Slide 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 Bureau’s 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.
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Slide 2: Table of Contents:
Facts on Health Coverage in the USA
Overview Age & Gender Uninsured Children Race/Ethnicity Educational Attainment Income & Poverty Status Workers Source of Coverage Employment-Based Coverage Industry and Occupation Retiree Health Benefits Health Behavior National Spending on Healthcare Health Insurance Premiums Out-of-Pocket Spending on Health Care Services 3 4-5 6-10 11 12-13 14-15 16-17 18 19-21 22-23 22 24-26 27-31 32-34 35-37
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Slide 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.
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Slide 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.
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Slide 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.
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Slide 6: Percentage of Children Under Age 18 Without Health Insurance, 1994-2006
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
Uninsured Children
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.
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Slide 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.
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Slide 8: Uninsured Children
Uninsured Children by Age, 2006
Source: Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.
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Slide 9: Uninsured Children
Uninsured Children by Family Poverty Status, 2006
Source: Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.
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Slide 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.
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Slide 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
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Slide 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 highschool 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.
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Slide 13: Educational Attainment
Uninsured Nonelderly Adults by Education, 2006
Source: Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.
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Slide 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.
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Slide 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.
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Slide 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
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Slide 17: Workers
Nonelderly Adult Uninsured Workers by Work Status, 2006
Source: Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.
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Slide 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.
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Slide 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.
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Slide 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.
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Slide 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.
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Slide 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.
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Slide 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.
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Slide 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.
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Slide 25: Health Behavior
Time Since Last Mammogram, Female Workers Ages 30-64, by Insurance Status, 2005
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Source: Employee Benefit Research Institute estimates from the 2005 Medical Expenditure Panel Survey
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Slide 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
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Slide 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.)
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Slide 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.)
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Slide 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.)
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Slide 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.
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Slide 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.
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Slide 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.
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Slide 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.
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Slide 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.
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Slide 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 p<.05.
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Slide 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.
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Slide 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 copayments or coinsurance for specially identified types of drugs, such as lifestyle or injectable drugs.
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