U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

NCHS Data Brief ■ No. 83 ■ January 2012

Health and Access to Care Among Employed and 

Unemployed Adults: United States, 2009–2010

Anne K. Driscoll, Dr.P.H., and Amy B. Bernstein, Sc.D.

Key findings

Data from the National 

Health Interview Survey, 

2009–2010

•	 In 2009–2010, 48.1% of 

unemployed adults aged 18–64 

years had health insurance 

compared with 81.4% of 

employed adults; among the 

insured, a higher proportion 

of the unemployed had public 

insurance.

•	 Unemployed adults had 

poorer mental and physical 

health than employed adults; 

this pattern is found for insured 

and uninsured adults.

•	 Unemployed adults were 

less likely to receive needed 

medical care due to cost than 

the employed in each insurance 

category.

•	 The unemployed were 

less likely to receive needed 

prescriptions due to cost than 

the employed in all insurance 

categories.

•	 Uninsured adults were less 

likely to receive needed medical 

care and prescription drugs due 

to cost than those with public or 

private insurance, regardless of 

employment status.

The 2007–2009 recession was the longest and deepest since the Great 

Depression; the economy is still recovering (1). U.S. unemployment rates 

were 9.3% in 2009 and 9.6% in 2010, levels not seen since 1983 (2). Health 

insurance is a major determinant of access to both preventive and acute 

health care. Most Americans rely on employer-provided insurance. Thus, 

unemployment affects their access to health services, due to both loss of 

employer-sponsored health insurance and reduced income (3).

This report uses data from the 2009 and 2010 National Health Interview 

Survey (NHIS) to compare the health insurance status, health, and access to 

health care of employed and unemployed adults aged 18–64 years. It compares 

health status and access to care between the employed and unemployed by 

insurance status to show associations between these factors and employment 

net of insurance status, a major determinant of health care access.

Keywords: health insurance • employment • health • access to care

Unemployed adults aged 18–64 years were less likely to 

have private insurance and more likely to be uninsured than 

employed adults.

NOTE: Access data table for Figure 1 at: http://www.cdc.gov/nchs/data/databriefs/db83_tables.pdf#1.

SOURCE: CDC/NCHS, National Health Interview Survey.

Figure 1. Insurance status among adults aged 18–64 years, by employment status: United States, 

2009–2010

Uninsured

51.0

Public

19.7

Private

29.3

Unemployed

Uninsured

18.2

Public

6.6

Private

75.2

Employed
NCHS Data Brief ■ No. 83 ■ January 2012

■  2  ■

•	 In 2009–2010, three quarters (75.1%) of employed adults aged 18–64 years had private 

health insurance coverage; more than four in five (81.4%) had either public or private

insurance (Figure 1).

•	 Less than one-half (48.1%) of unemployed adults had any health insurance coverage. 

Of those with coverage, 59% had private coverage and 41% had public health insurance.

•	 Unemployed adults were more likely to be non-Hispanic black, to have less than a high 

school education, and to have family income below the poverty level in the previous year 

than employed adults (Appendix table).

Unemployed adults in 2009–2010 were more likely to have fair or poor health 

than employed adults across all categories of insurance coverage.

•	 Overall, 11.3% of unemployed adults aged 18–64 years had fair or poor health compared with 

5.3% of employed adults (Figure 2).

•	 Among adults with private insurance, 4.3% of employed adults had respondent-reported fair 

or poor health compared with 7.8% of the unemployed. Among those with public insurance, 

1 in 10 (10.2%) employed adults had fair or poor health compared with 1 in 7 (14.7%) 

unemployed adults.

•	 Adults with public health insurance and the uninsured were more likely to have fair or poor 

health than those with private coverage, regardless of employment status.

NOTE: Access data table for Figure 2 at: http://www.cdc.gov/nchs/data/databriefs/db83_tables.pdf#2.

SOURCE: CDC/NCHS, National Health Interview Survey.

Figure 2. Fair or poor health status among adults aged 18–64 years, by employment status and insurance status:

United States, 2009–2010 Percent

Health insurance status

95% Confidence interval

0

5

10

15

20 Employed Unemployed

All Private Public Uninsured

Unemployed adults were more likely to have serious psychological distress 

than employed working-age adults, regardless of health insurance coverage.

•	 Overall, 6.3% of unemployed adults aged 18–64 years reported serious psychological 

distress compared with 1.7% of employed adults (Figure 3).
NCHS Data Brief ■ No. 83 ■ January 2012

■  3  ■

•	 Among adults with private health insurance, unemployed persons were more than three 

times as likely to experience serious psychological distress as their employed peers 

(4.8% versus 1.3%); and among those with public health insurance, the unemployed 

were almost three times as likely to suffer serious psychological distress as the employed 

(8.7% compared with 3.1%). 

•	 Adults with public health insurance and the uninsured were more likely to suffer serious 

psychological distress than those with private insurance, regardless of employment status.

NOTE: Access data table for Figure 3 at: http://www.cdc.gov/nchs/data/databriefs/db83_tables.pdf#3.

SOURCE: CDC/NCHS, National Health Interview Survey.

Figure 3. Serious psychological distress among adults aged 18–64 years, by employment and insurance status: 

United States, 2009–2010 Percent

Health insurance status

0

5

10

15

20

All Private Public Uninsured

Employed Unemployed 95% Confidence interval

Unemployed adults had more difficulties obtaining needed medical care 

due to cost than employed adults, regardless of insurance coverage.

•	 Among adults with private health insurance, one in seven (14.7%) unemployed adults 

experienced either a delay or lack of needed medical care because of cost compared with 

8.7% of employed adults (Figure 4).

•	 Among adults with public health insurance, one in six (16.0%) unemployed adults reported 

a cost-related delay or lack of needed medical care compared with one in nine (11.2%) 

employed adults.

•	 Uninsured adults were more likely to experience delayed or no needed medical care than 

adults with either private or public health insurance. This pattern holds among both the 

employed and unemployed. Among unemployed adults, two-fifths (41.2%) of the uninsured

experienced a delay or lack of needed medical care compared with 16.0% of those with 

public coverage and 14.7% of those with private coverage.
NCHS Data Brief ■ No. 83 ■ January 2012

■  4  ■

NOTE: Access data table for Figure 4 at: http://www.cdc.gov/nchs/data/databriefs/db83_tables.pdf#4.

SOURCE: CDC/NCHS, National Health Interview Survey.

Figure 4. Delayed or did not receive needed medical care due to cost among adults aged 18–64 years, by employment 

and insurance status: United States, 2009–2010

Health insurance status

Percent

0

10

20

30

40

50

All Private Public Uninsured

Employed Unemployed 95% Confidence interval

Unemployment was associated with reduced access to needed prescription 

drugs due to cost.

•	 Among those with private health insurance, 5.7% of employed adults did not get needed 

prescriptions because they could not afford them compared with 9.2% of unemployed adults 

(Figure 5).

•	 Similarly, among those with public health insurance, 1 in 12 (8.3%) employed adults did not 

get needed prescriptions compared with almost 1 in 7 (13.9%) of unemployed adults.

•	 Three in 10 (30.1%) unemployed uninsured adults did not get a needed prescription in the 

past year compared with 23.2% of employed uninsured adults.

NOTE: Access data table for Figure 5 at: http://www.cdc.gov/nchs/data/databriefs/db83_tables.pdf#5.

SOURCE: CDC/NCHS, National Health Interview Survey.

Figure 5. Did not receive a needed prescription due to cost among adults aged 18–64 years, by employment and 

insurance status: United States, 2009–2010

Health insurance status

Percent

0

10

20

30

40

50

All Private Public Uninsured

Employed Unemployed 95% Confidence interval
NCHS Data Brief ■ No. 83 ■ January 2012

■  5  ■

•	 Adults without health insurance, both employed and unemployed, were more than twice 

as likely to not get needed prescription drugs because they could not afford them as those 

with either public or private insurance. Among unemployed adults, 3 in 10 (30.1%) of the 

uninsured did not get needed prescription drugs due to cost compared with 13.9% of those 

with public coverage and 9.2% of those with private coverage.

Summary

Lack of health insurance has been shown to be associated with problems obtaining needed health 

care (3), and the unemployed are less likely to have health insurance than are their employed 

counterparts. The number and rate of adults aged 18–64 years lacking health insurance has 

been increasing, in part due to the historically high unemployment rates. However, even having 

comprehensive health insurance coverage does not guarantee access to needed services, in part 

because of cost-sharing, including copayments and deductibles. Unemployed persons may retain 

their health insurance through the Consolidated Omnibus Budget Reconciliation Act (COBRA) 

or through other programs, but COBRA payments in particular may be quite expensive, and 

individual insurance plans may be less comprehensive than many employer-sponsored plans 

(4). Thus, although some unemployed adults may retain coverage for some period of time, they 

may be less able to meet cost-sharing requirements because of reduced income associated with 

unemployment.

This analysis compares the health status and access to care of employed and unemployed adults 

and shows that unemployment is associated with unfavorable health and access to care among 

adults in the labor force over and above the loss of health insurance. However, it is not possible to 

know from these data the extent to which unemployment is a cause or effect of poor health. Poor 

health may be both a cause and effect of unemployment. Adults with private health insurance 

were more likely to have serious psychological distress and respondent-reported fair or poor 

health status if they were unemployed. In fact, unemployed privately insured persons were more 

than three times as likely to have serious psychological distress as their employed counterparts. 

Similar patterns were found for adults with public insurance and no health insurance. There were 

no significant differences between employed and unemployed adults in the percentage who had

ever been diagnosed with selected chronic conditions, including hypertension, heart disease, 

diabetes, or cancer (NCHS unpublished analysis of NHIS data), and so the need for health care 

to treat these chronic conditions exists for both employed and unemployed adults.

In addition to having poorer health, unemployed adults were more likely to delay or not receive 

needed medical care and needed prescriptions due to cost than their employed counterparts across 

categories of insurance coverage. Thus, the unemployed reported both worse health and less 

access to needed care and treatment than employed adults. This pattern was found not only for 

those without health insurance but also those with public and private insurance.

Definitions

Unemployed and employed: NHIS respondents were asked “What was [person]/were you 

doing last week?” for each person aged 18 and older. Those who were “looking for work” were 

classified as unemployed. Those who were “working for pay at a job or business,” “with a job or

business but not at work,” or “working, but not for pay, at a family-owned job or business” were 

classified as employed. Persons “not working at a job or business and not looking for work” were

not in the labor force and are not included.
NCHS Data Brief ■ No. 83 ■ January 2012

■  6  ■

Insurance: Measured at time of interview. Private insurance is coverage obtained through 

an employer, union, or individual purchase. Public insurance is Medicaid, Medicare, other 

government-sponsored programs, or a military health plan (TRICARE, VA, or CHAMP-VA). 

Adults covered by both private and public insurance were considered to have private insurance. 

Persons without private or public insurance and those with only Indian Health Service coverage 

or only a private plan that paid for one type of service such as accidents or dental care are 

considered uninsured.

Health status: Measured by asking the family respondent about his/her health or the health of a 

family member: “Would you say [person’s] health in general is excellent, very good, good, fair, 

or poor?”

Serious psychological distress: The K6 instrument measures psychological distress associated with 

unspecified but potentially diagnosable mental illness. Serious psychological distress during the

past 30 days is defined as a score of 13 or more on the K6 instrument (5).

Access to medical care: Measured by asking the family respondent: “During the past 12 months, 

has medical care been delayed for [person] because of worry about the cost?” and “During the 

past 12 months, was there any time when [person] needed medical care, but did not get it because 

[person] couldn’t afford it?” If the answer to either question was ‘yes’, participants experienced a 

delay or lack of care.

Access to prescription medicines: Measured by asking sample adults: “During the past 12 months, 

was there any time when you needed any of the following, but didn’t get it because you couldn’t 

afford it?” “Prescription medicine” is one possible response.

Data source and methods

Data from the 2009 and 2010 National Health Interview Survey (NHIS) were combined for this 

analysis. NHIS data are collected continuously throughout the year for the Centers for Disease 

Control and Prevention’s (CDC) National Center for Health Statistics (NCHS), by interviewers 

from the U.S. Census Bureau. NHIS collects information about the health and health care of the 

civilian, noninstitutionalized U.S. population. Interviews are conducted in respondents’ homes, but 

follow-ups to complete interviews may be conducted over the telephone. The family component 

collects information on all family members and the sample adult component collects additional 

data on a randomly selected adult (the “sample adult”). Most information presented in this data 

brief was reported by a family respondent in the family component of the survey. Questions on 

serious psychological distress and access to prescription drugs were self-reported 

by the sample adult. All estimates in this report are based on data for sample adults. 

For further information about NHIS and the questionnaire, visit the NHIS website at 

http://www.cdc.gov/nchs/nhis.htm.

NHIS is designed to yield a sample representative of the civilian noninstitutionalized population of 

the United States, and this analysis uses weights to produce national estimates. Point estimates and 

estimates of corresponding variances for this analysis were calculated using SUDAAN software 

to account for the complex sample design of the NHIS. All estimates shown in this report have a 

relative standard error less than or equal to 30%. Differences between percentages were evaluated 

using two-sided significance tests at the 0.05 level with no adjustment for multiple comparisons.
NCHS Data Brief ■ No. 83 ■ January 2012

■  7  ■

Terms such as “higher than” and “less than” indicate statistically significant differences. Terms

such as “similar” and “no difference” indicate that the statistics being compared were not 

significantly different. Lack of comment regarding the difference between any two statistics does

not necessarily suggest that the difference was tested and found 

to be not significant.

Appendix table. Sociodemographic characteristics of employed and unemployed adults aged 18–64 years:

United States, 2009–2010

Characteristic Employed Unemployed

Percent SE Percent SE

Sex

 Male 52.7 0.2 57.3 0.6

 Female 47.3 0.2 42.7 0.6

Age

18–44 58.8 0.3 69.9 0.6

45–64 41.2 0.3 30.1 0.6

Race and ethnicity

 Non-Hispanic white 68.3 0.4 55.9 0.8

 Non-Hispanic black 11.2 0.3 21.0 0.7

 Hispanic 14.7 0.3 18.0 0.6

 Other 5.8 0.2 5.1 0.3

Education

 Less than high school 12.2 0.2 24.9 0.6

 High school 23.6 0.3 29.0 0.6

 Some college 31.6 0.2 31.4 0.6

 College degree 32.6 0.4 14.6 0.5

Percent of Poverty Level

<100% 8.2 0.2 29.3 0.8

100%–199% 14.2 0.2 24.3 0.6

200%–399% 30.4 0.3 27.4 0.7

≥400% 47.2 0.4 19.0 0.6

NOTES: SE is standard error. Percent of poverty level is based on family income and family size and composition using U.S. Census Bureau poverty thresholds. 

Missing family income data were imputed.

SOURCE: CDC/NCHS, National Health Interview Survey, 2009 and 2010.

About the authors

Anne K. Driscoll and Amy B. Bernstein are with CDC’s NCHS, Division of Analysis 

and Epidemiology.
NCHS Data Brief ■ No. 83 ■ January 2012

References

1. National Bureau of Economic Research (NBER), Business Cycle Dating 

Committee. Memo, September 20, 2010. Available from: 

http://www.nber.org/cycles/sept2010.html.

2. Bureau of Labor Statistics (BLS). Household Data Annual Averages; 

Table 1. Employment status of the civilian noninstitutional population, 1940 

to date. 2011. Available from: http://www.bls.gov/cps/cpsaat1.pdf.

3. Fronstin P. The impact of the recession on employment-based health 

coverage. EBRI Issue Brief, no. 342. Employee Benefit Research Institute, 

Washington, DC. 2010.

4. Holahan J, Garrett AB. Rising unemployment, Medicaid and the 

uninsured. Washington, DC: Kaiser Commission on Medicaid and the 

Uninsured, The Urban Institute. 2009.

5. Kessler RC, Barker PR, Colpe LJ, Epstein JF, Gfroerer JC, Hiripi E, et 

al. Screening for serious mental illness in the general population. Arch Gen 

Psychiatry 60(2):184–9. 2003.

Suggested citation

Driscoll AK, Bernstein AB. Health and 

access to care among employed and 

unemployed adults: United States, 

2009–2010. NCHS data brief, no 83. 

Hyattsville, MD: National Center for Health 

Statistics. 2012.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Edward J. Sondik, Ph.D., Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Office of Analysis and Epidemiology

Diane M. Makuc, Dr.P.H., Acting Director

For e-mail updates on NCHS publication 

releases, subscribe online at: 

http://www.cdc.gov/nchs/govdelivery.htm 

For questions or general information 

about NCHS: 

Tel: 1–800–232–4636 

E-mail: cdcinfo@cdc.gov

Internet: http://www.cdc.gov/nchs

ISSN 1941–4927 (Print ed.) 

ISSN 1941–4935 (Online ed.) 

CS229054 

DHHS Publication No. (PHS) 2012–1209

U.S. DEPARTMENT OF 

HEALTH & HUMAN SERVICES

Centers for Disease Control and Prevention 

National Center for Health Statistics 

3311 Toledo Road

Hyattsville, MD 20782

OFFICIAL BUSINESS 

PENALTY FOR PRIVATE USE, $300

FIRST CLASS MAIL 

POSTAGE & FEES PAID 

CDC/NCHS 

PERMIT NO. G-284