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About the Uninsured


 

Why does insurance matter? People without insurance are more likely to go without preventive care, to delay or forgo medical care, and to die prematurely. When sick, the uninsured may turn to emergency rooms for care, where oftentimes they are charged more for services than insured patients. And when uninsured patients can’t afford their medical bills, the cost of this care is passed on to the insured in the form of higher premiums. The new health care act will provide opportunities for the uninsured to get health insurance. For more about the new law, go to Health Reform Central.

From Families USA:

Dying for Coverage: The Deadly Consequences of Being Uninsured estimates the number of Americans who are dying prematurely due to lack of health coverage. It includes state-level data that are broken down by week, month, and year that were generated using the methodology originally developed by the Institute of Medicine. (June 2012)

Health Reform: Help for Americans with Pre-Existing Conditions discusses how, under health reform, no one will be denied coverage, charged a higher premium, or sold a policy that excludes coverage of essential benefits because of pre-existing conditions. The report presents the number of Americans with diagnosed pre-existing conditions who, absent reform, would be at risk of being denied coverage in the individual insurance market. It breaks down this number by age, income, and race. | State Reports (May 2010)

The Dangers of Defeat: The Cost of Failure to Pass Health Reform analyzes the many consequences for America's families and businesses if health reform is—or is not—enacted. It examines what will happen to health insurance premiums, out-of-pocket health care costs, and businesses struggling to provide coverage to workers. (March 2010)

Lives on the Line: The Deadly Consequences of Delaying Health Reform examines what would happen if Congress fails to pass health reform. Specifically, it provides national and state-level estimates of the number of deaths that would occur due to lack of health coverage if reform doesn't pass. It also quantifies how many Americans died due to lack of health coverage since the last effort to pass reform in 1994. (March 2010)

For a complete list of Families USA's publications on the uninsured, go to Publications by Topic.

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From the Access Project:

2007 Health Insurance Survey of Farm and Ranch Operators finds that, although family farmers and ranchers were insured at a rate higher than the general population, 10 percent were uninsured or had an uninsured family member. In addition, farmers and ranchers often cannot afford to offer their employees health coverage. (June 2009)

2007 Health Insurance Survey of Farm and Ranch Operators provides key findings from a survey of 2,000 farmers from seven states. It discusses their age, racial and ethnic background, income, and health insurance status, as well as whether health care expenses contribute to other financial problems, overall debt, and reduced access to health care. (September 2007)

From the Agency for Healthcare Research and Quality:

The State Children’s Health Insurance Program (SCHIP), created in 1997, has been a major factor in improving health coverage rates for children. Changes in Children’s Health Insurance Status, 1996-2005: Estimates for the U.S. Civilian Noninstitutionalized Population under Age 18 examines trends in children’s health insurance coverage by race/ethnicity and finds that improvements have been particularly dramatic for minority children. (September 2006)

From the Alliance for Health Reform:

Making Sense of the Census Uninsured Numbers discusses localized Census data on health coverage and examines recent trends in cities, counties, and congressional districts. It also addresses insurance trends for several demographic groups. (September 2012)

50 Million Uninsured: The Faces behind the Headlines is a panel discussion that addresses who the uninsured are, why so many Americans lack coverage, the trends among different segments of the population, and what the high number of uninsured people means for health care costs. A webcast and podcast are available. (October 2011)

Covering Health Issues Campaign 2000 and Beyond is a source book for Journalists that will also prove useful to Advocates. The chapter on The Uninsured covers issues such as Who Are the Uninsured, The Consequences of Being Without Coverage, and Solving the Problem. (March 2000)

From the American Immigrant Law Foundation:

The welfare reform law known as the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) barred most lawful permanent residents of the United States from receiving many of the public benefits their tax dollars help fund. Not Getting What They Paid For: Limiting Immigrants' Access to Benefits Hurts Families without Reducing Healthcare Costs finds that benefit restrictions have reduced access to health insurance for both legal immigrants and their citizen children and have failed to significantly reduce government health care expenditures because of the high costs of providing medical care for the uninsured. (June 2003)

From The California Health Care Foundation:

Haves and Have-Nots: A Look at Children’s Use of Dental Care in California found that uninsured children were least likely to have had a recent dental visit and most likely to have never visited a dentist. Denti-Cal (a part of California’s Medicaid program) beneficiaries were least likely to have ever seen a dentist compared to those with other types of insurance. The report suggests a number of public health initiatives to help these children get the dental care they need, such as increasing oral health outreach and education. (February 2008)

From the Center for American Progress:

Health Care in Crisis: 14,000 Losing Coverage a Day estimates that since the recession began, 14,000 U.S. residents have been losing job-based health coverage each day because of layoffs. The report finds that a one percentage point increase in the national unemployment rate results in 2.4 million people losing job-based coverage. Of those, 1 million seek coverage through Medicaid or CHIP, while 1.1 million remain uninsured. (February 2009)

From the Center for Economic and Policy Research and Georgetown University:

Health-Insurance Coverage for Low-Wage Workers, 1979-2012 and Beyond discusses the steady decline in coverage for low-wage workers over the past three decades, but it also explains that the experience with health reform in Massachusetts suggests that the Affordable Care Act may reverse this trend. (February 2012)

From the Centers for Disease Control and Prevention:

Vital Signs: Health Insurance Coverage and Health Care Utilization—United States, 2006-2009 and January-March 2010 finds that 59.1 million people were uninsured during 2010, an increase from 56.4 million people in 2008. This trend cuts across age and income levels, meaning that more and more people are going without needed health care. (November 2010)

Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, January-March 2010 estimates rates of health insurance coverage, including private versus public coverage. Lack of health insurance is measured in three ways: whether a person was uninsured at the time of the interview, uninsured for at least part of the year, or uninsured for more than a year. (September 2010)

From the Center for Studying Health System Change:

Trade-Offs Getting Tougher: Problems Paying Medical Bills Increase for U.S. Families, 2003-2007 estimates that 14 million more people had problems paying medical bills in 2007 compared to 2003. Among the non-elderly insured and uninsured, 2.2 million were in families that filed for bankruptcy as a result of medical debt, while a much larger number reported other financial consequences, such as difficulties paying for necessities or having to borrow money. (September 2008)

According to Falling Behind: Americans' Access to Medical Care Deteriorates, 2003-2007, the number and proportion of Americans that reported going without or delaying needed medical care increased sharply between 2003 and 2007. One in five Americans—59 million people—reported not getting or delaying needed medical care in 2007, up from one in seven—36 million people—in 2003. Cost of care was an often-cited obstacle, as were increasing rates of health system barriers, such as health plan prior-authorization requirements. (June 2008)

Visits to hospital emergency departments have increased greatly in recent years, contributing to crowded conditions and ambulance diversions. But contrary to the popular belief that uninsured people are the major cause of emergency department use, insured Americans accounted for most of the 16 percent increase in visits between 1996-97 and 2000-01. Insured Americans Drive Surge in Emergency Department Visits examines trends in emergency and other ambulatory care use, focusing on differences among insurance groups. (October 2003)

Mounting Pressures: Physicians Serving Medicaid Patients and the Uninsured, 1997-2001 reports that the percentage of doctors providing any kind of charity care decreased from 76.3 percent in 1997 to 71.5 percent in 2001. The proportion of physicians serving Medicaid patients decreased by a lesser amount during that timeframe, from 87.1 percent to 85.4 percent. The authors note that while these decreases do not appear to have had any negative consequences for Medicaid beneficiaries, they are consistent with other evidence showing decreased access to physicians by the uninsured. (December 2002)

Working Families' Health Insurance Coverage, 1997-2001 reports that, despite a booming economy, falling unemployment, and moderate health insurance premium growth, the proportion of Americans in working families covered by employer-sponsored health insurance remained almost flat between 1997 and 2001. The tracking report concludes that "relying on economic growth alone to reduce the number of uninsured is unlikely to be effective in achieving substantial expansion of employer coverage." (August 2002)

The Insurance Gap and Minority Health Care, 1997-2001 reports that, despite a booming economy and increased national attention being focused on the problem, racial and ethnic disparities failed to improve. Such disparities were particularly pronounced among those who lack health insurance. The author notes that "the gaps between minority groups and whites remain nearly the same as a decade ago." (June 2002)

Treading Water: American's Access to Needed Medical Care, 1997-2001 presents the results of the latest Community Tracking Study Household Survey from the Center for Studying Health System Change. This national Tracking Report found that despite a strong economy, fewer uninsured people, and record low unemployment, overall rates of unmet need and delayed medical care failed to improve. About one in seven Americans reported some difficulty in obtaining care in both 1997 and 2001, and, during that period, problems such as an inability to get timely appointments actually increased. (March 2002)

Physicians and Charity Care: The Center for Studying Health System Change has issued a new study, titled Physicians Pulling Back from Charity Care, that documents the recent drop in the percentage of physicians providing charity care. The findings are based on the Community Tracking Study Physician Survey of more than 12,000 physicians. The authors conclude that reduced physician participation in charity care will hurt the medically indigent if, as projected, growth in physician supply slows and the number of uninsured rises along with escalating health care costs. (August 2001)

From the Center for Studying Health System Change and the Robert Wood Johnson Foundation:

Americans’ Access to Prescriptions Drugs Stabilizes, 2007-2010 explains that, despite the weak economy and high uninsurance rates, reported difficulty affording prescription drugs remained level between 2007 and 2010. This trend may be a byproduct of fewer visits to the doctor because of the weak economy and therefore fewer prescriptions being filled. (December 2011)

Medical Bill Problems Steady for U.S. Families, 2007-2010 finds that the proportion of families reporting problems paying medical bills in 2010 is about the same as it was in 2007, which may be a byproduct of people getting less medical care because of losing jobs or health insurance. However, the proportion of families facing these difficulties in 2010 is dramatically higher than it was in 2003. (December 2011)

From the Center on an Aging Society:

The Decade Preceding Medicare: Insurance Matters for People with Chronic Conditions presents the eleventh in a series of data profiles on chronic and disabling conditions. The data demonstrate that adults with chronic conditions who are uninsured as they approach age 65 are a vulnerable group-they are less healthy and more likely to need health care services than insured adults with chronic conditions who are the same age. They are also less likely to have a regular physician and to use preventive and screening services and more likely to use emergency rooms for medical care. (September 2003)

"Data Profile: Screening for Chronic Conditions" from the Center on an Aging Society is the most recent statistical portrait in their series entitled Challenges for the 21st Century: Chronic and Disabling Conditions. This Data Profile examines the use of screening services according to age, insurance status, and source of care. It takes a look at the proportions of different groups screened for breast, cervical, colorectal, prostate, and skin cancers, as well as the proportion of adults asked about risk-related behaviors. (January 2002)

From the Center on Budget and Policy Priorities:

Private Health Coverage Unstable for Middle Class examines Census data to show how families have been affected by insurance loss. One-quarter of privately insured, middle-class families had at least one member who lost coverage between 2004 and 2007. These numbers are likely higher today in light of the recession and high rates of unemployment. (March 2010)

According to recent data from the Census Bureau, 46.6 million Americans lack health insurance. The Number of Uninsured Americans Is at an All-Time High discusses the increased number of uninsured, the decline in employer-sponsored coverage, and changes in Medicaid and SCHIP enrollment. (August 2006)

Executive Summary- Health Care after Welfare: An Update of Findings from State-Level Leaver Studies. During the debate over the 1996 federal welfare law, a bipartisan consensus emerged that low-income families with children should not lose health care coverage as a result of changes in welfare policies.

Millions of Uninsured and Underinsured Children Are Eligible For Medicaid

Employed But Not Insured: A State-By-State Analysis of The Number of Low-Income Working Parents Who Lack Health Insurance (February 1999)

From the Centers for Disease Control:

Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, 2007 finds that lack of health coverage was greatest in the South and West, with 30 percent of adults under age 65 and 18 percent of children lacking coverage. The brief also provides state-specific estimates for the uninsured and estimates for those enrolled in high-deductible health plans. (June 2008)

From the Commonwealth Fund:

Gaps in Health Insurance: Why So Many Americans Experience Breaks in Coverage and How the Affordable Care Act Will Help finds that one-quarter of adults aged 19 to 64 experienced a gap in their health insurance in 2011, with a majority remaining uninsured for one year or more. It also explains how the Affordable Care Act’s Medicaid expansion and exchanges will help people maintain coverage. (April 2012)

When Unemployed Means Uninsured: The Toll of Job Loss on Health Coverage, and How the Affordable Care Act Will Help discusses the difficulty people face finding and paying for insurance if they lose their jobs. Although the Affordable Care Act will provide affordable insurance in 2014, this report suggests that policy makers should help the recently unemployed now by offering COBRA subsidies or extending unemployment benefits. (August 2011)

Rite of Passage: Young Adults and the Affordable Care Act of 2010 discusses provisions in the new law that will help young adults gain health coverage. Key provisions include dependent coverage up to age 26, a Medicaid expansion, new health insurance “exchanges,” and subsidies to help people purchase private insurance. (May 2010)

Young, Uninsured, and Seeking Change: Health Coverage of Young Adults and Their Views on Health Reform found that almost half of young adults are uninsured at some time during the year. In the current economic climate, young adults are less likely to find jobs, especially jobs with health benefits, and are often dropped from their parents' insurance upon graduation from college or high school. Provisions in federal health reform legislation could significantly help this group get and keep health coverage. (December 2009)

Aiming Higher: Results from a State Scorecard on Health System Performance, 2009 finds rising health care costs are making coverage less affordable across the country. The report projects that these costs are also likely to widen gaps in access based on income, insurance status, or race/ethnicity. These nationwide problems underscore the need for comprehensive national reform to expand and improve the quality of coverage. (October 2009)

Rite of Passage? Why Young Adults Become Uninsured and How New Policies Can Help, 2009 Update explains why young people ages 19-29 continue to be one of the largest and fastest-growing groups without health insurance and the possible repercussions of this trend. The brief also suggests policy reforms that could help young adults stay insured as they become more independent. (August 2009)

Health Insurance and Health Care Access before and after SSDI Entry sheds new light on the experiences of people with disabilities and raises the question of why many people who are eligible for Medicare are denied coverage when they are perhaps most in need of it. While the cost of eliminating the waiting period seems high, it represents only a small percentage increase in Medicare spending, and it could help states reduce their spending on public coverage programs. (May 2009)

Losing Ground: How the Loss of Adequate Health Insurance Is Burdening Working Families discusses the insurance status of adults under age 65 and the implications for family finances and access to health care. It reports that health coverage has deteriorated over the past six years, with declines in coverage most severe for moderate-income families. Nearly two-thirds of adults had medical bill problems or debt, went without needed care because of cost, or were uninsured. (August 2008)

Seeing Red: The Growing Burden of Medical Bills and Debt Faced by U.S. Families reports that the proportion of working-age Americans who struggled to pay medical bills and accumulated medical debt climbed from 34 percent to 41 percent between 2005 and 2007. Families with low or moderate incomes were particularly hard hit, as were the uninsured and adults who had gaps in health coverage. Those experiencing financial hardship due to medical debt reported that they used up all their savings, incurred large credit card debt, or were unable to pay for basic necessities. (August 2008)

Who Pays for Health Care When Workers Are Uninsured? reports that holes in employer-based coverage generate public costs in the form of public insurance programs or uncompensated care programs that cover care that would otherwise be paid for through insurance. This report quantifies those costs and finds that, in 2004, uninsured and publicly insured workers cost taxpayers $45 billion. (May 2008)

Overburdened and Overwhelmed: The Struggles of Communities with High Medical Cost Burdens: The number of people with potentially high medical cost burdens varies widely across the nation. Some of these people lack insurance, while others are insured but are paying a high portion of their income to get that coverage. Federal support will be critical to addressing this problem. (November 2007)

Although men and women have some similar challenges with regard to health insurance, women face unique barriers to becoming insured. Women and Health Coverage: The Affordability Gap describes these obstacles and stresses the importance of addressing these disparities in health policy proposals. (April 2007)

Health Care Disconnect: Gaps in Coverage and Care for Minority Adults investigates racial disparities found in the analysis of the 2005 Commonwealth Fund Biennial Health Insurance Survey. The survey indicates that Hispanic and African American adults are up to three times more likely to be uninsured than white adults. Only 20 percent of white adults were uninsured at some point during 2005, compared to 33 percent of African Americans and 62 percent of Hispanics. (August 2006)

Americans between the ages of 19 and 29 represent the largest and fastest-growing segment of the population without health coverage. Rite of Passage? Why Young Adults Become Uninsured and How New Policies Can Help argues that there are several ways to extend coverage to young adults—and prevent others from losing it. These include extending eligibility for Medicaid and SCHIP beyond age 18; extending eligibility for dependents beyond age 18 or 19 regardless of student status; and ensuring that colleges and universities require full- and part-time students to have insurance. (May 2006)

Gaps in insurance coverage, a problem once believed to affect mainly lower-income families, actually affect a much wider swath of Americans. Gaps in Health Insurance: An All-American Problem shows that moderate-income Americans are increasingly going without health coverage. (April 2006)

Nonstandard workers-those employed on a part-time, temporary, or contractual basis-are far more likely than regular, full-time employees to lack health care coverage, experience gaps in their coverage, or depend on their spouse's employer coverage or on public insurance programs, according to On the Fringe: The Substandard Benefits of Workers in Part-Time, Temporary, and Contract Jobs. The report estimates that in 2001, only 21 percent of nonstandard workers received health insurance through their employers, compared to 74 percent of standard workers.  The report also offers policy options for reaching these uninsured, nonstandard workers and their families. (December 2005)

Unequal Access: Insurance Instability Among Low-Income Workers and Minoritiesexplores why low-income minority workers had higher uninsured rates and greater insurance instability than had been previously documented. According to the report, most low-income adults worked during the four years studied, but many had only intermittent job-based coverage or none at all. (April 2004)

A generally unreported trend in recent years is the increasing number of American workers in large firms who lack health coverage. Although large employers are much more likely than small ones to offer health insurance, recent evidence suggests that workers in large firms and their dependents comprise a significant and growing share of the working uninsured. The Growing Share of Uninsured Workers Employed by Large Firms profiles uninsured workers in large firms; compares their characteristics to other groups of uninsured; and assesses health coverage trends in small, mid-sized, and large firms. (October 2003)

Insurance, Access, and Quality of Care among Hispanic Populations: 2003 Chartpack is intended to serve as a quick reference and overview of insurance status, health care access, and quality of care experiences among Hispanic communities in the U.S. The chartpack profiles uninsured rates and insurance instability over time; examines the link between lack of insurance, access to health care, and receipt of preventive health care; and documents the extent to which limited English proficiency undermines patient-provider communication and overall quality of care for Hispanics. (October 2003)

Impact of Medicare Coverage on Basic Clinical Services for Previously Uninsured Adults explores the effect that gaining Medicare coverage has on insured and uninsured adults. The study found that gaining access to Medicare coverage substantially improves use of appropriate preventive health services such as cancer and cholesterol screening among previously uninsured older adults, and it reduces the difference in use of preventive health care between those who are and are not covered under Medicare by at least half. (August 2003)

Young adults between the ages of 19 and 29 represent one of the largest and fastest-growing segments of the population without health coverage. Rite of Passage? Why Young Adults Become Uninsured and How New Policies Can Help contends that jobs available to young adults often pay poorly or are temporary and typically do not provide health coverage. This Issue Brief assesses the scope of the health insurance problem facing young adults, its causes, implications, and what can be done about it. (May 2003)

Low-wage workers are at a serious disadvantage when it comes to health insurance coverage and access to care, even when they work for large businesses. On the Edge: Low-Wage Workers and Their Health Insurance Coverage assesses the relative health insurance experiences of workers across the country by the wages they earn and the size of the companies in which they work. The study reveals that, although employees of small companies are particularly unlikely to have coverage through their jobs, low-wage workers in firms of all sizes have less access than their higher-earning counterparts. (April 2003)

Hispanic Patients' Double Burden: Lack of Health Insurance and Limited English discusses the high uninsured rates found among Hispanics and the resulting difficulties encountered in gaining access to care. It reports that Hispanics who speak primarily Spanish are in poorer health, are less likely to have a regular doctor, and are more likely to lack insurance and rely on public or community clinics for their health care when compared with Hispanics who speak primarily English, whites, and African Americans. (February 2003)

The Erosion of Employer-Based Health Coverage and the Threat to Workers' Health Care presents the results of the Commonwealth Fund's 2002 Workplace Health Insurance Survey. Among the findings are that 41 percent of workers experienced increases in their premiums or cost-sharing, or both, during the year, and that many workers are not confident that employers will continue to offer health coverage to them down the road. (August 2002)

More detailed findings of the 2001 Health Insurance Survey are presented in two separate Issue Briefs, Maintaining Health Insurance During a Recession: Likely COBRA Eligibility and Experiences of Working-Age Adults in the Individual Insurance Market

The Commonwealth Fund presents the results of their 2001 Health Insurance Survey in Security Matters: How Instability in Health Insurance Puts U.S. Workers at Risk. The survey focuses on health insurance stability throughout the year and the extent to which lacking insurance during the year affects access to care, financial security, and confidence in the health care system. The interviews revealed that adults without health insurance at any time during the past year often had difficulty obtaining care when sick; many of those surveyed "had gone without physician-recommended tests, treatment, or prescribed medications." (December 2001)

How the Slowing U.S. Economy Threatens Employer-Based Health Insurance sets out to document the link between loss of health insurance and unemployment. To that end, it summarizes recent findings of other reports and provides new analyzes of employment-based health insurance, unemployment, and the economic consequences of lack of health coverage. These consequences include: lack of health insurance limits a person's ability to find a good job; an increased number of uninsured strains the health care sector; and more unemployed, more uninsured adults will further stress state budgets. (November 2001)

Health Care and Health Insurance Disparities Experienced by Women: A new report issued by The Commonwealth Fund documents the disparities women face in accessing health care and health insurance. Diagnosing Disparities in Health Insurance for Women: A Prescription for Change includes a review of selected coverage expansion approaches. It concludes that building on options that currently exist-employer-sponsored insurance, CHIP, and Medicaid-offers the greatest promise. (August 2001)

Working Without Benefits: The Health Insurance Crisis Confronting Hispanic Americans: this report documents the health care crisis facing America's Hispanic community. Nearly 40 percent of Hispanics under age 65 do not have insurance. Despite their increasingly vital contribution to the nation's economy, Hispanic Americans are twice as likely to be uninsured as the general population. (February 2000)

From the Commonwealth Fund and the Christopher Reeve Paralysis Foundation:

Nearly 6 million Medicare beneficiaries qualify because they have severe and permanent disabilities, but unlike older Americans, who typically enroll and become eligible for coverage within months of turning 65, beneficiaries with disabilities must wait two years before their coverage takes effect. Many beneficiaries face enormous problems during this period. The authors of Waiting for Medicare: Experiences of Uninsured People with Disabilities in the Two-Year Waiting Period for Medicare talked to these individuals in focus groups and in-depth telephone interviews. (October 2004)

From Community Voices:

A Poor Man's Plight: Uncovering the Disparity in Men's Health examines the health status of African American, Latino, Asian/Pacific Islander, Native American, and mixed raced men. The report finds that men of color overall are less likely to have health insurance, less likely to use health care services, and less likely to have access to mental health, substance abuse, and oral health services. The report also includes descriptions of programs and projects in several communities that can serve as examples of how to promote and encourage change that will improve the overall health of men of color, particularly low-income men. (February 2002)

From Demos and Young Invincibles:

The State of Young America: Health Care and Coverage describes the difficulties young adults face in obtaining health insurance and paying for medical services. It notes that provisions of the Affordable Care Act have started to reverse the trend of rising uninsurance among young adults. (November 2011)

From the Department of Health and Human Services (HHS):

The Value of Health Insurance: Few of the Uninsured Have Adequate Resources to Pay Potential Hospital Bills finds that lacking health insurance poses a greater risk of financial catastrophe than lacking car or homeowner’s insurance. This is due partly to uninsured people having limited financial assets (although even higher-income uninsured people have difficulty paying hospital bills), and due to the high cost of a single hospitalization. (May 2011)

From the Department of the Treasury:

The Risk of Losing Health Insurance over a Decade: New Findings from Longitudinal Data reveals that nearly half of all Americans under the age of 65 go without health insurance in a 10-year period. In fact, 36 percent will go without coverage for at least one full year during that period. Given the frequency of gaps in coverage among Americans under 65, the study concludes that, without health reform that expands coverage, these trends are likely to worsen in the years to come. (September 2009)

From Démos and the Access Project:

The high costs associated with health care for people both with and without health insurance are leading many patients to turn to credit cards to cover health expenses. Borrowing to Stay Healthy: How Credit Card Debt Is Related to Medical Expenses examines this phenomenon and the makeup of the population of those with medical credit card debt. (January 2007)

From the Employee Benefit Research Institute:

Employment-Based Health Benefits: Trends in Access and Coverage, 1997—2010 provides data on the offer, coverage, and take-up rates among workers. It also examines why many workers are not covered, and it includes breakdowns by age, gender, and race/ethnicity. (April 2012)

Tracking Health Insurance Coverage by Month: Trends in Employment-Based Coverage among Workers, and Access to Coverage among Uninsured Workers, 1995-2010 examines trends in job-based health benefits to show the effects of recessions and unemployment on health coverage. (October 2011)

Tracking Health Insurance Coverage by Month: Trends in Employment-Based Coverage among Workers, and Access to Coverage among Uninsured Workers, 1995-2009 shows the effects of the recession and unemployment on changes in coverage. The findings underscore the degree to which employment rates directly influence the levels of the uninsured. (June 2011)

Sources of Health Insurance and Characteristics of the Uninsured: Analysis of the March 2008 Current Population Survey examines the factors that affect whether an individual has health insurance and the sources of that coverage. According to the report, the percentage of U.S. residents younger than age 65 who had health coverage through their employer remained at 62.2 percent between 2006 and 2007, but this year’s rise in unemployment and food and gasoline prices suggest a future decline in the number of workers who have or are able to afford employer-based health insurance. (September 2008)

From George Washington University Center for Health Services Research and Policy:

The literature on health disparities suggests that, although the lack of health coverage is the most basic barrier to obtaining health care, improved access to clinically appropriate care is key, particularly for communities of color and low-income groups where the health risks are greatest. Reducing Racial and Ethnic Health Disparities: Estimating the Impact of High Health Center Penetration in Low-Income Communities examines the relationship between health center penetration into medically underserved communities and the reduction of state-level health disparities. (September 2003)

From George Washington University Medical Center:

Uninsured and Medicaid Patients’ Access to Preventive Care: Comparison of Health Centers and Other Primary Care Providers examines the role of community health centers (CHCs) in reducing disparities in access to preventive health care for medically vulnerable and high-risk populations. The analysis finds that, despite having a more vulnerable patient mix, CHCs outperform other primary care providers in the use of preventive care for both Medicaid and uninsured patients by as much as 22 percent. (August 2008)

From the Georgetown University Center for Children and Families:

Uninsured Children 2009-2011: Charting the Nation’s Progress finds that, nationally, children’s coverage continued to improve, but that half of all kids who are still uninsured live in the following six states: AR, CA, FL, GA, NY, and TX. It also includes data for the states with the highest and lowest rates of uninsured children. (October 2012)

From Health Affairs:

The 2007-09 Recession and Health Insurance Coverage finds that 5 million Americans lost job-based health insurance during the recession, particularly residents of the Midwest and South. Adults bore the burden of this decline in insurance, while children were largely protected by public insurance programs. (December 2010) Subscription Required

Uninsured Adults with Chronic Conditions or Disabilities: Gaps in Public Insurance Programs discusses why an increasingly large number of working-age adults with low incomes and chronic health conditions or disabilities lack insurance. The brief argues that narrow eligibility requirements for Medicaid often exclude this vulnerable group. Expanding these requirements to ensure greater access to coverage should be a priority in national health reform. (October 2009) Subscription Required

Families with Mixed Eligibility for Public Coverage: Navigating Medicaid, CHIP, and Uninsurance finds that, in families with multiple children who have different eligibility statuses, there is a 26 percent chance that one or more children will be uninsured. Mixed eligibility occurs most often in families with children of different immigration statuses, where older, foreign-born children may not be eligible for the public coverage their younger, U.S.-born siblings can receive. Medicaid income eligibility thresholds that are linked to age also play a role: In some families, older children are eligible for CHIP, while younger children are eligible for Medicaid. (June 2009) Subscription required

How Many Are Underinsured? Trends among U.S. Adults, 2003 and 2007 estimates that there are nearly 25 million underinsured adults, a 60 percent increase from 2003. The rate of increase was steepest among those with incomes above 200 percent of poverty ($10,400 for an individual in 2008), where underinsurance rates nearly tripled. In total, 42 percent of U.S. adults were underinsured or uninsured. (June 2008)

The Uninsured and the Affordability of Health Insurance Coverage indicates that more than half of the nation's uninsured are ineligible for public programs and do not have enough resources to purchase coverage themselves. Childless adults made up the largest block of those who are uninsured and ineligible for public coverage, which the study attributes to a lack of eligibility for public programs such as Medicaid. (A subscription is necessary to view the full article.) (November 2006)

The nation's inability and unwillingness to ensure equal access to high-quality health care is fueling a widening rift between rich and poor, according to A Widening Rift in Access and Quality: Growing Evidence of Economic Disparities. The report states that most of the investments and initiatives that are designed to expand coverage are occurring in more affluent areas where people have employer-based health care coverage and not in low-income community where people are more likely to rely on Medicaid. (December 2005)

How Much Medical Care Do the Uninsured Use, and Who Pays for It? seeks to determine the resources that are already in the medical care system and potentially available to help pay for expanded insurance coverage, because knowing the existing sources of payment for care can help policymakers identify where some of the money for new coverage could come from. This analysis demonstrates that uninsured Americans received about $35 billion in uncompensated health care in 2001, with federal, state, and local governments covering as much as 85 percent of it. The authors conclude that a substantial amount of public money from existing programs is potentially available for a program to expand health coverage. (February 2003)

From the Institute of Medicine:

The discontinuity in health coverage or lack of health coverage of millions of Americans every year entail costs for our society in lost health and longevity; financial risk, uncertainty, and anxiety within families with one or more uninsured members; financial stresses for and instability of health care providers and institutions in communities with high uninsured rates; and lost workforce productivity. Hidden Costs, Value Lost: Uninsurance in America, the fifth in a series of six reports on the impact of the medical insurance gap, tallies some of the most clearly identifiable economic and social costs of lack of insurance. The report asserts that allowing millions of Americans to go without health coverage costs the country between $65 and $130 billion every year. (June 2003)

A Shared Destiny: Community Effects of Uninsurance, the fourth in a series of reports on the consequences of uninsurance, explores the ways in which those who do have health coverage are affected by those who don't. The authors document a series of spillover effects of uninsurance on community health care institutions, providers, and others and assess the limited empirical evidence that exists about community effects. Among the authors' findings is that, in communities with higher uninsured rates, access to health care services and consequent benefits are compromised even for people with health coverage. (2003)

Health Insurance Is a Family Matter is the third in a series of reports examining the consequences of lacking health coverage. The report looks at the patterns and consequences of having uninsured members within the family and the impact of insurance status on the health of children and pregnant women. To that end, the report addresses the impact that lack of health coverage has on family health, financial stability, and general well-being. (Fall 2002)

From the Journal of Community Health:

Beyond Affordability: The Impact of Nonfinancial Barriers on Access for Uninsured Adults in Three Diverse Communities looks at the types of nonfinancial barriers to health care faced by low-income, uninsured adults and how nonfinancial and financial barriers interact. The survey of low-income, uninsured adults in California, Maine, and Texas suggests that, while financial barriers are the most common, many uninsured adults also face nonfinancial barriers to health care. (June 2010) Subscription Required

From the Journal of the American Medical Association:

Health of Previously Uninsured Adults after Acquiring Medicare Coverage strengthens the argument that health coverage improves the health of adults who had previously been uninsured. Medicare improved the general health, mobility, and agility of patients 65 years and up, particularly those with cardiovascular disease or diabetes. (December 2007)

From the Kaiser Commission on Medicaid and the Uninsured:

Faces of the Medicaid Expansion: Experiences of Uninsured Adults Who Could Gain Coverage provides insight into the potential impact of expanding Medicaid by highlighting the struggles that uninsured adults face. It includes an overview brief that explains what’s at stake, as well as profiles of 10 people who would gain coverage if their states choose to expand Medicaid. (November 2012)

The Uninsured and Their Health Care Needs: How Have They Changed Since the Recession? finds that uninsurance rose the fastest among the near-elderly, whites, and those with higher incomes, likely because of the recession that began in 2007. (October 2011)

The Uninsured: A Primer presents basic information about the uninsured, including who they are and why they do not have health coverage. The brief also describes how the health reform law will expand coverage to a majority of those who are currently uninsured. (December 2010)

Assessing the Risk of Becoming Uninsured after Leaving a Job: A Look at the Data uses data from before the current recession (2004-2007) and finds that more than 30 percent of individuals who left a job with health insurance became uninsured for six months or more. This trend has likely worsened given the recession and higher unemployment rates. (March 2010)

Rising Health Pressures in an Economic Recession: A 360-Degree Look at Four Communities explores the financial and personal struggles of families who have suffered economic reversals and lost health coverage. The report and accompanying video, On the Edge: Health Care in a Recession, reveal that many people who have lost jobs are exhausting their savings and collecting limited unemployment benefits, yet they still do not qualify for public safety net programs such as Medicaid. (August 2009)

Health Care and the Middle Class: More Costs and Less Coverage examines the availability, affordability, and stability of health coverage of families with incomes of $44,000 to $88,000 for a family of four. Overall, health insurance and medical care have become less affordable for the middle class, and one in 10 middle-class, working-age adults have lost health insurance. (July 2009)

CHIP Tips: New Federal Funding Available to Cover Immigrant Children and Pregnant Women highlights new opportunities for covering children under the Children’s Health Insurance Program Reauthorization Act (CHIPRA). The brief examines how the new option works and provides information about eligibility requirements. In addition, it explains the choices states face when deciding whether to pursue this option. (July 2009)

Low-Income Adults under Age 65—Many Are Poor, Sick, and Uninsured examines the characteristics and insurance coverage of this group, which numbers more than 50 million. People in this group are more likely to be in poor health than other Americans and are the least likely to have health insurance. And because Medicaid coverage is extremely limited for adults without dependent children, a large share of low-income adults with significant health needs is uninsured. (June 2009)

How Is the Primary Care Safety Net Faring in Massachusetts? Community Health Centers in the Midst of Health Reform reports that community health centers in the state saw an increase in patients from 2005-2007 as the health reform law was implemented. The Massachusetts experience shows that community health centers play a critical role in caring for newly insured patients while continuing to serve as the primary care safety net for those who remain uninsured. (March 2009)

Snapshots from the Kitchen Table: Family Budgets and Health Care shows the central role of health care costs and coverage in a household’s economic stability. It finds that health care costs were of particular concern, with many families forgoing doctor visits, skipping prescription medications, and postponing needed care. Even those with health insurance reported delaying care in order to avoid copayments, rising deductibles, and out-of-pocket costs. (February 2009)

Turning to Medicaid and SCHIP in an Economic Recession: Conversations with Recent Applicants and Enrollees examines the impact of the recession and illuminates the emotional and financial difficulties of families who have lost health coverage, which has forced many to skip medications and postpone doctor visits. Many who once had steady employment are now turning to Medicaid and CHIP for the first time, even as these programs face increasing budget constraints as state tax revenues decline. (December 2008)

Five Basic Facts on Immigrants and Their Health Care addresses questions about how immigrants use and affect the health care system, including their impact on the nation’s uninsured problem, their participation in public health coverage programs, and their use of hospital emergency rooms. The brief concludes that immigrants play a relatively small role in our current health care crisis. (March 2008)

How Trends in the Health Care System Affect Low-income Adults: Identifying Access Problems and Financial Burdens highlights the role insurance plays in allowing low-income adults to obtain health care and how it helps defray cost. Uninsured adults forgo health care more often than insured adults, or they incur large amounts of debt from paying out-of-pocket fees. (December 2007) 

Uninsured Children in the South, December 2007 covers 17 Southern states and the District of Columbia. The study reveals the disproportionate numbers of uninsured children in the South compared to the rest of the country. It contains state-specific fact sheets with estimates of uninsured children and uninsured pregnant women. (December 2007)

The Uninsured: A Primer presents basic information about the uninsured—who they are and why they do not have health coverage. It also explores the difference that health insurance makes in people’s lives, provides a summary of how and why the number of uninsured is growing, and discusses currently proposed solutions. (October 2007)

The year 2006 was marked by economic recovery, yet the number of uninsured continued to increase. What Happened to the Insurance Coverage of Children and Adults in 2006? attempts to explain why. (September 2007)

Characteristics of the Uninsured: Who Is Eligible for Public Coverage and Who Needs Help Affording Coverage? (February 2007)

Aging out of Early and Periodic Screening, Diagnostic and Treatment (EPSDT): Issues for Young Adults with Disabilities discusses the challenges and implications for young people with disabilities when they become adults and lose their EPSDT benefits. It also examines the effects of recent changes to the Deficit Reduction Act that increase states’ power to aid individuals with disabilities. (January 2007)

Covering the Uninsured: Growing Need, Strained Resources explains the continued increase in the number of uninsured Americans and examines how federal programs have struggled to stem these increases. (January 2007)

The slide presentation Resuming the Path to Health Coverage for Children and Parents consists primarily of charts showing the state of health insurance access for families. States have shown renewed enthusiasm for covering the uninsured, especially children, but the DRA has also caused some setbacks. (January 9, 2007)

The Uninsured: A Primer profiles the 45.5 million Americans under age 65 without health insurance. The report reviews how they receive and pay for medical care, explains why the number of uninsured individuals has changed recently, and describes options for expanding coverage. (January 2006)

In the face of prolonged budge difficulties, a number of states have cut eligibility or are considering such cuts in public coverage. What Happens When Public Coverage Is No Longer Available? concludes that no more than 9 percent of low-income adults would have access to an alternative source of insurance in the absence of public coverage. (January 2006)

The Uninsured and Their Access to Health Care, a fact sheet from the Kaiser Commission on Medicaid and the Uninsured. The fact sheet states that, while the majority of Americans (62%) under the age of 65 receive health insurance coverage through their employers and almost all the elderly are covered through Medicare, 44.7 million nonelderly Americans lacked health insurance in 2003. Medicaid and the State Children's Health Insurance Program (SCHIP) play an important role in covering millions of nonelderly low-income people, especially children.

Policymakers at both the state and federal level have expressed interest in the concept of premium assistance, which entails the use of federal and state funds to subsidize the purchase of employer-sponsored or other private coverage for Medicaid and SCHIP (State Children's Health Insurance Program) beneficiaries. Serving Low-Income Families through Premium Assistance: A Look at Recent State Activityexamines new Bush Administration policies associated with using Medicaid and/or SCHIP funds to promote private insurance options, ways that states have responded to these new policies, and key questions that policymakers and others should consider as they think about premium assistance programs. (October 2003)

State Fiscal Conditions and Health Coverage: An Update on FY2004 and Beyond encompasses three reports on how states are coping with a fourth year of fiscal stress. The reports present the results of the third annual survey of all 50 states, which reveals a far-reaching impact on health coverage for low-income families at a time when enrollment is increasing due to sluggish economic conditions. The reports address such topics as Medicaid spending growth, actions states have taken to control various health care costs, and the falloff in state tax revenue. (September 2003)

One in five Americans lives in a rural area, but the health and economic status of people living in remote rural counties differ substantially from rural residents who live closer to large urban areas. Health Insurance Coverage in Rural America is a chartbook that presents an analysis of the most recent national data on health insurance coverage based on a county's proximity to a large urban area-an important factor that helps determine rural residents' access to economic opportunities and health care services. (September 2003)

How Race/Ethnicity, Immigration Status and Language Affect Insurance Coverage and Access to Care and Quality of Care among the Low-Income Population seeks to clarify the roles that race, language, and citizenship status play in health coverage and access to and quality of health care, particularly for the low-income Latino community. The report found that Latinos who are not citizens or who have limited English proficiency are much more likely to be uninsured, less likely to use health care services, and more likely to experience problems communicating with health care providers than their citizen and English-speaking counterparts. It notes that understanding the roles played by citizenship status and language is important for developing policies to help reduce disparities in health care coverage. (August 2003)

Covering the Uninsured: How Much Would It Cost? presents the results of a study that was designed to provide benchmarks for evaluating the costs of alternative proposals to cover the uninsured. It provides two sets of cost estimates derived from medical spending patterns of lower- or middle-income people with private coverage and people with public coverage during the 1996-1998 period. The authors estimate that the cost of medical care provided to the newly insured would run between $34 and $69 billion per year if they were fully insured, depending on the approach taken. (June 2003)

Statistics from the most recent Census report on the number of uninsured have been interpreted by some as evidence that lack of health coverage is now becoming a problem of middle-income families. The New Middle Class of Uninsured Americans-Is It Real? examines the difference between Kaiser's findings and the Census Bureau's data in an effort to clarify how much the uninsured problem is shifting to higher-income Americans. The authors conclude that the Census data have been misinterpreted and that the middle- to upper-classes did not account for most of the recent growth in the number of uninsured. (March 2003)

Changes in Insurance Coverage: 1994-2000 and Beyond explores the insurance trends for the latter half of the 1990s and examines why the number of uninsured Americans under 65 fell in 2000 for the second straight year. The report examines data showing changes in private and public coverage, the uninsured rates for adults and children, by race, by the number of workers in a family, and by the number of employees in a worker's firm. The report notes that, despite the recent gain in coverage for children, the trends in health coverage remain bleak. (August 2002)

The Kaiser Family Foundation and its Commission on Medicaid and the Uninsured have released two new fact sheets that demonstrate how specific changes in the unemployment rate affect both the number of uninsured Americans and the demand for Medicaid coverage. In Rising Unemployment and the Uninsured, Kaiser presents its analysis showing that, for every percentage point increase in the unemployment rate, 1.2 million people will become uninsured. (January 2002)

Sicker and Poorer: The Consequences of Being Uninsured synthesizes the major findings from the past 25 years of health services research analyzing the most important effects of health insurance. The report evaluates thousands of citations and 230 research articles to assess the health and economic consequences of being uninsured. The report concludes that this large body of research makes a compelling case that having health coverage does lead to improved health and better access to care. (May 2002)

Immigrants' Access to Health Care After Welfare Reform: Findings from Focus Groups in Four Cities Results from these focus groups conducted look at immigrants' knowledge of and attitudes toward public programs such as Medicaid and CHIP. The focus groups were also intended to assess immigrants' understanding of recent welfare and immigration policy changes. (November 2000)

Uninsured in America: A Chart Book: this chart book provides a comprehensive portrayal of information related to the uninsured, including trends and major shifts in coverage, a profile of the uninsured, an assessment of why so many Americans are uninsured, and data documenting the difference that health insurance makes in the lives of Americans. The chart book includes detailed tables with data broken down by demographics and by state. (May 2000)

The Uninsured in America web page offers links to key reports, policy briefs, and fact sheets that address questions such as what difference health insurance makes and who is likely to be uninsured.

From the Kaiser Commission on Medicaid and the Uninsured and the Urban Institute:  

Changes in Health Insurance Coverage in the Great Recession, 2007-2010 notes a severe decline in job-based coverage during this time period. Public coverage through Medicaid or the Children’s Health Insurance Program (CHIP) has offset some loss of coverage, but the overall uninsurance rate has risen. (December 2011)

From The Kaiser Family Foundation:

Women’s Health Insurance Coverage describes the different sources of health insurance for women and discusses how the Affordable Care Act will help the 20 percent of women ages 18 to 64 who are uninsured. (December 2011)

Health Reform: Implications for Women’s Access to Coverage and Care discusses a range of women’s health care issues, including access to coverage, affordability, scope of benefits, reproductive health, and long-term care, as well as how current health reform proposals address these issues. (October 2009)

In Pursuit of Affordable Health Care: On the Ground Lessons from Families in Massachusetts details how the state’s health reform legislation has achieved near-universal coverage (94.7 percent) by combining a foundation of public coverage with greater access to private insurance through employers. While some budgetary challenges remain, the program has been largely successful, including a marked increase in job-based coverage. (September 2009)

State Variation and Health Reform discusses how the impact of reform on individual states will vary based on their economic situation, current health coverage, and health care expenditures. This analysis pulls together key information related to state variation, including their economic profiles, Medicaid and CHIP eligibility and enrollment levels, coverage of the non-elderly population, and their individual and small-group markets. (July 2009)

Health Insurance Coverage of Women Ages 18 to 64, by State, 2006-2007 is an updated fact sheet with the latest state-by-state data on health coverage of non-elderly women. It builds on Women’s Health Insurance Coverage Fact Sheet, a related report that provides statistics on health coverage and describes the major sources of health insurance for women ages 18-64, including employer-based coverage, Medicaid, individually purchased insurance, and Medicare. (December 2008)

Eroding Access among Nonelderly Adults with Chronic Conditions: Ten Years of Change finds that the number of working-age adults who have major chronic conditions grew by 25 percent between 1997 and 2006, bringing the total to nearly 58 million. The study also reveals that, regardless of insurance status, the cost of prescription drugs poses more of a problem today for those with chronic conditions. (July 2008)

Women’s Health Insurance Coverage provides data on the percentages of women who are privately insured or have job-based coverage, those with Medicaid, and those who are uninsured. Although women make up three-quarters of Medicaid beneficiaries, childless women who are not disabled are almost never eligible for coverage no matter their income. (December 2007) 

Characteristics of Frequent Emergency Department Users uses data from the Medical Expenditures Panel Survey (MEPS) to examine the demographic and health characteristics of people who frequently use hospital EDs. (October 2007)

Providing health coverage for the entire family can both help increase coverage of children and assist low-income families in obtaining more affordable health care. Spotlight on Uninsured Parents: How a Lack of Coverage Affects Parents and Their Families uses data from the 2005 Kaiser Low-Income Coverage and Access Survey to examine health coverage, access, and the financial effects of health care for low-income parents and their families. (June 2007)

Health Insurance Coverage and Access to Care for Low-Income Non-Citizen Adults analyzes heath insurance coverage and access for low-income non-citizen adults and discusses provider insights into the obstacles that this group faces. It finds that, although low-income non-citizens have more limited access to care, these adults are not relying on the emergency room for care. Instead, many rely on clinics and health centers. (June 2007)

Health Insurance Coverage of Women Ages 18 to 64, by State, 2004-2005 provides statistics on insurance for all women, including low-income women. In addition, Women’s Health Insurance Coverage describes the various sources of insurance for women and examines how being uninsured affects women. (February 2007)

One of the many reasons an individual may be uninsured is that she or he decides that an employer’s offer of health insurance is too expensive. Insurance Premium Cost-Sharing and Coverage Take-Up looks at how the take-up rate for workers within firms varies with the level of premium contributions in those firms. (February 2007)

Health Coverage and Access to Care for Hispanics in "New Growth Communities" and "Major Hispanic Centers" finds that as the Hispanic population grows and moves beyond urban centers, Hispanics in “new growth communities” face greater barriers to health care than those in “major Hispanic centers.” Much of this disparity is linked to the accessibility of community health centers and safety-net hospitals. (September 2006) 

The Kaiser Women's Health Survey was designed to better understand how the health care system is working for women in terms of health coverage, access to services, and in meeting their health needs. The resulting 2001 Kaiser Women's Health Survey and Issue Briefs present an in-depth look at health care access challenges faced by low-income women and women of color, as well as women's roles in family health care decision-making and coordination. (March 2004)

Health Insurance Coverage in America: 2000 Data Update uses year 2000 data (the most current information available) to describe health insurance coverage in the U.S., with special attention to the uninsured. This chart book examines the non-elderly population (those under 65) according to age, gender, family income, family work status, education, race/ethnicity, citizenship, and health status. The report includes separate analyses of children, adults, and low-income populations, as well as state-level tables that provide health insurance distributions for each state's non-elderly population. (February 2002)

Health Insurance Accessibility for Those in Less Than Perfect Health: A study conducted by researchers at Georgetown University's Institute for Health Care Research and Policy for the Kaiser Family Foundation found that consumers with various health conditions can often get coverage of some kind in the individual insurance market, but that coverage often comes with limits on benefits and may be priced out of their reach. This study created seven hypothetical applicants and asked 19 insurance companies and HMOs in eight markets around the country to consider them as actual consumers. Sixty applications for coverage for each of the hypothetical consumers resulted in "clean offers" (where applicants were offered coverage without restrictions on covered benefits) just 10% of the time, rejections 37% of the time, and coverage with benefit limits and/or premium increases 53% of the time. (June 2001)

Falling Through the Cracks: Health Insurance Coverage of Low-Income Women Recent changes in public and private health and welfare policies have had a disproportionate impact on low-income women and have resulted in increased numbers of women who lack coverage. This report, prepared by researchers at the Center for Health Policy Research at UCLA, reviews the challenges low-income women face and assesses the impact health coverage has on policy changes associated with the 1996 federal welfare reform law. (February 2001)

Why Did the Number of Uninsured Fall in 1999? This policy brief from the Kaiser Family Foundation analyzes the factors contributing to the first decline in the uninsured population in a decade. Findings include the large role stabilized Medicaid enrollment and CHIP expansion played in the decline. (January 2001)

The Uninsured and Their Access to Health Care. This fact sheet from the Kaiser Family Foundation outlines the problem of the uninsured in America. It identifies the uninsured and includes statistics on the number of uninsured by poverty level. (May 2000)

In Their Own Words: The Uninsured Talk About Living Without Health Insurance. This report profiles eight families without health insurance, illustrating how not having health coverage affects the lives and well-being of the entire family. A unique family story unfolds in each chapter -- as told in their own words -- weaving health problems, financial insecurity, and health system barriers into the full context of the family's life.

The Uninsured 101: What You Really Need to Know About an American Dilemma: this webcast, co-sponsored by the Alliance for Health Reform and the Kaiser Family Foundation, provides key information on the uninsured. (Real Player is needed to hear the webcast)

From the Kaiser Family Foundation, National Public Radio, and the Kennedy School of Government:

National Survey on Health Care points to a significant medical divide along socio-economic lines. The survey found that those in the top income categories have few problems getting health care or paying for it, but those in the bottom income groups-and many in the middle class-are burdened by such problems. The survey also found that, despite most peoples' lack of confidence in the health care system, few are pushing for sweeping changes to that system. (June 2002)

From the Kaiser Family Foundation and the National Women's Law Center:

State policies play a critical role in shaping women's access to health care. Women's Access to Care: A State-Level Analysis of Key Health Policies details state activity on a range of polices that affect women's access to care, with an emphasis on private coverage, Medicaid, and reproductive health. Specific policies covered in the report include Medicaid eligibility expansions, managed care protections, and assistance with the costs of prescription drugs. (July 2003)

From KaiserEDU.org:

Health Insurance and Access to Health Care: The Evidence is a narrated slide tutorial that reviews the body of evidence on the health consequences of being uninsured. The presenter discusses the impact of health insurance on the use of and access to health care services, such as primary and preventative care, as well as the treatment for and survival rates of cancer patients and those who have experienced a heart attack. (February 2009)

From Mathematica:

SCHIP Children: How Long Do They Stay and Where Do They Go? highlights findings from a seven-state study examining retention of children in SCHIP and enrollees’ coverage after they leave the program. Once enrollees leave SCHIP, they are far more likely to become uninsured and remain uninsured for some time than they are to obtain private coverage. The findings suggest that the extent to which SCHIP has substituted for private insurance is well below the rates estimated in other studies. (January 2009)

From the National Association of Community Health Centers:

Thirty-six million Americans - some of whom actually have health insurance coverage -  lack access to basic medical care because they live in communities where there is an acute shortage of health care providers. A Nation's Health at Risk describes who and where those people are, why having a regular provider is so important, and how the national initiative to expand community health centers has helped meet this pressing need. (March 2004)

From the National Center for Health Statistics:

Access to and Utilization of Medical Care for Young Adults Aged 20-29 Years: United States, 2008 discusses the continued trend of young adults lacking health coverage. In 2008, young adults were almost twice as likely as other adults to lack health coverage. While this age group is often referred to as the “young invincibles,” young adulthood is a high-risk period for unintended pregnancy, sexually transmitted diseases, substance abuse, and injuries. (February 2010)

From the National Council of Jewish Women:

Facing the Crisis in Women’s Health Care addresses the special challenges that many American women face in affording and obtaining comprehensive health care. The article discusses women’s health needs and barriers to care, the growing number of uninsured, and the emerging issues for women in Medicaid and Medicare. (Summer 2006)

From the National Council of La Raza:

Employer-Sponsored Health Insurance: Already Poor Access Dwindles Further for Working Latino Families examines the rates at which the Latino community receives employer-sponsored health insurance, which is lower than that of any other major racial or ethnic group in the U.S. Employers are less likely to offer Latino workers health coverage, so Latinos have to seek out other avenues of insurance coverage, which are often unaffordable. (January 2008)

From the Northwest Federation of Community Organizations:

Access Denied reveals why so many eligible families are being turned away from support programs and what can be done to address the problem (May 2000)

From the Office of Health Policy in the Office of The Assistant Secretary for Planning and Evaluation:

Understanding Different Estimates of Uninsured Children: Putting the Differences in Context

From Pediatrics:

Young adults have the lowest rate of insurance coverage of any age group. Health Insurance across Vulnerable Ages:Patterns and Disparities from Adolescence to the Early 30s finds that the safety net of public programs that cover adolescents disappears in young adulthood, leaving young adults vulnerable. Moreover, for low-income individuals, this problem often persists into their 30s because premiums in the private market are too high. (May 2007)

Many eligible children are not enrolled in public insurance programs. Low-Income Uninsured Children with Special Health Care Needs: Why Aren’t They Enrolled in Public Health Insurance Programs? concludes that parents’ lack of information about the programs and negative perceptions of the application process are two primary reasons why eligible children are not being enrolled. (A subscription is necessary to view the full article.) (January 2007)

From the Pew Hispanic Center:

Hispanics and Health Care in the United States: Access, Information and Knowledge reports that about 27 percent of Hispanic adults in the U.S. do not have regular health care providers, although many of those adults have health insurance and speak English. The survey finds that among Hispanic adults, the groups least likely to have a usual health care provider are men, the young, the less educated, and those without health insurance. (August 2008)

From the Robert Wood Johnson Foundation:

Deteriorating Health Insurance Coverage from 2000 to 2010: Coverage Takes the Biggest Hit in the South and Midwest examines trends for children, parents, and adults without dependent children by income in the Midwest, Northeast, South, and West. It found that parents in the South experienced greater declines in coverage than parents in other areas, and children in the South and West experienced increased insurance rates due to the effectiveness of Medicaid and the Children’s Health Insurance Program (CHIP). (August 2012)

What Is the Link between Having Health Insurance and Enjoying Better Health and Finances? finds that previously uninsured adults who enroll in Medicaid experience better physical and mental health, reduced financial strain, and improved access to preventive services. (January 2012)

Health Reform in Massachusetts: An Update on Insurance Coverage and Support for Reform as of Fall 2008 provides an update of the impact on working-age adults, the primary target of reform policies, as well as an update on public support for health reform. The state has achieved its goal of near universal health coverage, and residents continue to show strong support for health reform, despite the rising costs of the program. (September 2009)

Coverage for Low-Income People: Should the Medicaid Program Be Expanded to Cover More of the Uninsured? Should There Be Changes in the Children’s Health Insurance Program? examines the options being debated by key congressional committees and summarizes arguments for and against expansion of these public programs. The proposed changes could raise income eligibility levels, allow low-income individuals to buy private insurance with help from subsidies, or even enroll in a public option. (July 2009)

A Needed Lifeline: Chronically Ill Children and Public Health Insurance Coverage provides a state-by-state analysis of children’s access to health care and examines whether children who have public or private coverage obtain health care differently than children who are uninsured. The data demonstrate the strength of CHIP and Medicaid as safety nets for kids, but more than 9 million children remain uninsured. (August 2008)

The Coverage Gap: A State-by-State Report on Access to Care examines the disparities in access to health care between insured and uninsured Americans. The findings confirm that not receiving needed medical care is taking a toll on the millions of Americans who do not have health coverage. (April 2006)

Health Services Used by Uninsured vs. Insured Children: The Robert Wood Johnson Foundation released the results of a new study in a report titled Survey of American Families: Comparison of Households with Insured Children vs. Uninsured Children Eligible for SCHIP/Medicaid Coverage. The report findings were based on 1,662 interviews of parents with children aged 18 and younger living in the household. Among the findings were that 21 percent of eligible-uninsured children went without needed medical care because their parents could not afford to pay for treatments (compared to three percent of insured children), and that nearly three-quarters of families with eligible-uninsured children do not have access to an employer-provided health plan for children. (August 2001)

From The Urban Institute:

Uninsurance Is Not Just a Minority Issue: White Americans Are a Large Share of the Growth from 2000 to 2010 compares changes in health coverage across racial and ethnic groups. It finds that nearly half of uninsured Americans are white, and the uninsurance rate among whites and blacks increased while the rate for Hispanics remained constant. (November 2012)

Opting Out of the Medicaid Expansion under the ACA: How Many Uninsured Adults Would Not Be Eligible for Medicaid? explains that state decisions about whether to expand Medicaid will directly affect 15.1 million uninsured adults. Of these adults, 11.5 million have incomes that are below the poverty level and therefore would not be eligible for tax credits to help with the cost of coverage. The report includes state-level data on the number of uninsured adults with incomes below 138 percent of poverty, and it breaks these data down by those who are currently eligible for Medicaid and those who would be newly eligible. (June 2012)

The Biggest Losers Health Edition: Who Would Be Hurt the Most by a Failure to Enact Comprehensive Reforms? lists several groups, including the 13.1 million self-employed people, and the 47.8 million people who are employed by firms of fewer than 100 workers. Without reform, health care costs will continue to grow faster than incomes, and more and more people will be unable to afford coverage, worsening the situation for these groups and others. (February 2010)

Variation in Insurance Coverage across Congressional Districts: New Estimates from 2008 reveals which districts face the greatest deficiencies in private coverage and where public coverage has been able to close some of these gaps. Rates of private coverage are lowest in districts that have higher poverty rates, and despite above-average rates of public coverage in these areas, lack of insurance continues to be a serious problem. (October 2009)

Health Insurance for Low-Income Working Families proposes comprehensive reforms that are designed to provide coverage for everyone at every income level, while still encouraging work. According to the study, in 2005, only 37 percent of adults in low-income working families had employer-based health insurance, and 42 percent had no health coverage. The proposals include state purchasing pools, individual mandates, and strategies for reducing health care costs. (July 2008)

Health Insurance Coverage of Young Adults: Issues and Broader Considerations looks at why young adults are disproportionately uninsured and what policies could address this coverage gap. Nearly one in three adults ages 19-26 lack health insurance. (June 2008)

Why Do People Lack Health Insurance? looks at the reasons people are uninsured overall and by key population subgroups (by age, race/ethnicity, health status, and family and employment characteristics). The brief also examines how those reasons have changed over time. (May 2008)

Uninsured and Dying Because of It reports that, as the number of the uninsured grows, the number of preventable deaths does as well. From 2000 to 20006, an estimated 137,000 people from ages 25 to 64 died due to a lack of insurance. The report includes charts that show the total number of Americans who died and the numbers that died because they were uninsured. (January 2008)

Why Health Insurance Is Important explains the correlation between health coverage and improved health outcomes. (November 2007)

Forty-six million people, nearly 6 million more than in 2000, are uninsured today. Why Do People Lack Health Insurance? looks at individual’s reasons and motivations and also highlights the growing concern among the uninsured about the high cost of insurance. (May 2006)  

Uninsured Americans with Chronic Health Conditions: Key Findings from the National Health Interview Survey examines the well-being of uninsured adults with chronic health problems. The analysis, which is based on the 2003 National Health Interview Survey, finds that almost half of uninsured adults with chronic conditions forgo needed medical care or prescription drugs at much higher rates than their insured counterparts. (May 2005)

Health Insurance Coverage of Children in Mixed-Status Immigrant Families uses data from the 1999 and 2002 National Survey of America's Families to examine the health insurance coverage of low-income citizen children. The report also looks at differences in health coverage between children whose families responded to the survey in English and those whose families responded in Spanish. (November 2003)

Snapshots of America's Families 3: Tracking Change 1997-2002, which presents the first findings from the 2002 round of the National Survey of America's Families (NSAF), shows how American families have changed since 1997. These snapshots paint a detailed portrait of health insurance coverage and use, child well-being, and participation in government programs, as well as a first glimpse of how the sluggish economy is changing the lives of American families. The NSAF sample provides reliable estimates for differences by income, race and ethnicity, age of children, and employment status. (Summer/Fall 2003)

Gains in Public Health Insurance Offset Reductions in Employer Coverage among Adults examines changes in insurance coverage among adults ages 19-64 between 1999 and 2002, with a detailed discussion of changes among low-income adults. It reports that the share of nonelderly adults who were uninsured remained stable between 1999 and 2002 because overall increases in enrollment in public health coverage programs offset reductions in employer coverage. This trend held even among low-income adults, who experienced greater reductions in employer coverage than other adults, although uninsurance rose among low-income adults who were 19-34 years old or in fair or poor health. (September 2003)

Children's Insurance Coverage and Service Use Improvepresents data showing that the number of uninsured children under age 19 fell from 9.6 to 7.8 million from 1999 to 2002 (an overall drop of 2.6 percentage points). This improvement was concentrated among low-income children: for such children, the rate of those without health coverage fell by almost six percentage points. Over that same period, the number of children covered by Medicaid or SCHIP (the State Children's Health Insurance Program) increased by 4.8 million to 17.4 million. (July 2003)

Does the Health Care Safety Net Narrow the Access Gap? presents the results of a study that examined the role of the health care safety net in increasing health care use and access for uninsured adults and in narrowing the gap between the uninsured and the insured. The study found little variation in use of and access to health services among low-income adults when examining local safety net conditions, but it found large differences according to insurance status. The authors therefore argue that expanding health coverage would be a more effective tool for increasing health care use and access among low-income adults than expanding the safety net. (April 2003)

Understanding why some low-income people may not be willing to spend much on health coverage requires a better appreciation of the circumstances of those people, especially the extent to which they face other financial hardships. The debate around alternative policies to increase health coverage seldom considers the competing demands on family budgets. Hardship among the Uninsured: Choosing among Food, Housing, and Health Insurance explores the extent to which nonelderly, uninsured adults also face other hardships in their daily lives and argues that strategies to increase health coverage need to allow for these competing demands on limited resources. (May 2003)

Variations among States in Health Insurance Coverage and Medical Expenditures: How Much Is Too Much? attempts to answer this question: How well is our decentralized health care system doing in providing coverage and access to Americans, particularly low-income Americans, regardless of where they live? To that end, it explores the considerable variation in health insurance coverage for children and nonelderly adults. It provides information on private and public coverage, uninsurance rates, and on expenditures on Medicaid and other programs states use to support health services. (June 2002)

Health Care Access for Uninsured Adults: A Strong Safety Net Is Not the Same as Insurance examines the extent to which differences in the safety-net environment account for differences in access to and use of health care by the uninsured. The brief draws on representative samples of the population from 13 states (AL, CA, CO, FL, MA, MI, MN, MS, NJ, NY, TX, WA, WI) and focuses on low-income adults and on residents of metropolitan areas. (January 2002)

State Profiles of Health Insurance, Access, and Use is based on the 1999 National Survey of America's Families and provides basic state- and national-level data in easy-to-use tables. These tables break down the type of health insurance people have according to age, income, sex, race/ethnicity, family structure, family work status, firm size, and country of origin. Separate profiles for each of the 13 states studied (AL, CA, CO, FL, MA, MI, MN, MS, NJ, NY, TX, WA, and WI) also include characteristics of the uninsured, as well as a description of Medicaid and SCHIP enrollees. (January 2002)

Children Eligible for Medicaid but Not Enrolled: How Great a Policy Concern? Part of assessing the New Federalism series, this report finds that Medicaid-eligible uninsured children were healthier than Medicaid enrollees, but were 17 percent more likely to lack a usual source of care, 12 percent more likely to report unmet need, and 16 percent more likely to report high out-of-pocket medical spending. Medicaid-eligible children with private insurance were more likely to have a usual source of care, but were also more likely to report delays in seeking care and face higher out-of-pocket spending. Results suggest that Medicaid enrollment gains will yield important improvements in access to care. (September 2000)

Workers Without Health Insurance: Who Are They and How Can Policy Reach Them? offers a detailed picture of the uninsured working population. It also compares the relative merits of two key vehicles for expanding coverage-tax credits and public programs. The report is based on an analysis of 1999 Current Population Survey (Census) Data and a survey of the literature on the working uninsured. The report includes a "Worker's Health Insurance Index" that provides basic statistics on workers without health insurance. Index (October 2001)

Who Are The Adult Uninsured?(March 2000)

From the Urban Institute and the Robert Wood Johnson Foundation:

Virtually Every State Experienced Deteriorating Access to Care for Adults over the Past Decade examines access to care by determining how likely it is that adults will have unmet medical needs due to cost, will get regular check-ups, and will go to the dentist. It finds that, in every state, uninsured adults saw greater declines in access to care than insured adults. (May 2012)

How Will the Patient Protection and Affordable Care Act of 2010 Affect Young Adults? describes how different elements of health reform will help young adults, specifically the Medicaid expansion, subsidies for private insurance, the expansion of dependent coverage, and insurance market reforms. (July 2010)

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