Agency for Healthcare 

Medical Expenditure Panel Survey Research and Quality 

STATISTICAL BRIEF #87 

July 2005 

Attitudes toward Health Insurance 

among Adults Age 18 and Over 

Steve Machlin and Kelly Carper 

Introduction 

Health insurance is viewed by policymakers and others concerned 

with the cost and quality of medical care as important for access to 

care and protection against the risk of costly and unforeseen medical 

events. Attitudes among consumers toward the need for and cost of 

health insurance may impact the extent to which the population is 

covered. 

The 1987 National Medical Expenditure Survey (NMES) and the 

2002 Medical Expenditure Panel Survey (MEPS) each contained 

questions that asked adults age 18 and over whether they strongly 

agreed, agreed, were uncertain, disagreed, or strongly disagreed 

with each of the following statements: “I’m healthy enough that I 

really don’t need health insurance” and “Health insurance is not 

worth the money it costs.” 

This Statistical Brief examines differences in the extent to which 

persons agreed with these statements in 2002 versus 1987, as well 

as the variation in agreement with these attitudes in 2002 by selected demographic and socioeconomic characteristics (age, race/ 

ethnicity, sex, education, family income, and insurance status for 

adults under 65). Strongly agreed and agreed responses were 

combined into an “agreed” category while strongly disagreed and 

disagreed responses were combined into a “disagreed” category. All 

differences between estimates discussed in the text are statistically 

significant at the 0.05 level or better. 

Findings 

Comparison of 1987 with 2002 

There were small differences between 1987 and 2002 in the distribution of responses to the attitudes toward health insurance items. 

The percentage who agreed with the statement “I’m healthy enough 

that I really don’t need health insurance” declined from 11.0 percent 

to 9.9 percent, while the percentage who agreed with the statement 

“health insurance is not worth the money it costs” increased from 

20.7 percent to 23.9 percent (figure 1).

Highlights 

� The percentage of adults 

age 18 and over who 

agreed with the statement 

“I’m healthy enough that I 

really don’t need health 

insurance” was slightly 

lower in 2002 than 1987, 

while the percentage who 

agreed with the statement 

“Health insurance is not 

worth the money it costs” 

was slightly higher. 

� In 2002, adults age 18–44 

were more likely than persons age 65 and over to 

feel that they did not need 

health insurance because 

they were healthy and that 

health insurance was not 

worth the cost. 

� Hispanics were more likely 

than non-Hispanic whites or 

non-Hispanic blacks to feel 

they were healthy and did 

not need health insurance. 

� Men were more likely than 

women to feel that they did 

not need health insurance 

because they were healthy 

and also that health insurance was not worth the 

cost. 
Variations among subgroups in 2002 

Age. In 2002, adults age 18–44 were more likely than persons age 65 and over to feel that they did not 

need insurance because they were healthy (13.2 versus 5.8 percent) (figure 2) and to feel that health 

insurance was not worth the cost (25.9 versus 18.2 percent) (figure 3). Among persons age 45–64, the 

proportion who felt they did not need health insurance (6.8 percent) was closer to that for older persons 

(figure 2), while the proportion who felt health insurance was not worth the cost (23.7 percent) was closer 

to that for younger adults (figure 3). 

Race/ethnicity. Hispanics were more likely (15.5 percent) than non-Hispanic whites or non-Hispanic 

blacks (about 9 percent each) to feel they were healthy and did not need health insurance (figure 2). 

However, there were no significant differences across race/ethnicity categories in the percentage of 

persons who felt that health insurance was not worth the cost—these percentages ranged from 22.6 

percent to 25.7 percent (figure 3). 

Sex. In 2002, males were more likely than females to feel that they did not need health insurance 

because they were healthy (12.5 versus 7.5 percent) (figure 2) and to feel that health insurance was not 

worth the cost (26.1 versus 21.9 percent) (figure 3). 

Education. Adults with fewer than 12 years of education were more likely than persons with 12 or more 

years of education to feel they were healthy and did not need health insurance (12.2 percent versus 

about 9–10 percent) (figure 2). Further, adults with more than 12 years of education were slightly less 

likely to agree that “health insurance is not worth the cost” than persons with lower educational attainment 

(22.2 percent versus about 25–26 percent) (figure 3). 

Family income. Adults in the poor/near poor income category were more likely to feel they were healthy 

and did not need health insurance than persons in the middle/high income category (12.2 versus 9.3 

percent) (figure 2), but the percentage of persons who felt that health insurance was not worth the cost 

was not statistically different among these groups (25.3 versus 23.3 percent) (figure 3). 

Insurance status (persons age 18–64 only). In 2002, the uninsured population 18–64 years old were more 

than twice as likely to feel they were healthy and did not need health insurance (18.9 percent versus 

about 9 percent for persons with private or public health insurance) (figure 2). In addition, about one-third 

of adults without health insurance felt that it was not worth the cost compared with approximately onequarter of persons with private or public health insurance (figure 3). Among adults age 18–64 with health 

insurance, the percentages who agreed with the attitudinal statements toward health insurance were not 

significantly different for those with private versus public coverage (figures 2 and 3). 

Data Source 

The estimates in this Statistical Brief are based upon data from the 1987 NMES and the MEPS 2002 Full 

Year Consolidated Data file (HC-070). 

Definitions 

Racial and ethnic classifications 

Classification by race and ethnicity is based on information reported for each family member. 

Respondents were asked if each family member’s race was best described as American Indian, Alaska 

Native, Asian or Pacific Islander, black, white, or other. They also were asked if each family member's 

main national origin or ancestry was Puerto Rican; Cuban; Mexican, Mexicano, Mexican American, or 

Chicano; other Latin American; or other Spanish. All persons whose main national origin or ancestry was 

reported in one of these Hispanic groups, regardless of racial background, were classified as Hispanic. 

Since the Hispanic grouping can include black Hispanic, white Hispanic, Asian and Pacific Islanders 

Hispanic, and other Hispanic, the race categories of black, white, Asian and Pacific Islanders, and other 

do not include Hispanic. Beginning in 2002, MEPS respondents were allowed to report multiple races, 

and these persons were included in the other non-Hispanic category. As a result, there was a slight 

increase in the percentage of persons classified in this category in 2002 compared with prior years. 
Health insurance status 

– Private coverage: Private health insurance coverage was defined as nonpublic insurance that provided 

coverage for hospital and physician care (including TRICARE and Medigap coverage). 

– Public only coverage: People were considered to have only public health insurance coverage if they 

were not covered by private insurance, and they were covered by Medicare, Medicaid, or other public 

hospital and physician coverage. 

– Uninsured: People who did not have insurance coverage at any time during the survey year were 

classified as uninsured. People who were covered only by noncomprehensive State-specific programs 

(e.g., Maryland Kidney Disease Program) or private single service plans (e.g., coverage for dental or 

vision care only, coverage for accidents or specific diseases) were considered to be uninsured. 

Family income 

Each sample person was classified according to the total yearly income of his or her family. Within a 

household, all individuals related by blood, marriage, or adoption were considered to be a family. 

Personal income from all family members was summed to create family income. Based on the ratio of 

family income to the Federal poverty thresholds, which control for family size and age of the head of 

family, categories are defined as follows: 

– Poor/near poor: Persons in families with income less than or equal 125 percent of the poverty line, 

including those who reported negative income 

– Low income: Persons in families with income over 125 percent through 200 percent of the poverty line 

– Middle/high income: Persons in families with income over 200 percent of the poverty line 

About MEPS and NMES 

The Medical Expenditure Panel Survey (MEPS) is the third in a series of nationally representative surveys 

of medical care use and expenditures. MEPS is cosponsored by the Agency for Healthcare Research and 

Quality and the National Center for Health Statistics. MEPS collects nationally representative data on 

health care use, expenditures, sources of payment, and insurance coverage for the U.S. civilian noninstitutionalized population. The first survey, the National Medical Care Expenditure Survey (NMCES) was 

conducted in 1977; and the second survey, the National Medical Expenditure Survey (NMES), was 

carried out in 1987. 

NMES and MEPS data are released to the public in public use data files. NMES data files are available 

from the AHRQ Publications Clearinghouse (E-mail: ahrqpubs@ahrq.gov). MEPS data files are available 

on the MEPS Web site. 

For more information about MEPS, call the MEPS information coordinator at AHRQ (301-427-1656) or 

visit the MEPS Web site at http://www.meps.ahrq.gov/. 

References 

For a detailed description of the MEPS Household Component survey design, sample design, and 

methods used to minimize sources of nonsampling error, see the following publications: 

Cohen, J. Design and Methods of the Medical Expenditure Panel Survey Household Component. MEPS 

Methodology Report No. 1. AHCPR Pub. No. 97-0026. Rockville, Md.: Agency for Health Care Policy and 

Research, 1997. 

Cohen, S. Sample Design of the 1996 Medical Expenditure Panel Survey Household Component. MEPS 

Methodology Report No. 2. AHCPR Pub. No. 97-0027. Rockville, Md.: Agency for Health Care Policy and 

Research, 1997. 

Cohen, S. Design Strategies and Innovations in the Medical Expenditure Panel Survey. Medical Care, 

July 2003: 41(7) Supplement: III-5–III-12. 

For more information on the NMES survey design, see the following publications: 

Cohen, S., DiGaetano, R., and Waksberg, J. Sample design of the 1987 Household Survey. AHCPR Pub. 

No. 91-0037. National Medical Expenditure Survey Methods 3. Agency for Healthcare Policy and 

Research. Rockville, Md.: U.S. Department of Health and Human Services, Public Health Service, 1991. 
Edwards, W. and Berlin, M. Questionnaires and data collection methods for the household survey and the 

survey of American Indians and Alaskan Natives. DHHS Pub. No. (PHS) 89-3450. National Medical 

Expenditure Survey Methods 2. National Center for Health Services Research and Health Care 

Technology Assessment. Rockville, Md.: U.S. Department of Health and Human Services, Public Health 

Service, 1989. 

Suggested Citation 

Machlin, S. and Carper, K. Attitudes toward Health Insurance among Adults Age 18 and Over, 1987 and 

2002. Statistical Brief #87. July 2005. Agency for Healthcare Research and Quality, Rockville, Md. 

http://www.meps.ahrq.gov/papers/st87/stat87.pdf 
Component of the Medical Expenditure Panel Survey, 2002. 

Figure 1. Distribution of responses to health insurance 

attitude items, adults age 18 and over, 1987 and 2002 

67.0 

83.7 80.6 

63.5 

8.4 6.5 

12.3 12.7 

23.9 20.7 9.9 11.0 

0% 

20% 

40% 

60% 

80% 

100% 

Disagree Uncertain Agree 

1987 2002 

Healthy enough not to need health insurance Health insurance not worth the money it costs 

1987 2002 

Source: Center for Financing, Access, and Cost Trends, AHRQ, National Medical Expenditure Survey, 1987, and the Household 

Component of the Medical Expenditure Panel Survey, 2002. 

are healthy and don’t need health insurance, 

by selected characteristics, 2002 

13.2 

6.8 5.8 

8.9 

15.5 

9.2 

12.1 12.5 

7.5 

12.2 

9.6 9.0 

12.2 10.6 9.3 9.2 9.2 

18.9 

0 

10 

20 

30 

40 

50 

18-4445-64 

65+ 

White non-Hispanic

Hispanic

Black non-Hispanic

Other non-Hispanic 

Male

Female 

<12 years

12 years

>12 years

Poor/near poor 

Low

Middle/High 

Any PrivatePublic Only

Uninsured 

Percent 

Age Race/ethnicity Sex Education Family income Insurance status

Source: Center for Financing, Access, and Cost Trends, AHRQ, National Medical Expenditure Survey, 1987, and the Household 

Figure 2. Percentage of adults who feel they 

(age 18-64 only) 
Component of the Medical Expenditure Panel Survey, 2002. 

Figure 3. Percentage of adults who feel that 

health insurance is not worth the cost, 

by selected characteristics, 2002 

25.9 23.7 

18.2 

23.8 24.9 22.6 

25.7 26.1 

21.9 

25.1 25.6 

22.2 

25.3 25.8 23.3 23.0 23.8 

35.6 

0 

10 

20 

30 

40 

50 

18-4445-64 

65+ 

White non-Hispanic

Hispanic

Black non-Hispanic

Other non-Hispanic 

Male

Female 

<12 years

12 years

>12 years

Poor/near poor 

Low

Middle/High 

Any PrivatePublic Only

Uninsured 

Percent 

Age Race/ethnicity Sex Education Family income Insurance status 

Source: Center for Financing, Access, and Cost Trends, AHRQ, National Medical Expenditure Survey, 1987, and the Household 

(age 18-64 only)