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Health Insurance
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Health Insurance Coverage: 1997
The Haves and Have-Nots
An estimated 43.4 (+/-0.5) million people in the United States or
16.1 (+/-0.2) percent of the population were without health
insurance coverage during the entire 1997 calendar year. This
number was up 1.7 million from the previous year; statistically,
the proportion was also higher than the previous year.
Other highlights are:
- The status of children's health care coverage was unchanged
in 1997. The number of uninsured children under 18 years of
age was 10.7 (+/-0.2) million in 1997, 15.0 (+/-0.3) percent
of all children; both the number and percent were not
significantly different from the previous year.
- Despite the Medicaid program, 11.2 (+/-0.3) million poor
people had no health insurance in 1997, nearly one-third of
all poor people, or 31.6 (+/-0.7) percent.
- The highest uninsured rate was among people of Hispanic
origin: Over one-third or 34.2 (+/-0.6) percent of Hispanics
were uninsured in 1997, compared with 12.0 (+/-0.2) percent
for non-Hispanic Whites.
- Among the general population 18-64 years old, workers (full-
and part-time) were more likely to be insured than
nonworkers, but among the poor, workers were less likely to
be insured than nonworkers. About one-half, or 49.2 (+/-2.0)
percent, of poor full-time workers were uninsured in 1997.
- A higher proportion of the foreign-born population in the
U.S. was without health insurance in 1997, compared with
natives, 34.3 (+/-0.8) percent versus 14.2 (+/-0.2) percent.
Poor immigrants were even worse off; 51.7 (+/-2.0) percent
were without health insurance.
- Young adults between the ages of 18 to 24 were more likely
than other age groups to not have coverage; 30.1 (+/-0.7)
percent were without coverage in 1997. Because of Medicare,
the elderly were at the other extreme; only 1.0 (+/-0.1)
percent lacked coverage.
Note: The figures above in parentheses denote the 90-percent confi-
dence intervals.
Employment is the leading source of health insurance coverage.
Most people (70.1 percent) were covered by a private insurance
plan for some or all of 1997. A private plan is one that is
offered through employment (either one's own or a relative's) or
privately purchased. Most private insurance was obtained through
a current or former employer or union (employment-based).
The government also provides health care coverage (24.8 percent
of people have government insurance)--Medicare (13.2 percent),
Medicaid (10.8 percent), and military health care (3.2 percent).
Many people carry coverage from more than one plan during the
year; for example, 7.9 percent were covered by both private
insurance and Medicare.
The poor and near poor are more likely not to have coverage.
Despite the Medicaid program, 31.6 percent of the poor (11.2
million) had no health insurance of any kind during 1997. This
percentage--which was double the rate for all people--was
statistically unchanged from the previous year. Poor people
comprised 25.9 percent of all uninsured people.
Medicaid was the most widespread type of coverage among the poor.
About 43.3 percent of all poor people were covered by Medicaid at
some time during the year.
Among the near poor, 30.8 percent were without health insurance
(3.8 million). (The near poor are those with a family income
greater than the poverty level but less than 125 percent of the
poverty level.)
Key factors influencing the chances of not having health
insurance coverage are:
Age - Young adults between the ages of 18 to 24 were more likely
than other age groups to lack coverage during all of 1997 (30.1
percent). Because of Medicare, the elderly were at the other
extreme (only 1.0 percent lacked coverage). Among the poor,
adults aged 18 to 64 had much higher noncoverage rates than
either children or the elderly.
Race and Hispanic origin - People of Hispanic origin had the
highest chance of not having health insurance coverage in 1997.
The uninsured rate for Hispanics was 34.2 percent, compared with
12.0 percent for non-Hispanic Whites. Among the poor, African
Americans and non-Hispanic Whites had the lowest uninsured rates
(27.4 percent and 29.0 percent, respectively);/1 many poor African
Americans were covered by Medicaid.
Educational attainment - Among all adults, the likelihood of
being uninsured declined as the level of education rose. Among
those who were poor in 1997, there were few differences across
the education groups.
Work experience - Of those 18-64 years old who worked, part-time
workers had a higher noncoverage rate (24.1 percent) than full-time
workers (16.8 percent)./2 Among the general population 18-64, workers
(full- and part-time) were more likely to be insured than nonworkers,
but among the poor, workers were less likely to be insured than non-
workers. About one-half of poor full-time workers were uninsured in
1997 (49.2 percent).
Foreign-born - In 1997, a higher proportion of the foreign-born
population in the U.S. was without health insurance (34.3 percent),
compared with natives/3 (14.2 percent). Of the foreign-born,
noncitizens had a noncoverage rate more than twice as high as
naturalized citizens, 43.6 percent versus 18.5 percent. Poor
immigrants were even worse off; 51.7 percent were without health
insurance.
Income and firm size play important roles.
Noncoverage rates fall as household income rises. In 1997, the
percent of people without health insurance ranged from 8.1
percent (among those in households with incomes of $75,000 or
more) to 25.4 percent (among those in households with incomes
less than $25,000).
Of the 144.6 million workers, 53.0 percent had employment-based
health insurance policies in their own name. The proportion
varied widely by size of employing firm; workers employed by
small firms (less than 25 employees) were the least likely to
have employment-based health insurance policies in their own name.
These estimates do not reflect the fact that some workers are
covered by employment-based coverage through another family member.
Children's health care coverage status was unchanged in 1997.
The number of uninsured children less than 18 years of age was
10.7 million (15.0 percent of all children) in 1997; both the
number and percent were not significantly different from the
previous year.
Among poor children, 3.4 million (23.8 percent) were uninsured in
1997, statistically unchanged from the previous year. Poor
children comprised 31.3 percent of all uninsured children in
1997.
Other findings concerning children are--
Older children (12 to 17 years of age) were less likely to have
health care coverage than younger children (those less than 12
years of age). Uninsured rates for children by age group were--
14.4 percent of children less than 6, 13.9 percent of children 6
to 11,and 16.7 percent of children 12 to 17./4
Children of Hispanic origin were far more likely to be
uninsured (28.6 percent) than non-Hispanic White children (10.7
percent); and African American children were more likely to go
uninsured (18.9 percent) than White children (14.1 percent) or
Asian and Pacific Islander children (15.1 percent)./5
While most children were covered by a private health insurance
plan (privately purchased or employment-based) in 1997, about
one-fifth were covered by Medicaid: 66.9 percent were covered by
a private plan and 20.5 percent (14.7 million) were covered by
Medicaid in 1997.
Significantly higher proportions of African-American and
Hispanic children, than of White or Asian and Pacific Islander
children, were covered by Medicaid in 1997--36.7 percent of
African-American children, 17.1 percent of White children and
17.9 percent of Asian and Pacific Islander children; 32.3 percent
of Hispanic children and 13.8 percent of non-Hispanic White
children.
Some states have higher noncoverage rates than others.
Using 3-year averages between 1995 and 1997, state uninsured
rates ranged from 7.9 percent in Wisconsin to 24.4 percent in
Texas. However, we advise against using these estimates to rank
the states. Results from different samples could easily show
different estimates and rankings because of small sample sizes.
For example, the high noncoverage rate for Texas was not
statistically different from that in New Mexico (23.5 percent),
while the rate for Wisconsin was not statistically different from
Hawaii (8.3 percent).
Based on comparisons of 2-year averages (1996-97 versus 1995-96),
noncoverage rates fell in five states: Louisiana, Missouri,
New Mexico, Rhode Island, and Vermont. Meanwhile, noncoverage
rates rose in sixteen states: Alabama, Alaska, Arizona, Arkansas,
Connecticut, Florida, Idaho, Michigan, Nebraska, New Jersey, New
York, North Dakota, South Carolina, South Dakota, Utah, and West
Virginia.
TECHNICAL NOTE
This report presents data on the health insurance coverage of
people in the United States during the 1997 calendar year. The
data, which are shown by selected demographic and socioeconomic
characteristics, as well as by state, were collected by the March
1998 Supplement to the Current Population Survey (CPS).
In the Current Population Survey (CPS), Medicare and Medicaid
coverage estimates are underreported, compared with enrollment
and participation data from the Health Care Financing
Administration (HCFA)./6 A major reason for the lower CPS
estimates is the fact that CPS is not designed to specifically
collect health insurance data. Instead, it is largely a labor
force survey, with minimum interviewer training on health
insurance concepts. Data from HCFA represent the actual number
of people who were enrolled or participated in these programs and
is therefore a more accurate source of data on levels of
coverage. Also, it is believed that many people are not aware
that they or their children are covered by a health insurance
program, and therefore do not report coverage.
Since the publication of last year's CPS health insurance report,
as a result of consultation with health insurance experts, the
Census Bureau has made a modification in its definition of the
population without health insurance. Previously, people with no
coverage other than access to Indian Health Service were
considered to be part of the insured population. Beginning with
this report, that is no longer true; instead, these people are
considered to be uninsured. The effect of this change on the
overall estimates of health insurance coverage is negligible.
ACCURACY OF THE ESTIMATES
All statistics are subject to sampling error, as well as
nonsampling error such as survey design flaws, respondent
classification and reporting errors, data processing mistakes and
undercoverage. The Census Bureau has taken steps to minimize
errors in the form of quality control and edit procedures to
reduce errors made by respondents, coders, and interviewers.
Ratio estimation to independent age-race-sex-Hispanic population
controls partially corrects for bias attributable to survey
undercoverage. However, biases exist in the estimates when
missed people have characteristics different from those of
interviewed people in the same age-race-sex-Hispanic group.
Analytical statements in this report have been tested and meet
statistical standards. However, because of methodological
differences, use caution when comparing these data with data from
other sources. Contact Andrew Zbikowski, Demographic Statistical
Methods Division, at 301-763-4214 or on the Internet at
azbikows@census.gov for information on (1) the source of the
data, (2) the accuracy of the estimates, (3) the use of standard
errors, and (4) the computation of standard errors.
Footnotes:
1/The uninsured rate for poor African Americans was not significantly
different from that of poor non-Hispanic Whites.
2/Workers were classified as part time if they worked less than 35
hours per week in the majority of the weeks they worked in 1997.
3/"Natives" are people born in the United States, Puerto Rico, or
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 people born outside the U.S. are "foreign born."
4/Statistically, there was no significant difference between the
uninsured rates for children under 6 and those 6 to 11.
5/Statistically, there was no difference between the uninsured rates
for White children and for Asian and Pacific Islander children.
6/HCFA is the federal agency primarily responsible for administering
the Medicare and Medicaid programs at the national level.
Contact:
Robert Bennefield
301-763-3242
SOURCE: U.S. Bureau of the Census; Current Population Reports,
Series P60-202, September 1998.
Go to Health Insurance 1997
Contact the Demographic Call Center Staff at 301-763-2422 or 1-866-758-1060 (toll free) or visit
ask.census.gov for further information on Health Insurance Data.
Source: U.S. Census Bureau, Housing and Household Economic Statistics Division
Last Revised: September 22, 2009
