.
Population estimates in Tables
1-5 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.
Table
A. Standard errors for alternative estimates
of the uninsured population under age 65 from the
1996 Medical Expenditure Panel Survey
Corresponds to Table 1
Definition |
Percent of non-elderly
population |
|
Standard error |
Without coverage on
December 31,1996 |
0.54 |
Without coverage throughout
the first half
of 1996 (first round of interview) |
0.58 |
Without coverage the
entire year |
0.49 |
Without coverage for
part of the year only
(1 to 11 months) |
0.45 |
|
Source: Center
for Financing, Access, and Cost Trends, Agency
for Healthcare Research and Quality: Medical Expenditure
Panel Survey, 1996. |
Table
B. Standard errors for full-year health insurance
status of the
population under age 65: United States,1996
Corresponds to Table 2
Population
characteristic |
Insured
all
year |
Insured part
year |
Uninsured all
year |
|
Standard
error
|
Totala |
0.69 |
0.45 |
0.49 |
Age in years |
Less than 7 |
1.29 |
1.16 |
0.90 |
7-17 |
1.15 |
0.87 |
0.82 |
18-24 |
1.54 |
1.28 |
1.47 |
25-34 |
1.26 |
0.95 |
0.86 |
35-54 |
0.83 |
0.53 |
0.59 |
55-64 |
1.13 |
0.87 |
0.83 |
Race/ethnicity |
Total Hispanic |
1.61 |
0.97 |
1.59 |
Total black |
1.69 |
1.66 |
1.27 |
Total white |
0.76 |
0.52 |
0.48 |
Total other |
3.14 |
1.76 |
2.36 |
Hispanic male |
1.75 |
1.07 |
1.87 |
Black male |
2.12 |
1.82 |
1.81 |
White male |
0.88 |
0.63 |
0.60 |
Hispanic female |
1.82 |
1.23 |
1.61 |
Black female |
2.05 |
2.08 |
1.29 |
White female |
0.84 |
0.59 |
0.53 |
Marital
statusb |
Married all year |
0.82 |
0.59 |
0.54 |
Widowed all year |
3.45 |
2.12 |
2.91 |
Divorced all year |
1.67 |
1.39 |
1.42 |
Separated all year |
3.25 |
2.77 |
2.89 |
Never married all
year |
1.12 |
0.85 |
0.95 |
Changed marital status |
1.75 |
1.26 |
1.48 |
Perceived health
status |
Excellent,very good,or
good all year |
0.70 |
0.46 |
0.51 |
Fair or poor all year |
1.91 |
1.48 |
1.41 |
Ever fair or poor
during year |
1.33 |
0.94 |
1.00 |
Employment
statusb |
Employed all year |
0.68 |
0.45 |
0.48 |
Employed part year |
1.50 |
1.21 |
1.21 |
Not employed all year |
1.27 |
0.82 |
0.96 |
Incomec |
Poor |
1.75 |
1.38 |
1.40 |
Near-poor |
2.78 |
2.73 |
2.92 |
Low income |
1.70 |
1.32 |
1.41 |
Middle income |
0.91 |
0.67 |
0.62 |
High income |
0.73 |
0.59 |
0.43 |
|
aIncludes
persons with unknown marital status, health status,
employment status, and income.
bFor
individuals ages 16 and over.
cPoor
refers to incomes below the Federal poverty line;
near-poor, over the poverty line through 125 percent
of the poverty line; low income, over 125 percent
through 200 percent of the poverty line; middle
income, over 200 percent to 400 percent of the
poverty line; and high income, over 400 percent
of the poverty line.
Note: The
estimates in this table cover the civilian noninstitutionalized
population under age 65 who were resident for
the entire year.
Source: Center
for Financing, Access, and Cost Trends, Agency
for Healthcare Research and Quality: Medical Expenditure
Panel Survey, 1996. |
Table
C. Standard errors for full-year health insurance
status of persons under age 65 who were uninsured
in January 1996: United States
Corresponds to Table 3
|
Obtained
insurance
|
Population
characteristic |
Total |
Private |
Public |
|
Standard
error
|
Totala |
1.17 |
1.19 |
0.68 |
Age in years |
Less than 7 |
3.54 |
2.84 |
3.27 |
7-17 |
2.90 |
2.65 |
1.59 |
18-24 |
2.41 |
2.18 |
1.29 |
25-34 |
2.08 |
2.07 |
1.21 |
35-54 |
1.71 |
1.57 |
0.76 |
55-64 |
3.63 |
2.47 |
2.36 |
Race/ethnicity |
Total Hispanic |
1.83 |
1.64 |
1.26 |
Total black |
3.32 |
3.16 |
2.00 |
Total white |
1.59 |
1.73 |
0.88 |
Total other |
3.98 |
3.67 |
1.56 |
Hispanic male |
2.07 |
1.72 |
1.32 |
Black male |
3.94 |
3.68 |
2.01 |
White male |
1.84 |
1.87 |
0.92 |
Hispanic female |
2.27 |
2.13 |
1.93 |
Black female |
3.88 |
3.44 |
2.97 |
White female |
2.09 |
2.17 |
1.17 |
Marital
statusb |
Married all year |
2.02 |
2.04 |
0.84 |
Widowed,divorced,or
separated all year |
2.60 |
2.19 |
2.04 |
Never married all
year |
1.75 |
1.72 |
0.86 |
Changed marital status |
2.85 |
2.81 |
1.63 |
Perceived health
status |
Excellent,very good,or
good all year |
1.31 |
1.33 |
0.70 |
Fair or poor all year |
3.97 |
2.93 |
3.54 |
Ever fair or poor
during year |
2.24 |
1.71 |
1.73 |
Employment
statusb |
Employed all year |
1.48 |
1.45 |
0.54 |
Employed part year |
2.08 |
1.96 |
1.25 |
Not employed all year |
2.20 |
1.47 |
1.86 |
Incomec |
Poor |
2.11 |
1.92 |
1.51 |
Near-poor |
4.43 |
3.38 |
3.47 |
Low income |
2.53 |
2.50 |
1.14 |
Middle income |
2.02 |
1.95 |
1.07 |
High income |
3.10 |
3.06 |
1.36 |
|
aIncludes
persons with unknown marital status, health status,
employment status, and income.
bFor
individuals ages 16 and over.
cPoor
refers to incomes below the Federal poverty line;
near-poor, over the poverty line through 125 percent
of the poverty line; low income, over 125 percent
through 200 percent of the poverty line; middle
income, over 200 percent to 400 percent of the
poverty line; and high income, over 400 percent
of the poverty line.
Note: The
estimates in this table cover the civilian noninstitutionalized
population under age 65 who were resident for
the entire year.
Source: Center
for Financing, Access, and Cost Trends, Agency
for Healthcare Research and Quality: Medical Expenditure
Panel Survey, 1996. |
Table D. Standard
errors for full-year health insurance status of persons
under age 65 who were privately insured in January
1996: United States
Corresponds to Table 4
Population
characteristic |
Private
all year |
Ever
uninsured |
Ever public
coverage |
|
Standard
error
|
Totala |
0.40 |
0.39 |
0.11 |
Age in years |
Less than 7 |
1.17 |
1.07 |
0.39 |
7-17 |
0.87 |
0.87 |
0.23 |
18-24 |
1.55 |
1.54 |
0.60 |
25-34 |
1.05 |
1.03 |
0.16 |
35-54 |
0.43 |
0.43 |
0.08 |
55-64 |
0.82 |
0.80 |
0.26 |
Race/ethnicity |
Total Hispanic |
1.25 |
1.17 |
0.51 |
Total black |
1.50 |
1.42 |
0.68 |
Total white |
0.43 |
0.43 |
0.11 |
Total other |
1.86 |
1.86 |
0.04 |
Marital
statusb |
Married all year |
0.48 |
0.48 |
0.08 |
Widowed all year |
1.30 |
1.29 |
0.16 |
Divorced all year |
1.56 |
1.55 |
0.48 |
Separated all year |
2.90 |
2.89 |
0.73 |
Never married all
year |
0.91 |
0.90 |
0.29 |
Changed marital status |
1.58 |
1.57 |
0.56 |
Perceived health
status |
Excellent,very good,or
good all year |
0.40 |
0.40 |
0.09 |
Fair or poor all year |
1.56 |
1.44 |
0.77 |
Ever fair or poor
during year |
1.06 |
0.99 |
0.69 |
Employment
statusb |
Employed all year |
0.35 |
0.35 |
0.03 |
Employed part year |
1.60 |
1.59 |
0.56 |
Not employed all year |
1.05 |
0.96 |
0.65 |
Incomec |
Poor |
3.24 |
2.96 |
1.67 |
Near-poor |
4.96 |
4.80 |
1.42 |
Low income |
1.50 |
1.46 |
0.52 |
Middle income |
0.66 |
0.65 |
0.16 |
High income |
0.48 |
0.49 |
0.03 |
|
aIncludes
persons with unknown marital status, health status,
employment status, and income.
bFor
individuals ages 16 and over.
cPoor
refers to incomes below the Federal poverty line;
near-poor, over the poverty line through 125 percent
of the poverty line; low income, over 125 percent
through 200 percent of the poverty line; middle
income, over 200 percent to 400 percent of the
poverty line; and high income, over 400 percent
of the poverty line.
Note: The
estimates in this table cover the civilian noninstitutionalized
population under age 65 who were resident for
the entire year.
Source: Center
for Financing, Access, and Cost Trends, Agency
for Healthcare Research and Quality: Medical Expenditure
Panel Survey, 1996. |
Table E. Standard
errors for full-year health insurance status of persons
under age 65 who were publicly insured in January
1996: United States
Corresponds to Table 5
Population
characteristic |
Public all
year |
Ever
uninsured |
Ever private
coverage |
|
Standard
error
|
Totala |
1.82 |
1.54 |
1.15 |
Age in years |
Less than 7 |
2.88 |
2.57 |
1.53 |
7-17 |
2.91 |
2.35 |
2.05 |
18-24 |
4.23 |
4.28 |
1.83 |
25-34 |
3.07 |
2.97 |
2.35 |
35-54 |
3.04 |
2.65 |
1.86 |
55-64 |
4.52 |
4.38 |
1.67 |
Race/ethnicity |
Total Hispanic |
2.53 |
2.37 |
0.73 |
Total black |
3.97 |
3.55 |
1.51 |
Total white |
2.81 |
2.24 |
2.28 |
Total other |
4.41 |
4.41 |
0.00 |
Hispanic male |
3.22 |
3.19 |
1.04 |
Black male |
3.92 |
3.86 |
1.06 |
White male |
3.27 |
2.63 |
2.40 |
Hispanic female |
2.86 |
2.75 |
0.77 |
Black female |
4.53 |
3.90 |
2.19 |
White female |
3.28 |
2.66 |
2.72 |
Marital
statusb |
Married all year |
3.83 |
3.68 |
2.11 |
Widowed or separated
all year |
5.26 |
5.01 |
2.96 |
Divorced all year |
3.17 |
2.93 |
1.68 |
Never married all
year |
2.51 |
2.47 |
1.02 |
Changed marital status |
5.67 |
5.16 |
3.76 |
Perceived health
status |
Excellent,very good,or
good all year |
2.13 |
1.76 |
1.49 |
Fair or poor all year |
1.81 |
1.65 |
1.01 |
Ever fair or poor
during year |
1.90 |
1.82 |
0.88 |
Employment
statusb |
Employed all year |
4.96 |
4.35 |
4.04 |
Employed part year |
3.44 |
3.46 |
1.71 |
Not employed |
1.38 |
1.30 |
0.63 |
Incomec |
Poor |
1.93 |
1.89 |
0.67 |
Near-poor |
5.80 |
5.52 |
3.42 |
Low income |
4.36 |
3.67 |
4.61 |
Middle income |
5.14 |
4.22 |
3.47 |
High income |
6.19 |
5.57 |
3.68 |
|
aIncludes
persons with unknown marital status, health status,
employment status, and income.
bFor
individuals ages 16 and over.
cPoor
refers to incomes below the Federal poverty line;
near-poor, over the poverty line through 125 percent
of the poverty line; low income, over 125 percent
through 200 percent of the poverty line; middle
income, over 200 percent to 400 percent of the
poverty line; and high income, over 400 percent
of the poverty line.
Note: The
estimates in this table cover the civilian noninstitutionalized
population under age 65 who were resident for
the entire year.
Source: Center
for Financing, Access, and Cost Trends, Agency
for Healthcare Research and Quality: Medical Expenditure
Panel Survey, 1996. |
^top
Suggested
Citation:
Monheit, A. C., Vistnes, J. P., and Zuvekas, S. H. Research Findings #18: Stability and Change in Health Insurance Status: New Estimates from the 1996 MEPS. December 2001. Agency
for Healthcare Research and Quality, Rockville,
MD.
http://www.meps.ahrq.gov/data_files/publications/rf18/rf18.shtml
|