Facts on Health Coverage

1
Facts on Health Coverage in the USA
Updated February 2008
Prepared for Cover the Uninsured and the Robert
Wood Johnson Foundation by the Employee Benefit
Research Institute (EBRI) using the Census
Bureaus Current Population Survey (CPS)
numbers. Although EBRI uses CPS numbers, the
same dataset used by the Census Bureau, EBRI
estimates may vary from Census estimates due to
the fact that EBRI's analysis excludes Medicare
beneficiaries and active-duty military. Please
note that EBRI's analysis defines children as
individuals ages 0-17, whereas other sources may
define children as ages 0-18. This difference
accounts for the variance between the reported
numbers of uninsured children, depending on the
source and method of analysis.
2
Table of ContentsFacts on Health Coverage in
the USA

Overview 3 Age Gender 4-5 Uninsured
Children 6-10 Race/Ethnicity 11 Educational
Attainment 12-13 Income Poverty Status
14-15 Workers 16-17 Source of
Coverage 18 Employment-Based
Coverage 19-21 Industry and Occupation 22-23
Retiree Health Benefits 22 Health
Behavior 24-26 National Spending on
Healthcare 27-31 Health Insurance
Premiums 32-34 Out-of-Pocket Spending on Health
Care Services 35-37
3
Overview
The problem of the uninsured is continuing to
grow. The federal government estimates that 47
million individuals lacked health insurance
coverage of any kind during 2006. Other research
shows that tens of millions more Americans go
without health coverage for shorter periods of
time.

Percentage of Nonelderly Americans Without Health
Insurance Coverage, 1987-2006
                                                  
                                                  
                                                  
                                                  
                                               
Source Employee Benefit Research Institute
estimates from the Current Population Survey,
March 1988-2007 Supplements.Note 1987-2003 data
are adjusted for Census correction announced in
March 2007.
4
Age Gender
The likelihood of being uninsured varies by age
and gender. Men are more likely to be uninsured
than women. More than 22 percent of men are
uninsured, while 18.1 percent of women are
uninsured.1 As a result, men account for more of
the uninsured than women.                        
                                                  
                                                  
                                                  
                            
Uninsured Nonelderly Adult Population by Gender,
2006
Source Employee Benefit Research Institute
estimates from the March Current Population
Survey, 2007 Supplement.
5
Age Gender
Percentage Uninsured Among Nonelderly Adults by
Age, 2006                                       
                                                  
                                                  
                                                  
                                     
Source Employee Benefit Research Institute
estimates from the March Current Population
Survey, 2007 Supplement.
6
Uninsured Children
Nearly twenty percent of uninsured Americans
8.7 million individuals are children. The
likelihood that a child is uninsured has fallen
from 13.9 percent in 1998 to 10.5 percent in
2004. It has since increased to 11.7 percent in
2006. While children are more likely to be
insured than non-elderly adults, health insurance
is particularly important for children. Uninsured
children are more likely than insured children to
lack a usual source of health care, to go without
needed care and to experience worse health
outcomes.1

Percentage of Children Under Age 18 Without
Health Insurance, 1994-2006                     
                                                  
                                                  
                                                  
                                                  
       
Source Employee Benefit Research Institute
estimates from the Current Population Survey,
March 1995-2007 Supplements. Note 1994-2003 data
are adjusted for Census correction announced in
March 2007.
7
Uninsured Children
Uninsured Children by Race and Ethnic Origin,
2006
Source Employee Benefit Research Institute
estimates from the March Current Population
Survey, 2007 Supplement.
8
Uninsured Children
Uninsured Children by Age, 2006
                                                  
                                                  
                                                  
                                                  
            
Source Employee Benefit Research Institute
estimates from the March Current Population
Survey, 2007 Supplement.
9
Uninsured Children
Uninsured Children by Family Poverty Status, 2006
                                                  
               
Source Employee Benefit Research Institute
estimates from the March Current Population
Survey, 2007 Supplement.
10
Uninsured Children
Uninsured Children by Work Status of the Family
Head, 2006
                                                
                          Source Employee
Benefit Research Institute estimates from the
March Current Population Survey, 2007 Supplement.
11
Race/Ethnicity
Relative to their numbers in the overall
population, members of racial and ethnic minority
groups make up a disproportionate share of the
uninsured population. A variety of economic and
social factors underlie these disparities. When
differences in income, occupation, employment
sector and firm size, education, health status,
age, gender, citizenship status, and geography
are statistically removed, two-thirds of the
difference in uninsured rates between Hispanics
and non-Hispanic Whites is eliminated.1

Percentage Uninsured Among the Non-elderly
Population by Race and Ethnic Origin, 2005
Source Employee Benefit Research Institute
estimates from the March Current Population
Survey, 2007 Supplement
12
Educational Attainment
The likelihood of being insured increases as
level of educational attainment rises. However,
fully 40 percent of the difference in insured
rates between those with no high-school diploma
and those with some post-college education would
disappear if the two groups were alike with
respect to demographic, geographic and health
status factors.1
Percentage Uninsured Among Nonelderly Adults by
Education, 2006
                                                  
                                                  
                                                  
                                                  
                                  Source
Employee Benefit Research Institute estimates
from the March Current Population Survey, 2007
Supplement.
13
Educational Attainment
Uninsured Nonelderly Adults by Education, 2006
                                               
                         
Source Employee Benefit Research Institute
estimates from the March Current Population
Survey, 2007 Supplement.
14
Income Poverty Status
National surveys consistently show that the high
cost of health insurance is the primary reason
people are uninsured.1
Uninsured Non-elderly Population by Family
Poverty Status, 2006
Source Employee Benefit Research Institute
estimates from the March Current Population
Survey, 2007 Supplement.
15
Income Poverty Status
Percentage Uninsured Among Nonelderly Population
by Family Poverty Status, 2006
                                                  
                       
Source Employee Benefit Research Institute
estimates from the March Current Population
Survey, 2007 Supplement.
16
Workers
Having a job, even a full-time job, does not
guarantee access to health insurance.
Uninsured Nonelderly Population by Work Status of
Family Head, 2006
Source Employee Benefit Research Institute
estimates from the March Current Population
Survey, 2007 Supplement
17
Workers
Nonelderly Adult Uninsured Workers by Work
Status, 2006
Source Employee Benefit Research Institute
estimates from the March Current Population
Survey, 2007 Supplement.
18
Source of Coverage
Employment-based health insurance continues to be
the predominant source of coverage for the
non-elderly population.
Health Insurance Coverage of Nonelderly
Americans, by Source of Coverage, 2006
                                                  
                                                  
                                                  
                                                  
                                                
Source Employee Benefit Research Institute
estimates from the March Current Population
Survey, 2007 Supplement.
19
Employment-Based Coverage
Average annual increases in health insurance
premiums for all firms escalated from 0.8 percent
in 1996 to 13.9 percent in 2003, but then
declined to 6.1 percent in 2007.1 Over
approximately the same period, the percentage of
workers without health insurance increased from
16.0 percent in 1996 to 18.8 percent in 2006,
with workers accounting for 27.6 million of the
46.5 million uninsured.2
Percentage of Non-elderly Adult Workers Without
Health Insurance, 1987-2006
.
Source Employee Benefit Research Institute
estimates from the Current Population Survey,
March 1988-2007 Supplements.
20
Employment-Based Coverage
Almost one-half (49.2 percent) of all
non-elderly, adult uninsured workers work in
firms with fewer than 25 employees.3
Non-elderly Adult Uninsured Workers by Firm Size,
2006
Source Employee Benefit Research Institute
estimates from the March Current Population
Survey, 2007 Supplement.
21
Employment-Based Coverage
Almost all employers with more than 200 workers
offer health benefits (99 percent in 2007). In
contrast, 45 percent of firms with three to nine
employees offered health insurance in 2006.4
Percentage of Employers Offering Health Benefits
by Firm Size, 1996-2007
Source Kaiser/HRET Survey of Employer-Sponsored
Health Benefits.
22
Industry and Occupation

• More than one-third (36.3 percent) of workers
  employed in agriculture, forestry, fishing,
  mining and construction are uninsured, compared
  to 22.5 percent in personal services, 18 percent
  in wholesale and retail trade, 15.1 percent in
  manufacturing and 6.1 percent in the public
  sector. Workers in wholesale and retail trade and
  personal services account for 61.4 percent of all
  uninsured workers.1

Non-elderly Adult Uninsured Workers by Industry,
2006
Source Employee Benefit Research Institute
estimates from the March Current Population
Survey, 2007 Supplement.
23
Industry and Occupation
The uninsured are disproportionately concentrated
in blue collar jobs. Whereas about one-quarter of
the workforce is employed in such jobs as
construction, transportation, maintenance and
farming, these workers account for 35.3 percent
of all uninsured workers.2                     
                                                  
                                                  
                                                  
                         
Non-elderly Adult Uninsured Workers by
Occupation, 2005
Source Employee Benefit Research Institute
estimates from the March Current Population
Survey, 2007 Supplement.
24
Health Behavior
Health insurance coverage is an important
predictor of whether individuals obtain
health-promoting and life-extending health
screenings.
Time Since Last Pap Smear, Female Adult Workers
by Insurance Status, 2005
                                                  
                                                  
                                                  
                                                  
                                                  
  Source Employee Benefit Research Institute
estimates from the 2005 Medical Expenditure Panel
Survey.
25
Health Behavior
Time Since Last Mammogram, Female Workers Ages
30-64, by Insurance Status, 2005
                                                  
                                                  
                                                  
                                                  
                                                  
    .
Source Employee Benefit Research Institute
estimates from the 2005 Medical Expenditure Panel
Survey
26
Health Behavior
Time Since Last Prostate Specific Antigen (PSA)
Test, Male Workers Ages 39-64, by Insurance
Status, 2005                                    
                                                  
                                                  
                                                  
                                             
Source Employee Benefit Research Institute
estimates from the 2005 Medical Expenditure Panel
Survey
27
National Spending on Health Care

• Health care spending in the United States has
  grown rapidly since the 1960s, at an average rate
  of 10 percent a year.

National Health Expenditures (NHE), Aggregate and
Share of Gross Domestic Product (GDP), 1960-2017
Source Employee Benefit Research Institute
estimates from Centers for Medicare and Medicaid
Services and U.S. Department of Commerce.
(2006-2017 data are projected.)
28
National Spending on Health Care

• While health care spending has been increasing,
  the distribution of health care spending among
  different services has been changing.

Distribution of National Health Expenditures, by
Type of Expenditure, 1960-2017

Source Employee Benefit Research Institute
estimates from Centers for Medicare Medicaid
Services. (2006-2017 data are projected.)
29
National Spending on Health Care

• The share of private health care spending that
  health insurance covers has more than doubled
  since the 1960s.

Out-of-Pocket Spending as a Percent of Total
Private Spending, 1960-2017
Source Employee Benefit Research Institute
estimates from Centers for Medicare Medicaid
Services. (2006-2017 data are projected.)
30
National Spending on Health Care

• The cost of providing health care services has
  been increasing faster than the Gross Domestic
  Product (GDP) since 1998, but the gap between the
  two declined recently as the economy recovered
  from recession and health care costs grew more
  slowly.

Annual Growth Rates for Spending on Health Care
Services and Gross Domestic Product (GDP),
1998-2006
Source Bradley C. Strunk, Paul B. Ginsburg, and
John P. Cookson. "Tracking Health Care Costs
Declining Growth Trend Pauses In 2004." Health
Affairs Web Exclusive, June 21, 2005 and
Ginsburg, Paul B., Bradley C. Strunk, Michelle I.
Banker, and John P. Cookson. "Tracking Health
Care Costs Continued Stability But At High Rates
In 2005." Health Affairs Web Exclusive, Oct. 3,
2006.
31
National Spending on Health Care

• Recent spending on health care services has
  slowed for all categories of health care, but
  cost increases for hospital outpatient services
  and prescription drugs continue to outpace those
  for inpatient and physician services.

Annual Per Capita Percentage Change in Health
Care Spending, by Category of Service, 2001-2006
Source Bradley C. Strunk, Paul B. Ginsburg, and
John P. Cookson. "Tracking Health Care Costs
Declining Growth Trend Pauses In 2004." Health
Affairs Web Exclusive, June 21, 2005 and
Ginsburg, Paul B., Bradley C. Strunk, Michelle I.
Banker, and John P. Cookson. "Tracking Health
Care Costs Continued Stability But At High Rates
In 2005." Health Affairs Web Exclusive, Oct. 3,
2006.
32
Health Insurance Premiums

• With a few exceptions, growth in health
  insurance premiums has been outpacing overall
  inflation and increases in workers earnings since
  the late 1980s.

Annual Growth Rates for Health Insurance
Premiums, Workers Earnings, and Overall
Inflation, 1988-2007
Source Kaiser Family Foundation/Health Research
and Educational Trust.
33
Health Insurance Premiums

• Workers have been paying more per year for
  health benefits in the workplace, but they
  continue to pay the same share of total premiums.

Average Monthly Worker Premium Contribution,
1988-2007
Source Kaiser Family Foundation/Health Research
and Educational Trust.
34
Health Insurance Premiums

• Workers have been paying more per year for
  health benefits in the workplace, but they
  continue to pay the same share of total premiums.

Percentage of Premium Paid by Covered Workers,
1988-2007
Source Kaiser Family Foundation/Health Research
and Educational Trust.
35
Out-of-Pocket Spending on Health Care Services

In recent years, individuals with health
insurance coverage have experienced increases in
out-of-pocket expenses for health care.
Distribution of Deductibles for Employee-Only PPO
Coverage, 2000-2007                             
                                               
Source Kaiser Family Foundation/Health Research
and Educational Trust. Distribution is
statistically different from distribution for the
previous year shown at plt.05.
36
Out-of-Pocket Spending on Health Care Services

• Many workers are paying higher co-payments for
  physician visits in HMOs.

Percentage of Covered Workers Facing Various HMO
Co-payment Amounts for Physician Office Visits,
1996-2007
Source Kaiser Family Foundation/Health Research
and Educational Trust.
37
Out-of-Pocket Spending on Health Care Services

• Co-payment levels for prescription drugs have
  increased, and employers have added a fourth tier
  to the common three-tier co-payment system.

Average Co-payments Per Prescription in
Multi-Tier Arrangements, 2000-2007
Source Kaiser Family Foundation/Health Research
and Educational Trust. Note Four-tier drugs
New types of cost-sharing arrangements that
typically build additional layers of higher
co-payments or coinsurance for specially
identified types of drugs, such as lifestyle or
injectable drugs.