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Frequently Asked Questions...Access and the Uninsured
In this FAQ... · How many people are uninsured, and why are they so hard to count? · Why are people uninsured? What is the connection between employment and coverage? · Why is there so much difference from state to state in the number of people uninsured? · What difference does it make if people are insured? · What is cost-shifting and what does it have to do with access and the safety net? · If a single-payer system is simpler and cheaper, why don't we have one? · What does "medically uninsurable" mean? What's a high risk pool, and what does it have to do with CHIP? · How have insurance reforms, access expansions and public-private partnerships affected access to care and coverage, particularly for uninsured workers? · How do employer purchasing coalitions and insurance purchasing pools for small businesses work, and how effective are they?
How many people are uninsured, and why are they so hard to count? About 42.5 million people, or 15.5 percent of the national population (17.5 percent of the non-elderly population) were uninsured in 1999, according to the Census Bureau's most recent Current Population Survey (CPS). This is the first break in a steady upward trend that has prevailed since 1987. Although other surveys produce different estimates, they agree on the trends: in the last year or two, the number and share of the population that is uninsured has leveled off-or even declined somewhat-for the first time in a dozen years. The CPS is the most commonly cited source of information on the number of uninsured. Other surveys give different-usually lower-estimates. They differ because of who is counted, what is counted, how it is counted, and over what time period (all year, now, or any time during the year.) Recent estimates of the number of uninsured in the United States range from 19 million (uninsured for the entire year, 1994, based on three interviews conducted four months apart) to 44 million (uninsured throughout a three- to six-month period in 1996). The relatively high estimates produced by the CPS may be due to both virtues and flaws in its approach. Its tally may be more accurate than others because it does not depend on telephone interviews, which miss a group of people who are most likely to be uninsured. It also asks about each dependent, rather than assuming that everyone in a family has the same coverage. On the other hand, two problems in how it is administered are likely to lead to overestimates. Although the survey asks about coverage during the last year, the answer actually seems to reflect coverage in recent months. Finally, the CPS asks about specific kinds of coverage-workplace, Medicaid, etc.-but never asks "were you uninsured?". Because of confusion over names, the CPS is particularly prone to undercount people on Medicaid and other public programs. The CPS survey is a scientific sample designed for national estimates and estimates for larger states, but the number of people interviewed is too small for estimates for smaller states (let alone state legislative districts). To overcome that problem, analysts who want state-level coverage estimates for the smaller states often average three years of CPS data. To get better estimates, several states have conducted their own surveys. This is expensive. Small differences in how they are conducted and how questions are worded can lead to different findings. As a result, it is difficult to compare state surveys. Information about the numbers covered in Medicaid can be obtained from state Medicaid agencies, although high rates of movement in and out of Medicaid make these data problematic as well. Other national surveys sometimes used to estimate the number of uninsured include the Survey of Income and Program Participation (SIPP), the Behavioral Risk Factor Surveillance System (BRFSS), the Community Tracking Study (CTS), the Medical Expenditure Panel Survey (MEPS), the National Health Interview Survey (NHIS), and the National Survey of America's Families (NSAF). The Employee Benefit Research Institute (EBRI) has just issued an excellent comparison of the surveys. l
Why are people uninsured? What is the connection between employment and coverage? People are uninsured for many different reasons: they can't afford insurance (74 percent); they are ineligible for or do not want to enroll in public programs such as Medicaid; they are not offered insurance at work (48 percent); and they do not know where or how to obtain coverage (16 percent). Some groups are particularly likely to be uninsured. For example, although overall 15.5 percent of all people lacked coverage in 1999, Hispanics are uninsured at more than twice that rate (33.4 percent). About a third of the poor and 24 percent of people in households with incomes below $25,000 are uninsured, even though many are eligible for Medicaid and Medicare. Finally, barely half of all poor workers-52.5 percent-have any insurance. In 1999, 65.8 percent of working-age Americans were covered by employment-based health insurance, the highest rate since 1991. Only 17.5 percent of working adults lacked coverage (the rest had public or individual coverage). Nonetheless, most of the uninsured (83.2 percent in 1998) either work or are in families headed by workers, and 76 percent of uninsured children are in families with at least one full-time worker. In 1998, 58 percent of uninsured workers worked full-time all year, 21 percent worked full-time for part of the year; 10 percent worked part-time all year; and 11 percent worked part-time for part of the year. Workers who do not have coverage are likely to work in smaller companies (only 55 percent of companies with three to nine workers offered coverage in 1999, compared to 92 percent of companies with 50 to199 workers). Not quite half of the uninsured employees (46 percent) work for companies with fewer than 25 workers. Although smaller firms are much less likely to offer coverage, the sheer number of workers in large firms translates to an important percentage of uninsured in those companies (28 percent in firms with more than 500 workers). Service, domestic, agricultural and retail workers are particularly likely to be uninsured. Affordability is a problem for both low-wage workers and the firms where they work. Low-wage workers are less likely to have workplace insurance (42 percent of workers who earned less than $7 per hour, compared to 90 percent of workers who earned more than $15 per hour in 1996). They often cannot afford their share of a premium. 74 percent of uninsured adults said they were not covered because it is too expensive, and 13 percent of low-wage vs. 6 percent of high-wage workers declined coverage when offered. Moreover, companies with many low-wage workers are less likely to offer insurance. Among firms with less than 200 workers, only 40 percent of those with 33 percent or more low-wage workers offer coverage, compared to 79 percent of firms with fewer than 10 percent low-wage workers. Hawaii's unique employer mandate requires employers to insure workers employed more than 20 hours per week. This mandate predates the federal ERISA law, which preempts state laws related to employer benefit plans. It would require an act of Congress for another state to follow this example. About 10 years ago, two states (Massachusetts and Oregon) enacted and subsequently repealed so-called "employer pay or play" laws. These consist of a payroll tax that is forgiven if employers cover their workers. Because these laws never were implemented, no one knows if this approach would withstand an ERISA challenge. l
Why is there so much difference from state to state in the number of people uninsured? There is wide variation in the numbers of uninsured state by state. In 1999, according to the CPS, more than 20 percent were uninsured in six states (Arizona-21.2 percent; California, 20.3 percent; Louisiana, 22.5 percent; Nevada, 20.7 percent; New Mexico , 25.8 percent; and Texas, 23.5 percent) and an equal number of states had rates in single digits (Connecticut, 9.8 percent; Iowa, 8.3 percent; Minnesota, 8.0 percent; Missouri, 8.6 percent; Pennsylvania, 9.4 percent; Rhode Island, 6.9 percent). Some of the highest rates are found in southwestern border states, where a relatively young, disproportionately uninsured Hispanic population may be a factor (Arizona, California, and Texas). The labor market clearly affects coverage. Last year, uninsurance was down 0.9 percent and workplace coverage was up the same amount. States in areas with historically industrialized and unionized work forces, such as the Midwest, tend to have high rates of employer-based coverage, while states where wages historically have been lower and the workforce has been non-unionized (Southeast) show lower coverage rates. Employers in different regions also tend to have different practices in regard to offering and paying for dependent coverage. The relationship between public coverage and levels of uninsured is not clear-cut. Several states (Connecticut, Minnesota and Rhode Island) that have worked hard to expand coverage can brag about the results. Three other states known for distinctive and ambitious health reforms (Hawaii, Oregon and Tennessee), have below-average rates of uninsured but are closer to the mean. Tennessee has kept ahead of the average and well ahead of its region by opening up its Medicaid program to the uninsured, but other states with comparatively generous eligibility rules are swamped by the volume of need (California, New Mexico, New York and West Virginia). Several states that worked hard to enroll children in SCHIP and state programs (Minnesota, Missouri and Rhode Island) recently showed marked gains in coverage. Below-average state rates of Medicaid coverage from 1996 to1998 sometimes were associated with high levels of uninsured-more than 20 percent of those under age 65 in a swath of Western and Southern states (Florida, Texas, Oklahoma and Nevada). Yet, other states with better employer coverage had both low Medicaid rolls and low levels of uninsured (Iowa, Kansas, New Hampshire, Ohio and Wisconsin). Public coverage (Medicaid, SCHIP and state-only programs) interacts with employment in complicated ways. Concerns about "crowd-out"-the possibility that public coverage of children would supplant employer-based coverage-were voiced during debate over SCHIP. However, the converse seems at least as true: where workplace coverage is high, there is less need for public stop gap measures. States with high levels of workplace-based coverage can afford more generous public coverage programs because there are fewer uninsured to cover and these states have a higher tax base. Poorer states or states with larger proportions of poor workers have more people who will not be able to obtain coverage alone, but have fewer resources to meet the needs of their citizens (despite higher federal Medicaid funding levels). Finally, some states have political cultures that tend to minimize governmental spending on social programs. l
What difference does it make if people are uninsured? Most of the uninsured can obtain care in an emergency-that is, if they are in a life-threatening crisis or are in active labor-if they can make their way to a hospital that receives federal funds and has an emergency room. However, there is no other national standard that says they must receive care. Although many hospital outpatient departments, health centers and clinics provide care to the uninsured, many people have no way to obtain needed care. As a result, their health and finances suffer. Almost 40 percent of the uninsured have no regular source of care, and the same percentage report that they have skipped a recommended test or treatment in the past year. In some areas, the contrast in access is even more stark. In Los Angeles, more than 60 percent of uninsured residents interviewed reported that they had no "usual source of care"-a caregiver they routinely go to when they need treatment-compared with 8 percent of the insured. Children also suffer when they are uninsured. Ear infections (a common childhood illness that can lead to permanent hearing damage) go untreated 70 percent more often among uninsured children. These children are also 30 percent less likely to get medical care for injuries. The uninsured get less care and later care, because they often do not seek treatment until a disease or disorder has progressed. That can have expensive and even fatal consequences. They are more frequently hospitalized for avoidable conditions such as pneumonia and uncontrolled diabetes, and cancer is likely to be diagnosed in later stages. According to a study by the American College of Physicians-American Society of Internal Medicine, uninsured people are more likely to report being in poor health (1.5 times as often) and delay seeking care (3.6 times as often) than people with coverage. Unpaid bills hurt the finances of the uninsured and the institutions that care for them. Hospitals reportedly spent $19 billion on uncompensated care in 1998, straining their ability to care for all their patients. Medical bills are a major cause of personal bankruptcy. Institutions that care for the uninsured have not been able to compensate for lack of insurance in cities where large portions of the population lack coverage. Uninsured residents of cities with high uninsured rates were found to have more difficulty obtaining care than residents of cities where most people are insured. Ironically, a meaningful portion of the uninsured may be eligible for public coverage but are not signed up. Indeed, due to three-month federal retroactivity in Medicaid, those who are eligible for public coverage under Medicaid actually are covered even if they are not signed up. This is an important source of funding for hospitals that provide trauma and other emergency care because it means they receive compensation for some patients with large bills who qualify for Medicaid even if those people are not enrolled in Medicaid at the time they are admitted. l
What is cost-shifting and what does it have to do with access and the safety net? Cost-shifting once referred to hospitals' practice of covering the costs of care for the indigent and uninsured by raising the rates charged other payers. The term now is used in a number of different situations in which one buyer pays less and another pays more, such as when a commercial managed care contract is negotiated at a rate lower than the Medicaid rate. Hospital cost-shifting is a feature of an uncompetitive market where one seller can set different prices for different buyers for the same product. Economists and some policymakers argue that cost-shifting by hospitals no longer exists and may never have existed. They believe that the health system today is so competitive and closely scrutinized that insured buyers will not be willing to pay costs incurred by other users. Government and managed care plans have brought wholesale competition to the health market place. If all hospitals had the same mix of patients, this would not be an issue. However, some hospitals-known as disproportionate share hospitals (DSH)-care for above average levels of uninsured and Medicaid patients. They are eligible for certain enhanced Medicaid and Medicare DSH payments, which formalize cost-shifting for these programs. Hospitals that incur more uninsured costs also have fewer revenues across which to spread the deficit. Without non-patient funding, they cannot compete in a price-driven marketplace and risk becoming insolvent. These hospitals-as well as clinics and other providers that care for mostly poor and uninsured patients-make up a community's safety net, its last line of protection for uninsured people. Sometimes referred to as essential community providers, they provide access to health care services for people who have no health care coverage. The care they give may be of a high level in a given encounter, but tends to be poor overall because of a lack of the continuity that is created when a patient has a usual provider. The safety net depends heavily on direct public funding. According to a study by the National Association of Public Hospitals and Health Systems, costs for uncompensated care at a sample of urban hospitals represented 26 percent of total costs in 1996 (vs. a national average of 6.1 percent). Well over half (59 percent) of the funding for those costs came from state and local subsidies. Medicaid DSH payments covered 29 percent and federal DSH covered another 9 percent. Cost-shifting accounted for a miniscule 3 percent. Cuts in DSH as a result of the Balanced Budget Act are expected to have a harsh impact on these hospitals. A few states formalized the cost-shift either through uniform hospital rate regulation or systems that pool assessments and allocate them to hospitals that provide high levels of uncompensated care. Maryland still does rate regulation; Massachusetts, New Jersey and New York have repealed their rate-setting systems. l
If a single-payer system is simpler and cheaper, why don't we have one? Advocates for a single-payer system often refer to Canada-with its lower costs, better outcomes, and generally higher level of satisfaction-as an argument for changing the U.S. system. Opponents have countervailing images of long queues, dissatisfied doctors and patients skipping across the border, and high tax rates. According to one economic analysis, the main reason national health spending in the two countries diverged is that price increases leveled when the Canadian system went into place; to achieve the same savings would require the United States to travel back in time and cap health care prices in the 1960s. An alternative analysis, championed by David Himmelstein, points to high administrative costs in the current U.S. system as compared to very low overhead in both the Canadian system and the U.S. Medicare program (the single-payer system for those over age 65). In a single-payer system, all care is funded through one source. Providers do not have to contend with different eligibility and coverage rules and different forms from hundreds of insurers. For the insured and for health care givers, the same set of rules applies to everyone. This simplicity is a source of proposed saving, while equality is a foundation of the ethical argument for such a system. U.S. policy preferences make a single-payer system more problematic politically here than in Canada. The U.S. electorate today tends to distrust government, particularly big government. Given the choice, a majority tends to opt for liberty over equality, choice over simplicity and efficiency. Whatever the likely effect on total spending, proposals to consolidate all health spending into a single, governmentally controlled account have not received sufficient political support to be enacted. The public may be dissatisfied with their health plans, but they are even more fearful of the prospect of a monolithic single plan from which there is no escape. Moreover, universal coverage is more different from the status quo than are other proposed solutions. That means that more interest groups are likely to be affected, and thus can be politically mobilized. Some states have considered state-based single payer systems. A state considering such a move may discover that total health spending in the state is roughly the same size as the current general revenue budget, a number that points to a political dead end. Another concern often raised when states ponder such system is whether they will become magnets for uninsured people in adjacent states. Given the fear of governmental rigidity, the size of the health accounts, interest group dominance and consumer preferences, proponents of universal reform have worked to design models that include consumer choice and emphasize funding flexibility. The case for a single-payer system is also made by pointing to widely accepted existing programs such as Medicare or the Federal Employee Health Benefit Plan. This frames the debate in terms of programs that are familiar to interested constituents. l
What does "medically uninsurable" mean? What's a high risk pool, and what does it have to do with CHIP? An estimated 1percent to 3 percent of people seeking insurance have known health conditions that either will or are likely to incur higher costs than an insurer can charge or the would-be buyer is willing to pay. Cancer, hypertension, diabetes and major mental illness are examples of conditions that insurance companies underwrite, that is, take into account when setting insurance rates. For people enrolled in large groups, this usually is not an issue. For small groups and for individuals, this can be a severe problem. Insurers commonly require a health history before they will sell coverage. Although federal law (HIPAA) now prohibits carriers from refusing to sell to groups based on the health of their members, they may still charge whatever they believe is a fair price and may refuse to sell to individuals. Companies can effectively turn down a company by setting a high rate, if state law does not prohibit it (see FAQ on Insurance and Managed Care). To help this group of uninsured, more than half the states now have a state-sponsored insurance program, often called a medical high-risk pool or a comprehensive health insurance pool (CHIP). The CHIP sells insurance to people who have one of a list of specific conditions, have been refused a policy, have been offered coverage at rates that are a specified multiple (often 2 times) the standard rate, or who are guaranteed individual coverage through that mechanism as part of the state's implementation of HIPAA. Typically, premiums are 1.5 to 2 times the premiums outside the pool, which still is usually less than actual expenses. The remainder is covered from an assessment on insurers, general revenue or other funding sources. The near-elderly are particularly likely to be found medically uninsurable. Although this age group is more likely to be insured than younger workers, a small but disturbing increase in uninsurance in this group signals a growing gap in coverage for one of the most vulnerable groups. l
How have insurance reforms, access expansions and public-private partnerships affected access to care and coverage, particularly for uninsured workers? No single solution has been discovered. The uninsured are a heterogeneous group, including both unusually healthy people-males 18-25-and people with exceptionally high medical risks-such as the "medically uninsurable" and near-65 workers. Because large groups of the uninsured have economic barriers-personal or business-to coverage, effective strategies are likely to involve increased spending for coverage or care. Most coverage is employment-based and most uninsured individuals work (or are in workers' families); therefore, the private sector has a key role in any solution. The recent halt in the decade-long national slide in coverage is probably due to a robust economy where employers are competing for workers It is difficult to measure the success of insurance reforms and expansions because so many changes to the health system occured at the same time, but they seem to be modest and marginal. Even comparing states that do and do not implement a given policy change can be confusing, since it is not always possible to tell cause from effect. For example, some states that were experiencing rapidly disintegrating insurance markets passed particularly vigorous reforms. New York enacted a strict community rating law in the face of prospective insolvency and a 25 percent rate hike request from its carrier of last resort, Blue Cross. Was the deterioration that followed a result of the rating rule, or due to the same conditions that led to the 25 percent rate hike? Conversely, states with low levels of uninsured have sometimes enacted bolder reforms because the potential costs are limited. Connecticut and Minnesota are examples of states that continue to build on past successes and a business climate that results in low levels of uninsured. Local experiments, in locations as widespread as Hillsboro, Fla., Flint, Mich., and San Diego, Calif., combine public and private funding streams and provider discounts to make an insurance product available to low-income or uninsured workers. These public-private partnerships or community partnerships take various forms and have not been widely replicated. They have, however, attracted interest from government and foundations. l
How do employer purchasing coalitions and insurance purchasing pools for small businesses work, and how effective are they? As the number of uninsured grew in the last decade, analysts focused on the fact that small businesses offered health insurance much less often than larger ones. Insurance coverage actually costs these plans more than larger plans, for several reasons. Insurers assume that small businesses are riskier to cover and likelier to have sicker employees than larger businesses because, like individuals, they can "risk select"-choose to enter and leave the insurance market depending on expected costs (see FAQ on Insurance and Managed Care). Administrative overhead for both the employer and the insurance company is spread over a smaller pool and so is a larger share of the premium. Small employers also lack the bargaining clout of large employers, who theoretically can drive a hard bargain. Pooled purchasing was proposed as a remedy for some of these problems. There is a great variety of pooling arrangements, with varying levels of success. A number of trade or business associations offer group policies for their members. Some localities have similar pools for employers in a geographic area, sponsored by business groups such as a chamber of commerce. Perhaps the best-known of these is Cleveland's Council of Smaller Enterprises (COSE). In the early 1990s, a number of states (including California, Florida, Iowa and Texas) encouraged similar activities by creating a legal framework for such pools and subsidizing administration or start-up activities. These plans vary in terms of sponsorship (government, trade group, local business group); whether they bear risk themselves (acting like a self-insured plan for their group) or act as a go-between for insurers and employers (purchasing coalition); and whether employers or employees make the selection among plans offered by the pool. Some of these experiments have been moderately successful. Others have failed due to hostility from brokers, indifference from employers, or inability to keep rates down. State insurance regulators have been watchful, concerned that these experiments might destabilize the recently reformed insurance market and actually make it more difficult for people who might need care to obtain coverage. A key point of contention has been whether states should regulate these plans or whether they should have the same ERISA (see FAQ on Insurance and Managed Care) status as self-insured single employer plans. Multiple employer welfare arrangements (MEWAs) that purchase employee benefits for a group of employers are subject to state regulation. Unscrupulous marketers in the past have created inadequately underwritten mock associations that left providers and insured groups stranded. Because of this history, state insurance regulators have been particularly suspicious of MEWAs and other types of unregulated associations. As a result, they have erected barriers that make it difficult for non-employment associations to purchase coverage unless the groups are "bona-fide," that is, formed for a reason other than buying insurance. Risk selection is another problem that small employer groups encounter. The problem would likely be even worse for non-employment groups such as church groups. Low-risk people and groups generally find coverage outside the group. Consequently, prices for those left behind go up because the low-risk group no longer is part of the pool. Unless the pool then begins to risk-select for who can enter, costs can spiral out of control. On the other hand, if they do select, costs can escalate for those who are rejected from the pool, who then may find it even more difficult to obtain coverage. This segregation of people into different risk polls, known as risk segmentation, is a major concern for state regulators who fear that proposed federal "health marts" will harm the rest of the market by creating pools that do not have to follow state insurance regulations that prohibit such discrimination. l
1 A detailed chartbook on the uninsured is provided at http://www.kff.org/content/archive/1407/ 2 http://www.census.gov/prod/2000pubs/p60-211.pdf 3 A two-page overview of the characteristics of the uninsured is provided at http://www.kff.org/content/2000/1420/pub%201420.pdf 4 A collection of good links for additional information about high risk pools is at http://www.insurancevalues.com/links.html 5 A good discussion of various approaches to pooling is at http://www.americashealth.org/releases/stevesedit.html l
Crowd-out. The possibility that public coverage would supplant employer-based coverage. Disproportionate share hospitals (DSH). Reimbursement category by which Medicaid or Medicare funds are allocated to hospitals that care for above-average levels of uninsured and Medicaid patients. The hospitals themselves and, by analogy, any system to fund providers based on the proportion of non-covered lives they care for. ERISA (see Insurance FAQ). Federal law that limits state regulation of employer health insurance plans. Medically uninsurable. People with exceptionally high medical risks due to an existing or anticipated health condition, based on such things as medical history, family history and genetic makeup. No regular source of care. Survey question commonly used to indicate ability to achieve access to care. Having a regular source of care suggests continuity in care and the ability to get care when needed. Risk segmentation, risk selection. Insurance practices that result in groups with different likelihood of illness obtaining coverage at different rates, often resulting in untenably high rates for people who most need coverage. Safety net, essential community providers. Hospitals-as well as clinics and other providers-that care for large numbers of poor and uninsured patients, make up a community's safety net, its last line of protection for uninsured people. Sometimes referred to as essential community providers, they provide access to health care for those who have no insurance. Single-payer system. Financing system in which all care is funded through one source. Underwrite. Take into account medical or other factors when setting insurance rates. Uninsured. Lacking public or private health coverage. Medicaid and Medicare are considered coverage. Programs that pay for services but do not assure coverage for individuals usually are not considered insurance. Thus, someone who is receiving free care from health centers or Indian Health Services is considered uninsured. Underinsured. Having coverage that is inadequate, either because it includes high copayments and deductibles or because important costs are not covered. Coverage that results in high out-of-pocket costs in proportion to ability to pay. The definition is fluid because it changes with both income and health needs. The term has been applied to Medicare (because pharmaceuticals are not covered), managed care plans with stringent management styles, and low-income people who are unable to pay typical out-of-pocket costs. l
Other national surveys sometimes used to estimate the number of uninsured include the Survey of Income and Program Participation (SIPP), the Behavioral Risk Factor Surveillance System (BRFSS), the Community Tracking Study (CTS), the Medical Expenditure Panel Survey (MEPS), the National Health Interview Survey (NHIS), and the National Survey of America's Families (NSAF). The Employee Benefit Research Institute (EBRI) recently issued an excellent comparison of the surveys. l
The Kaiser Commission on Medicaid and the Uninsured has information about the uninsured and major shifts in insurance coverage. Their web site is at http://www.kff.org Of special interest is their Chart Book on Uninsured in America. This report can be found at http://www.kff.org/content/archive/1407/ The Urban Institute web site includes the Survey of American Families which contains state-level data from 13 states. The survey addresses the issues of access and coverage for both children and adults and looks at uninsurance rates by race and ethnicity. The site can be found at http://newfederalism.urban.org/nsaf/index.htm Also check the Snapshots section for information about the New Federalism Project, at http://newfederalism.urban.org/health_policy.html The U.S. Census Bureau web site contains statistics on the uninsured, including data on the number of uninsured people by state, low income uninsured children by state, and demographic data on the uninsured. The Current Population Survey data can be found at http://www.census.gov/hhes/www/hlthins.html The Blue Cross/Blue Shield of America web site has information about the percentage of uninsured people per state as well as a state-by-state comparison of the uninsured. This site can be found at http://bcbshealthissues.com/special/uninsured The Center for Studying Health Systems Change site has information about uninsured children and recent trends in children's health insurance coverage. This site is at http://www.hschange.com The Employee Benefit Research Institute (EBRI) http://www.ebri.org carries various articles on the working uninsured. Their issue brief on Small Employers and Health Benefits: Findings from the 2000 Small Employer Health Benefits Survey is a good source of data on the number of working uninsured individuals and demographic characteristics of the working uninsured. l
Health Insurance Coverage for the Non-Elderly, by State, 1998 (numbers in millions)
Source: William S. Custer, Ph.D., and Pat Ketsche, M.B.A., M.H.A., Health Insurance Coverage and the Uninsured: 1990-1998 (Washington, D.C.: Health Insurance Association of America,1999; http://membership.hiaa.org/pdfs/apps/custer.doc.
Health Insurance Coverage for the Non-Elderly, by State, 1998 (percentage within coverage categories)
Source: William S. Custer, Ph.D., and Pat Ketsche, M.B.A., M.H.A., Health Insurance Coverage and the Uninsured: 1990-1998 (Washington, D.C.: Health Insurance Association of America,1999; http://membership.hiaa.org/pdfs/apps/custer.doc.
Figure 1.
Source: William S. Custer, Ph.D., and Pat Ketsche, M.B.A., M.H.A., Health Insurance Coverage and the Uninsured: 1990-1998 (Washington, D.C.: Health Insurance Association of America,1999; http://membership.hiaa.org/pdfs/apps/custer.doc
Figure 2.
Source: Kaiser Commission on Medicaid and the Uninsured, Uninsured in America: a Chart Book (Washington, D.C.: Kaiser Commission on Medicaid and the Uninsured, May 2000, http://www.kff.org/content/archive/1407/
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