Academic journal article Health Care Financing Review

Americans' Health Insurance Coverage, 1980-91

Academic journal article Health Care Financing Review

Americans' Health Insurance Coverage, 1980-91

Article excerpt


This article provides an overview of trends in public and private health insurance coverage over the last decade, with special emphasis on age, income, employment, and regional characteristics of insured and uninsured populations. Our data source, the March Current Population Survey (CPS) by the U.S. Bureau of the Census, contains information on health insurance coverage for the non-institutionalized population. These data are frequently cited in discussions of the size of the uninsured population in the United States, but they are rarely used to show trends in insurance coverage such as those the United States has experienced over the last 12 years. Key findings include:

* Income is the single most important factor in a nonelderly

family's decision to purchase health

insurance. From the 1980 to the 1991 CPS, the

percent of the non-elderly population in poverty

increased, and the percent with insurance coverage

decreased. * For the elderly, income in relation to the poverty level

rose, with a substantially larger proportion of the

elderly in the highest income category. For the

elderly, income did not significantly affect insurance

coverage, and the likelihood of being uninsured was

low regardless of income level. * The data confirm that children in families with

incomes slightly above the Federal poverty level fell

through the Medicaid safety net more often than did

children in families that were poor. Children in the

near-poor income group were most likely of all

income groups to be uninsured. * Holding a full-time job for the entire year did not

guarantee health insurance coverage. In the 1991

CPS, 18.7 million members of families headed by

full-time, full-year workers were uninsured, up

18.1 percent from levels reported in the 1988 CPS. In

contrast, the total number of uninsured persons

increased 11.9 percent from 1988 to 1991, indicating

that relatively more full-time, full-year workers were

becoming uninsured. * From CPS survey years 1988 to 1991, industrial

composition of the United States shifted toward

service industries in which the provision of employer

sponsored insurance is less likely to be found.

Simultaneously, the percentage of workers offered

and/or able to afford insurance through their

employment declined in almost every industrial

sector. Together, these industry changes produced a

5-percent decline in the number of workers owning

coverage through employment, compared with those

who would have owned policies in the absence of

those shifts. * Selected industries subsidized the provision of

employer-sponsored health insurance to workers in

other sectors by providing dependent coverage to

employees in other industries. Sectors such as mining;

manufacturing, and transportation,

communications, and public utilities were found to

cross-subsidize industries such as agriculture,

forestry, and fisheries; construction; retail trade;

services; and the self-employed. * Large regional differences exist in the percentage of

the population that is uninsured. In 1991, 9.0 percent

of the population in New England lacked health

insurance coverage, while more than twice that

percentage were uninsured in the West South

Central States.


Since at least 1980, the United States has faced the twin problems of increasing numbers of uninsured and rising health costs. The problems are closely intertwined: Options for covering growing numbers of uninsured have become an increasingly important issue to policymakers and individuals as health costs have grown rapidly over the last decade and are projected to continue rising in the foreseeable future. …

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