Health Action in Depth

March 2003

Who Is Uninsured, and Why Does Health Insurance Matter?

The United States is the only industrialized nation in which everyone does not have health coverage. According to the most recent data from the U.S. Census Bureau, there were 41.2 million uninsured people in this country in 2001 (about 15 percent of the total population). But a new report prepared by Families USA for Cover the Uninsured Week (a project supported by the Robert Wood Johnson Foundation) documents a far more astounding statistic: during the last two years, 74.7 million people under the age of 65-nearly one in three-were uninsured for some amount of time. In nine states, including three of the four most populous states in the country-California, Florida, and Texas-more than one out of three non-elderly people were uninsured during all or part of 2001-2002. In fact, two-thirds of the people who were uninsured during 2001-2002 lacked health coverage for six months or longer.

Who are the uninsured?
The new report, Going without Health Insurance: Nearly One in Three Non-Elderly Americans, looks at what we know about the uninsured. The findings mirror previous analyses:

• Work status: Of those without health coverage during 2001- 2002, four out of five had some connection to the workforce-either they were adults who were employed full- or part-time or were actively seeking work, or they were children in families with a working parent.
• Income: People with lower incomes are more likely to lack health coverage. In fact, 56.1 percent of those without health coverage had incomes at or below the federal poverty level ($8,860 for a single adult, $15,020 for a family of three in 2002).
• Age: Of adults who are uninsured, young adults-18- to 24-year-olds-are the most likely to be uninsured (49.6 percent). The percentage of uninsured adults decreases as people age, presumably because they have better, more stable jobs. The rate for 25-44-year-olds is 32.7 percent, for 45-54-year-olds it's 21.2 percent, and for 55-64-year-olds it's 20.8 percent.
• Racial/ethnic group: While whites make up the majority of people under 65 without health coverage (52 percent), Hispanics and African Americans are more likely to lack health coverage. The rate of being uninsured is a shocking 52.2 percent for Hispanics, 39.3  percent for African Americans, and 23.3 percent for whites.

What are the consequences of being uninsured?
A common myth about the uninsured is that there are no serious health consequences to lacking health coverage-specifically, that uninsured people can get the care they need from community health centers, emergency rooms, and public clinics. In reality, the uninsured must often delay needed medical care, or forgo it altogether. Health consequences of being uninsured include the following:

• The uninsured are less likely to have a usual source of care aside from the emergency room, and they are more likely to rely on the emergency room for routine care. Compared to those with health coverage, uninsured adults are four times more likely to use the emergency room as a regular source of care, and uninsured children are five times more likely to use the emergency room as a regular source of care.

  Reprinted with permission. Copyright 2003 The New Yorker Collection from cartoonbank.com. All rights reserved.

• Uninsured adults and children are less likely to receive preventive care, such as annual check-ups. Compared to those with health coverage, uninsured adults are over 30 percent less likely to have had a check-up in the past year. Uninsured adults are less likely to be screened for cancer, cardiovascular disease, and diabetes than insured adults.
• Uninsured adults are more likely to skip a recommended medical test or treatment and to forgo care needed for a serious problem than are those with health coverage.
• Compared to those with health coverage, uninsured people suffering from chronic conditions such as arthritis, heart disease, and high blood pressure receive less care for those conditions, including fewer health visits and fewer prescription drugs.
• The uninsured are more likely to be hospitalized for conditions that could have been prevented than those with insurance. In fact, the rate of unnecessary hospitalizations for uninsured adults more than doubled from 1980 to 1988. In 1998, nearly 12 percent of hospital stays for uninsured people could have been avoided if the person had received appropriate treatment earlier.
• The uninsured are sicker and die earlier than those who have health coverage. Uninsured patients who have been admitted to the hospital are more likely to die in the hospital than insured patients. In addition, when uninsured patients are admitted, they are more likely to receive fewer services and to experience substandard care than insured patients.

What's in a number?
Most health advocates are familiar with the Census Bureau's latest estimate that 41.2 million Americans are uninsured. This estimate derives from the Census Bureau's Current Population Survey (CPS), which is designed to show how many people were uninsured throughout the previous year.

Families USA's analysis also used CPS data, but we combined it with other Census data to provide a more detailed picture of who was uninsured by estimating, state-by-state, how many people were uninsured for all or part of 2001-2002. These are people who were not included in the CPS estimate that 41.2 million Americans are uninsured-but they nonetheless may have been profoundly affected by being uninsured. These effects can extend both to health status and to economic well-being. As the report notes, "No picture of the causes and consequences of being uninsured is complete unless it includes all people who experience a significant gap in health insurance coverage."

What's the bottom line?
The plight of the uninsured in this country is getting increased attention. We hope that Cover the Uninsured Week can build on that to further raise public awareness and to show that that the public wants solutions for those struggling without health coverage. 

(Going without Health Insurance: Nearly One in Three Non-Elderly Americans, which provides both national and state-level data, is available on our Web site in pdf format.)