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Adapted from a U.S. Census Bureau report
September 30, 2002
Health Insurance Coverage: 2001
Highlights
- The number and percentage of people covered by employment-based health insurance dropped in 2001, from 63.6 percent to 62.6 percent, the foundation of the overall decrease in health insurance coverage.
- The number and percentage of people covered by government health insurance programs rose in 2001, from 24.7 percent to 25.3 percent, largely from an increase in the number and per centage of people covered by Medicaid ( from 10.6 percent to 11.2 percent).
- The proportion of uninsured children did not change, remain ing at 8.5 million in 2001, or 11.7 percent of all children.
- Although Medicaid insured 13.3 million poor people, 10.1 mil lion poor people still had no health insurance in 2001, repre senting 30.7 percent of the poor, unchanged from 2000.
- Hispanics ( 66.8 percent) were less likely than non-Hispanic Whites ( 90.0 percent) to be cov ered by health insurance. 2 The coverage rate for Blacks in 2001 ( 81.0 percent) did not differ from the coverage rate for Asians and Pacific Islanders ( 81.8 percent).
- American Indians and Alaska Natives were less likely to have health insurance than other racial groups, based on 3-year averages ( 1999-2001) 72.9 percent, compared with 80.8 percent of Blacks, 81.5 percent of Asians and Pacific Islanders, and 90.2 percent of non-Hispanic Whites. However, American Indians and Alaska Natives were more likely to have insurance than were Hispanics ( 67.0 percent).
- Among the entire population 18 to 64 years old, workers ( both full-and part-time) were more likely to have health insurance ( 83.0 percent) than nonworkers ( 75.3 percent) , but among the poor, workers were less likely to be covered ( 51.3 percent) than nonworkers ( 63.2 percent).
- Compared with 2000, the pro portion who had employment- based policies in their own name fell for workers employed by firms with fewer than 25 employees, but was unchanged for those employed by larger firms.
- Young adults ( 18 to 24 years old) were less likely than other age groups to have health insur ance coverage 71.9 percent in 2001, compared with 83.3 percent of those 25 to 64 and, reflecting widespread Medicare coverage, 99.2 percent of those 65 years and over.
More people did not have health insurance in 2001.
The number of people without health insurance coverage rose to 41.2 million ( 14.6 percent of the population) in 2001, up 1.4 million from the previous year, when 14.2 percent of the population lacked coverage . Interestingly, the number of people covered by health insurance also increased in 2001, up 1.2 million to 240.9 mil lion ( 85.4 percent of the population) . Both increases can be attrib uted in part to an overall population growth from 2000 to 2001.
A decline in employment- based insurance prompted the decrease in insurance coverage rates. 3
Most people ( 62.6 percent) were covered by a health insurance plan related to employment for some or all of 2001, a decrease of 1.0 per centage point from the previous year. The 1.1 percentage point decline in private health insurance coverage, to 70.9 percent in 2001, largely reflects the decrease in employment-based insurance.
Although it did not offset the over all decline, health insurance cover age provided by the government increased between 2000 and 2001. This increase largely reflects the increase in Medicaid coverage, which rose by 0.6 percentage points to 11.2 percent in 2001. 4 Among the entire population, 25.3 percent had government insurance, including Medicare ( 13.5 percent) , Medicaid ( 11.2 percent) , and mili tary health care ( 3.4 percent). Many people carried coverage from more than one plan during the year; for example, 7.6 percent of people were covered by both pri vate health insurance and Medicare.
The uninsured rates for the poor and the near poor did not change between 2000 and 2001.
Despite the Medicaid program, 10.1 million poor people, or 30.7 percent of the poor, had no health insurance of any kind during 2001. This per centage more than double the rate for the total population did not change significantly from the previous year. The uninsured poor comprised 24.5 percent of all unin sured people .
Medicaid was the most widespread type of health insurance among the poor, with 40.5 percent ( 13.3 million) of those in poverty cov ered by Medicaid for some or all of 2001. This percentage did not change from the previous year. 5
Among the near poor ( those with a family income greater than or equal to, but less than 125 percent of, the poverty level) , 26.5 percent ( 3.3 million people) lacked health insur ance in 2001, unchanged from 2000. Although private health insurance coverage among the near poor declined in 2001 from 40.3 percent to 37.8 percent their rate of government health insurance coverage did not change from 2000 ( it was 47.1 percent in 2001).
Key demographic factors affect health insurance coverage.
Age -People 18 to 24 years old were less likely than other age groups to have health insurance coverage, with 71.9 percent covered for some or all of 2001. Because of Medicare, almost all people 65 years and over ( 99.2 percent) had health insurance in 2001. For other age groups, health insurance cover age ranged from 76.6 percent to 88.3 percent.
Among the poor, people 18 to 64 years old had a markedly lower health insurance coverage rate ( 57.7 percent) in 2001 than either people under 18 ( 78.7 percent) or 65 years and over ( 97.3 percent). 6
Race and Hispanic origin -While the uninsured rate rose in 2001 for non-Hispanic Whites from 9.6 percent to 10.0 percent the unin sured rates among Blacks ( 19.0 per cent) and among Asians and Pacific Islanders ( 18.2 percent) did not change from 2000. 7 The uninsured rate among Hispanics ( 33.2 percent in 2001) also did not change from 2000. 8
The CPS Annual Demographic Supplement, the source of these data, obtained interviews from 78,000 households nationwide but is not large enough to produce reli able annual estimates for American Indians and Alaska Natives. However, Table 3 (not shown) displays 3-year averages of the number of American Indians and Alaska Natives, their uninsured rate, and 3-year-average uninsured rates for other race groups. The 3-year average ( 1999-2001) shows that 27.1 percent of American Indians and Alaska Natives were without coverage, higher than the 19.2 percent for Blacks, 18.5 percent for Asians and Pacific Islanders, and 9.8 percent for non-Hispanic Whites. 9 However, the 3-year-average uninsured rate for Hispanics ( 33.0 percent) was high er than the uninsured rate for American Indians and Alaska Natives.
Comparisons of 2-year moving averages ( 1999-2000 and 2000 2001) show that while the unin sured rate fell for American Indians and Alaska Natives from 27.7 per cent to 25.5 percent and for Blacks from 19.3 percent to 18.9 percent, uninsured rates among non Hispanic Whites, Asians and Pacific Islanders, and Hispanics did not change.
Nativity -In 2001, the proportion of the foreign-born population without health insurance ( 33.4 per cent) was more than double that of the native population ( 12.2 per cent). 10 Among the foreign born, noncitizens were much more likely than naturalized citizens to lack coverage 42.9 percent com- pared with 17.2 percent.
Educational attainment -Among all adults, the likelihood of being insured increased as the level of education rose. Compared with the previous year, coverage rates decreased for those with no high school diploma, those who are high school graduates only, and those with some college education but no degree. Coverage rates did not change from 2000 to 2001 for adults with an associate degree or higher.
Economic status affects health insurance coverage.
Income -The likelihood of being covered by health insurance rises with income. Among households with annual incomes of less than $ 25,000, the percentage with health insurance was 76.7 percent; the level rises to 92.3 percent for those with incomes of $ 75,000 or more. Compared with the previous year, coverage rates decreased at every level of household income.
Work experience -Of those 18 to 64 years old in 2001, full-time workers were more likely to be covered by health insurance ( 84.0 percent) than part-time workers ( 78.0 percent) , and part-time work ers were more likely to be insured than nonworkers ( 75.3 percent). 11 However, among the poor, non workers ( 63.2 percent) were more likely to be insured than part-time workers ( 54.0 percent) , who were more likely to be insured than full time workers ( 49.7 percent).
Firm size -Of the 142.6 million workers in the United States who were 18 to 64 years old, 56.3 per cent had employment-based health insurance policies in their own name. The propor tion increased with the size of the employing firm from 31.3 percent for firms with fewer than 25 employees to 69.6 percent for firms with 1000 or more employees. ( These estimates do not reflect the fact that some workers were cov ered by another family member s employment-based policy). Compared with the previous year, the proportion who had employment-based policies in their own name decreased for workers employed by firms with fewer than 25 employees, but was unchanged for those employed by larger firms.
The uninsured rate for children did not change between 2000 and 2001.
The percentage of children ( people under 18 years old) without health insurance did not change in 2001 , remaining at 8.5 mil lion or 11.7 percent. A decline in employment-based health insur ance coverage of children was off set by an increase in coverage by Medicaid or the State Children s Health Insurance Program.
Among poor children, 21.3 percent ( 2.5 million children) had no health insurance during 2001, unchanged from the previous year . For this group, employment- based coverage decreased from 20.1 percent to 18.6 percent, while government health insurance cov erage increased from 60.9 percent to 63.3 percent. Poor children made up 29.3 percent of all unin sured children in 2001.
Among near-poor children ( those in families whose income was greater than or equal to, but less than 125 percent of, the poverty level) ,
21.6 percent ( 0.9 million children) were without health insurance in 2001, unchanged from 2000. 12 For this group, private health insur ance coverage decreased from 39.8 percent to 36.4 percent, but government health insurance cov erage did not change.
The likelihood of health insurance coverage varies among children.
Children 12 to 17 years old were more likely to be unin sured than those under 12 13.1 percent compared with 11.0 percent.
The uninsured rate declined in 2001 for Hispanic children from 25.3 percent to 24.1 per cent. The uninsured rates for non-Hispanic White children ( 7.4 percent) , Black children ( 13.9 percent) , and Asian and Pacific Islander children ( 11.7 percent) were unchanged from 2000.
While most children ( 68.4 per cent) were covered by an employment-based or privately purchased health insurance plan in 2001, nearly 1 in 4 ( 22.7 per cent) was covered by Medicaid.
Black children had a higher rate of Medicaid coverage in 2001 than children of any other racial or ethnic group 38.3 percent, compared with 34.9 percent of Hispanic children, 18.0 percent of Asian and Pacific Islander children, and 15.3 percent of non-Hispanic White children .
Children living in single-parent families in 2001 were less likely to be insured than children liv ing in married-couple families 84.3 percent compared with 90.4 percent.
Some states had higher uninsured rates than others.
The proportion of people without health insurance ranged from 7.2 percent in Rhode Island to 23.2 percent in New Mexico, based on 3-year averages for 1999, 2000, and 2001 . Although the data presented suggest that New Mexico had the highest unin sured rate, its rate was not statisti cally different from the rate for Texas. Similarly, although the data suggest that Rhode Island had the lowest uninsured rate, its rate was not statistically different from the rate for Minnesota.
Comparisons of 2-year moving averages ( 1999-2000 and 2000 2001) show that the proportion of people without coverage fell in 14 states: Alaska, Arizona, Idaho, Louisiana, Massachusetts, Montana, Nevada, New Mexico, North Dakota, South Carolina, South Dakota, Virginia, West Virginia, and Wisconsin. Meanwhile, the proportion of peo ple without coverage rose in nine states: Arkansas, Georgia, Indiana, Missouri, Ohio, Oklahoma, Pennsylvania, Rhode Island, and Texas.
Accuracy of the Estimates Statistics from surveys are subject to sampling and nonsampling error. All comparisons presented in this report take sampling error into account and meet the Census Bureau s standards for statistical significance. Nonsampling errors in surveys may be attributed to a variety of sources, such as how the survey was designed, how respon dents interpret questions, how able and willing respondents are to provide correct answers, and how accurately answers are coded and classified. The Census Bureau employs quality control procedures throughout the production process including the overall design of surveys, the wording of questions, review of the work of interviewers and coders, and statistical review of reports.
The Current Population Survey weighting procedure uses ratio estimation whereby sample esti mates are adjusted to independent estimates of the national popula tion by age, race, sex, and Hispanic origin. This weighting partially corrects for bias due to undercoverage, but biases may still be present when people who are missed by the survey differ from those interviewed in ways other than age, race, sex, and Hispanic origin. How this weighting proce dure affects other variables in the survey is not precisely known. All of these considerations affect comparisons across different sur veys or data sources.
For further information on statisti cal standards and the computation and use of standard errors, contact Jeffrey Stratton of the Demographic Statistical Methods Division on the Internet at dsmd. source. and. accuracy@ census. gov.
Technical Note
This report presents data on the health insurance coverage of peo ple in the United States during the 2001 calendar year. The data, which are shown by state and selected demographic and socio- economic characteristics, were col lected in the 2002 Annual Demographic Supplement to the Current Population Survey (CPS).
Treatment of major federal health insurance programs
The Current Population Survey (CPS) underreports Medicare and Medicaid coverage compared with enrollment and participation data from the Centers for Medicare and
Medicaid Services ( CMS) , formerly the Health Care Financing Administration (HCFA). 13 A major reason for the lower CPS estimates is that the CPS is not designed pri marily to collect health insurance data; instead, it is largely a labor force survey. Consequently, inter viewers receive less training on health insurance concepts. Additionally, many people may not be aware that they or their children are covered by a health insurance program if they have not used cov ered services recently and there fore fail to report coverage. CMS data, on the other hand, represent the actual number of people who enrolled or participated in these programs and are a more accurate source of coverage levels.
Changes in Medicaid coverage esti mates from one year to the next should be viewed with caution. Because many people who are cov ered by Medicaid do not report that coverage, the Census Bureau assigns coverage to those who are generally regarded as categorical ly eligible ( those who received some other benefits, usually public assistance payments, that make them eligible for Medicaid). Since the number of people receiving public assistance has been drop ping, the relationship between Medicaid and public assistance has changed, so that the imputation process has introduced a down ward bias in the most recent Medi caid estimates.
After consulting with health insur ance experts, the Census Bureau modified the definition of the pop ulation without health insurance in the March 1998 Current Population Survey, which collected data about coverage in 1997. Previously, peo ple with no coverage other than access to the Indian Health Service were counted as part of the insured population. Beginning with the 1997 Health Insurance Coverage report, however, the Census Bureau counted these peo ple as uninsured. The effect of this change on the overall esti mates of health insurance coverage was negligible.
Contact: Robert J. Mills 301-763-3242 hhes-info@ census. gov
Notes
- Confidence intervals for estimates are provided in Table 1 (not shown). These measures of sampling error should be used when comparing estimates.
- Because Hispanics may be of any race, data in this report for Hispanics overlap slightly with data for the Black population and the Asian and Pacific Islander population. About 10.9 percent of White house- holds, 3.0 percent of Black households, 2.0 percent of Asian and Pacific Islander households, and 13.1 percent of American Indian and Alaska Native households are maintained by a person of Hispanic origin.
- Employment-based health insurance is coverage offered through one s own employment or a relative s.
- Some of this increased Medicaid coverage may be due to expansions in the State Children s Health Insurance Program. For further discussion, see Charles T. Nelson and Robert J. Mills; U. S. Census Bureau; The Characteristics of People Reporting State Children s Health Insurance Program Coverage in the March 2001 Current Population Survey; August 2002; ; at www. census. gov/ hhes/ hlthins/ asa02. pdf.
- Changes in year-to-year Medicaid estimates should be viewed with caution. For more information, see the Technical Note on page 12.
- The health insurance coverage rates of poor people 18-64 years old and poor people 35-44 years old were not different.
- Data users should exercise caution when interpreting aggregate results for the Asian and Pacific Islander (API) population because the API population consists of many distinct groups that differ in socio-economic characteristics, culture, and recency of immigration. In addition, the CPS does not use separate population controls for weighting the API sample to national totals.
- Data users should exercise caution when interpreting aggregate results for the Hispanic population because this population consists of many distinct groups that differ in socio-economic characteristics, culture, and recency of immigration.
- Data users should exercise caution when interpreting aggregate data for American Indians and Alaska Natives (AIAN) because the AIAN population consists of groups that differ in economic characteris tics. Data from the 1990 census show that economic characteristics of those American Indians and Alaska Natives who live in American Indian and Alaska Native areas dif- fer from the characteristics of those who live outside these areas. In addition, the CPS does not use separate population controls for weighting the AIAN samples to national totals. See Accuracy of Estimates on page 11 for a further discussion of CPS estimation procedures.
- Natives are people born in the United States, Puerto Rico, or an outlying area of the United States, such as Guam or the U. S. Virgin Islands, and people who were born in a foreign country but who had at least one parent who was a U. S. citizen. All other peo ple born outside the United States are for eign born.
- Workers were classified as part time if they worked fewer than 35 hours per week in the majority of the weeks they worked in 2001.
- The health insurance coverage rates of poor children and near-poor children were not different
- CMS is the federal agency primarily responsible for administering the Medicare and Medicaid programs at the national level.
This document is not necessarily endorsed by the Almanac of Policy Issues. It is being preserved in the Policy Archive for historic reasons.