Uninsured

  • Number of uninsured. According to the March 2009 CPS, there were 46.3 million uninsured [DeNavas-Walt: Table C-3]. The number of non-elderly who experienced at least one month of being uninsured over a 2-year period (2004-2005) was 82.0 million (31.8%); those who remained uninsured for that entire period numbered 26.1 million (10.1%), while the number uninsured for 4 consecutive years (2002-05) was 17.4 million (6.8%) [Rhoades and Cohen].
  • Uninsured trends. According to the CPS, the overall risk of being uninsured rose from 12.9% in 1987 to 15.4% in 2008, with the highest recorded rate (15.8%) occurring in 1998 and 2006 [DeNavas-Walt: Table C-1].
  • Characteristics of the uninsured.
    • Age. According to the CPS, the risk of being uninsured is highest among young adults (28.6% for 18-24; 26.5% for 25-34) and lowest among the elderly (1.7%) and children under 18 (9.9%) [DeNavas-Walt: Table C-3].
    • Race/Ethnicity.  According to the CPS, the risk of being uninsured is highest among Hispanics of any race (30.7%) and lowest among non-Hispanic Whites (10.8%), with Blacks (18.9%) falling in between [DeNavas-Walt: Table C-2].
  • Uninsured access barriers
  • Sources of care/payment for the uninsured
  • Health consequences of lack of coverage. The Institute of Medicine earlier calculated 18, 314 excess deaths among uninsured adults age 25-64 in 2000, based on a study showing mortality risk was 25% higher among the uninsured compared with those with private health insurance. Using a similar method, a 2009 study calculates that after controlling for age, gender, race/ethnicity, income, education, self- and physician-ratedhealth status, body mass index, leisure exercise, smoking, andregular alcohol use, the uninsured were more likely to die (hazardratio=1.40; 95% CI=1.06, 1.84) than those with insurance (Wilper: Table 2).  Using the IOM method of applying age-specific hazard ratios to the number of uninsured adults 18-64 in 2005, this study estimates there were 35,327 excess deaths attributable to lack of coverage. An alternative calculation using the global hazard ratio for uninsured adults rather than age-specific hazard ratios, shows the number of excess deaths may be as high as 44, 789.
  • Economic consequences of lack of coverage

Analysis

  • DeNavas-Walt, Carmen, Bernadette D. Proctor, and Jessica C. Smith. U.S. Census Bureau, Current Population Reports, P60-236, Income, Poverty, and Health Insurance Coverage in the United States: 2008, U.S. Government Printing Office, Washington, DC, 2009.
  • Gruber, J., Covering the Uninsured in the United States, Journal of Economic Literature, American Economic Association, Vol. 46, No. 3, 2008, pp. 517–606.
  • Hadley, J., J. Holahan, T. Coughlin, and D. Miller, Covering the Uninsured in 2008: Current Costs, Sources of Payment, and Incremental Costs,” Health Affairs, web exclusive, August 25, 2008, pp. w399–w415.
  • Levy, Helen and David Meltzer. The Impact of Health Insurance on Health. Annual Review of Public Health, 2008; 29: 399-409.
  • O’Neill, June E. and Dave M. O’Neill, Who Are the Uninsured? Employment Policies Institute. June, 2009.
  • Rhoades, Jeffrey A. and Steven B. Cohen, The Long-Term Uninsured in America, 2002-2005: Estimates for the U.S.
    Population under Age 65
    , Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey Statistical Brief #183, August 2007.
  • Short, Pamela Farley et al., New Estimates of Gaps and Transitions in Health InsuranceMedical Care Research and 

    Review, August 3, 2012.

  • Wilper, Andrew P., Woolhandler, Steffie, Lasser, Karen E., McCormick, Danny, Bor, David H., Himmelstein, David U. Health Insurance and Mortality in US Adults. Am J Public Health December 2009; 99(12). AJPH First Look, published online ahead of print Sep 17, 2009. [Abstract (html)][Full Text (pdf)]
  • Model-based Small Area Health Insurance Estimates (SAHIE) for Counties and States. The Census Bureau’s Small Area Health Insurance Estimates (SAHIE) program produces estimates of health insurance coverage for states and all counties. In July 2005, SAHIE released the first nation-wide set of county-level estimates on the number of people without health insurance coverage for all ages and those under 18 years old. In July 2010, SAHIE released 2007 estimates of health insurance coverage by age, sex, race, Hispanic origin, and income categories at the state-level and by age, sex, and income categories at the county-level.

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