Access Cost Choice

nd Quality

State Differences in Job-RelatedHealth Insurance, 1996

o. 4
‡

MT ND

SD

WY

ID

WA

OR

CA NV

UT

AZ NM

CO

NE

KS

TX

OK

HI

MN

IA

MO

AR

LA

MS AL

FL

GA

NC

VA

WI MI

TN

KY

IL IN OH MD DE

NJ

RI

CT

MA

NH

VT

NY

ME

PA

WV

SC

,Vistnes JP. State differences in job-related health insurance, 1996. Rockville (MD):Agency for Healthcare Research and

0. MEPS Chartbook No. 4.AHRQ Pub. No. 00-0017.

in this chartbook

workplace or location.

A firm can have many establishments or only one.

than 50 employees.

more employees.

at covers the employee only.

hat covers the employee and the employee’s family. If a plan offers more than one arrangement for family coverage, premium information for a

 paid for insurance, consisting of contributions by both the employer and employee.

—Insurance plan in which enrollees can go to the physicians of their choice on a fee-for-service basis. The plan does not have any providers

e plan in which enrollees are restricted in their choice of providers or have a financial incentive to go to a preferred provider. Includes both

ferred provider plans.

aged care plan, such as a health maintenance organization, in which enrollees must go to providers associated with the plan, except in an

naged care plan, such as a preferred provider organization or point-of-service plan, in which enrollees can go to a set of preferred providers

her providers. If they go to a non-preferred provider, they face higher costs.

ps show statistical significance at the 1% and 5% levels.The test for differences at the 1% level is stricter than the test at the 5% level.This

 level are more likely to be differences that did not occur by chance.
i

Establishments were most likely to offerjob-related insurance to at least some oftheir employees in Hawaii, where Statelaw mandates that employers offerhealth insurance and pay for at least halfof the premiums for most workers. (SeeNote 1.)

Access

Establishments in Mississippi, Arkansas,Oklahoma, and Nebraska were the leastlikely to offer insurance to theiremployees.

In every State, establishments in largefirms were more likely to offer insurancethan those in small firms.

Cost

The national average premium for singlecoverage was $1,997.The nationalaverage for family coverage was $4,953.

For both single and family coverage, thetotal premiums were most in thenortheastern States of Connecticut,New Jersey, Massachusetts, and NewYork. Premiums were lowest in SouthCarolina, New Mexico, and Arkansas.

Workers contributed less than onequarter of the total premiums for familycoverage in Michigan, Ohio,Wisconsin,Connecticut, Illinois, New York, andUtah.The national average was 29.1%.

Approximately 78% of establishments inthe Nation offered workers only oneplan.

Choice

Medical Expenditure Panel Survey

Agency for Healthcare Research and Quality

This report presents estimates of workers’ access to job-related health insurance, the cost of that insurance, and the choice of plans available to workers in 1996. Key findings include: In every State but West Virginia and Maine, establishments were more likely to offer a managed care plan than a conventional indemnity plan. In Wisconsin, Mississippi, Alabama, Minnesota, and West Virginia, more than 85% of the establishments that offered insurance had only one plan. Conventional indemnity plans were more common in the eastern United States.

iii

1 Introduction3 Data in This Report5 Section 1

Access

19 Section 2

Cost

27 Section 3

Choice

33 Looking Ahead34 References35 Notes

Medical Expenditure Panel Survey

Agency for Healthcare Research and Quality

In recent years, States have

been increasingly active in craftingpolicies for their residents who lackhealth insurance coverage. In theearly 1990s, most States establishedreforms to encourage more smallfirms to offer insurance to theirworkers. At the same time, Statesexpanded Medicaid’s eligibilitythresholds. In 1997, Congressenacted the State Children’s HealthInsurance Program (SCHIP), whichgave States the funds and flexibilityto extend public insurance coverageto more uninsured children. (Theenactment of SCHIP occurred after1996, the time period covered inthis report.)

In spite of increasing

enrollment in public health

insurance programs and decreasingprivate coverage from 1987 to1996, job-related coverage remainsthe primary source of healthinsurance for most Americans.However, employer-sponsoredcoverage varies significantly acrossStates. This report focuses on threekey aspects of State differences inemployer-sponsored healthinsurance. The first section looks atworkers’ access to job-related healthinsurance. The cost of insurance,which may be a factor in whetheremployers offer coverage andwhether workers accept it, isexamined in the second section.Finally, the report presents data onthe choice of plans offered toemployees.

Medical Expenditure Panel Survey

Agency for Healthcare Research and Quality

1

Medical Expenditure Panel Survey

Agency for Healthcare Research and Quality

3

Data in This

Report

The data in this report come

from the private-sector sample ofthe Medical Expenditure PanelSurvey Insurance Component(MEPS IC), conducted by theAgency for Healthcare Research andQuality. The MEPS IC is an annualsurvey of more than 25,000responding private-sectorestablishments and governments. Itprovides estimates of job-relatedinsurance both at the national leveland at the State level for 40 Statesin a given year. The data shown inthis chartbook refer exclusively tothe 23,000 responding privatesector establishments and are drawnfrom tables that appear on theMEPS Web site:

http://www.meps.ahrq.gov/data.htm

Specific sources for additional

information presented in thediscussion are listed in thereferences section.

Besides the Insurance

Component, MEPS includescomponents on households, medicalproviders, and nursing homes. Withall of its components, MEPS is anationally representative survey thatcollects detailed information onhealth status, health care use andexpenses, and health insurancecoverage of individuals and familiesin the United States.

Unless otherwise noted, only

differences that are statisticallysignificant at least at the 0.05 levelare discussed in the text. Stateswhose rates differ from the nationalaverage at the 0.05 or 0.01significance levels are identified onthe maps. Note that estimates forcertain States do not meet astandard of reliability or precision.Such estimates are indicated on theappropriate map. In such cases, thestandard error of the estimateexceeds 30% of the estimate itself.

When the text states that

findings are significant “in every
o the 40 States

able to make

ates. The District

0 States—Alaska,

Montana, New

Dakota, Rhode

ta, Vermont, and

uded from

because of limited

future, sufficient

aining State

ill be gathered

n a rotating

the 40 States for

ve been made are

 of about 13 or

their rankings

ordingly. In a few

of States in the

to make the

uable for

xample, if the

4 States was

significantly below the nationalaverage, the “bottom third”included all of them.

When a State is described as

having the highest or lowest rate,this means that it is significantlydifferent from the national average,but not that it is significantlydifferent from all other States. Forexample, Maine had the highestpercentage of workers who wereeligible for the insurance offered bytheir employer (88.5%). While thisrate is statistically different from thenational average, it is not statisticallydifferent from the rates in Ohio(87.4%) or South Carolina (87.2%).The text, however, may mentionthat workers in Maine were themost likely to be eligible for theinsurance offered by their employer.

In this report, “establishment”

refers to a particular workplace orlocation. “Firm” refers to a

company or business. A firm canhave many establishments or onlyone. “Single coverage” refers toinsurance that covers only theemployee. “Family coverage” is forthe employee and the employee’sfamily. If a plan offers more thanone arrangement for familycoverage, the survey asks forpremium information for a family offour.

The premium data in MEPS do

not assume a standardized packageof benefits for all health insuranceplans. Because plans offer variousbenefits, higher premiums in a Statemay indicate that the plans in thatState offer more generous benefits.The variations in premiums by Statealso reflect differences in medicalcosts, enrollment patterns, Stateregulations, and plan types.
Medical Expenditure Panel Survey

Agency for Healthcare Research and Quality

5

Access Job-related insurance plays a critical role in covering American workers and their families. Yet many workers may not receive needed medical care and are exposed to catastrophic financial risk because they do not have access to such coverage. In fact, among working- age Americans who are uninsured, more than two-thirds are employed

(Vistnes and Monheit, 1997).
Medical Expenditure Panel Survey

which States are establishments most likely

to offer health insurance to their workers?

Percent of private-sector establishments offering healthinsurance, 1996National average = 53.2%

Top third, 55.3%-83.8%Middle third, 50.7%-55.1%Bottom third, 42.5%-49.8%Significantly different from national averageat 5% levelSignificantly different from national averageat 1% levelData not available

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Agency for Healthcare Research and Quality

7

Medical Expenditure Panel Survey

tablishments were most

ely to offer insurance to at

st some of their employees

Hawaii (83.8%), where

mployers are mandated by

ate law to offer coverage to

ost workers. The other

ates where establishments

were most likely to offerhealth insurance wereOhio (61.4%),Massachusetts (60.1%),Pennsylvania (60.0%), andMichigan (58.6%).

• In 14 States, less than half of

the establishments offeredhealth insurance. Offer rateswere lowest in Mississippi(42.5%), Arkansas (45.3%),and Oklahoma (45.7%).
Medical Expenditure Panel Survey

ge-firm establishments more likely to

fer health insurance across the States?

establishments offering health insurance, 1996

age = 93.8%

Top third, 96.4%-99.7%Middle third, 93.2%-95.7%Bottom third, 83.9%-93.1%Significantly different from national average at 5% levelSignificantly different from national average at 1% levelData not available

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Agency for Healthcare Research and Quality

9

Medical Expenditure Panel Survey

every State, establishments

t were part of large firms

0 or more employees) were

re likely than those in small

ms to offer insurance.

• In Hawaii, nearly four out of five

small-firm establishments offeredhealth insurance (79.7%), compared to the next-highest rate inMassachusetts, where just overhalf of such establishmentsoffered insurance (50.8%).

ent of establishments offering health insurance, 1996

l firms

nal average = 42.1%

Top third, 44.6%-79.7%Middle third, 39.4%-44.3%Bottom third, 28.2%-39.1%Significantly different from national averageat 5% levelSignificantly different from national averageat 1% levelData not available

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When health insurance is offered at the

workplace, does the likelihood that workers

will be eligible for coverage vary by State?

Medical Expenditure Panel Survey

When an establishment offers

insurance, not all of its workers maybe eligible for coverage. Part-timeemployees may be ineligible. Newemployees may be excluded untilthey have completed a waitingperiod. Workers with pre-existingconditions also may not be eligible.(See Note 2.)

• Employees in firms offering

insurance were most likely to beeligible for coverage in Maine(88.5%), Ohio (87.4%), andSouth Carolina (87.2%).

• Eligibility was least likely for

employees in Nevada (72.9%)and Nebraska (74.6%).
ent of employees eligible for insurance in establishments

ing health insurance, 1996

nal average = 81.5%

Top third, 83.3% -88.5%Middle third, 80.6%-83.1%Bottom third, 72.9%-79.3%Significantly different from national averageat 5% levelSignificantly different from national averageat 1% levelData not available

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Agency for Healthcare Research and Quality

11

Medical Expenditure Panel Survey
Medical Expenditure Panel Survey

Are full-time employees more likely than

part-time employees to be eligible for

coverage across the States?

employees eligible for insurance in establishments offering

ance, 1996

ge = 89.8%

Top third, 90.9%-93.8%Middle third, 89.4%-90.7%Bottom third, 80.8%-89.1%Significantly different from national average at 5% levelSignificantly different from national average at 1% levelData not available

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Agency for Healthcare Research and Quality

13

Medical Expenditure Panel Survey

in eligibility

nd part-time

significant in

• The gap in the eligibility rates

between full- and part-timeemployees was smallest in Hawaii(90.4% for full-time, 62.2% forpart-time) and Maine (93.8% forfull-time, 63.3% for part-time),although the difference was stillsignificant.

• The difference was greatest in

Arkansas, where 91.7% of fulltime employees in establishmentsthat offered insurance wereeligible, compared to only 13.0%of part-time employees.

mployees eligible for insurance in establishments offering health

96

 = 33.7%

Top third, 38.1%-63.3%Middle third, 29.1%-37.6%Bottom third, 13.0%-27.2%Significantly different from national average at 5% level

Significantly different from national average at 1% level

Data not available

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Note: Estimates for the following States do not meet standard of reliability or precision:Arkansas, Kansas, Louisiana, Nevada,Tennessee, and Texas.
Even when workers are eligible

for job-related insurance, they maychoose not to enroll. They mayalready be covered through theirspouse’s employer, or they may thinkthat the premiums are too expensiveor that they do not need healthinsurance.

• Among workers eligible for

coverage through their job, thosein Utah were the least likely toenroll (81.5%).

• Enrollment rates were at least

90% in four States–Washington(91.3%), Mississippi (91.3%),Tennessee (90.4%), and Indiana(90.0%).

Medical Expenditure Panel Survey

In which States are workers who are

eligible for coverage most likely to enroll?
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Agency for Healthcare Research and Quality

15

Medical Expenditure Panel Survey

ent enrolled among employees eligible for job-related insurance,

6

nal average = 85.4%

Top third, 87.4%-91.3%Middle third, 84.2%-87.3%Bottom third, 80.1%-84.0%Significantly different from national average at 5% levelSignificantly different from national average at 1% levelData not available

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Medical Expenditure Panel Survey

Across States, are employees in large firms

more likely to enroll?

nrolled among employees eligible for job-related single

coverage, 1996

age = 86.5%

Top third, 88.8%-92.4%Middle third, 86.3%-88.6%Bottom third, 79.4%-85.6%Significantly different from national average at 5% levelSignificantly different from national average at 1% levelData not available

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Agency for Healthcare Research and Quality

17

Medical Expenditure Panel Survey

e disparity in enrollment

es between large and small

ms was significant in 16

tes.

• In no State were enrollment

rates significantly higher insmall firms than in largefirms.

• Enrollment rates among

workers in small firms werelowest in Massachusetts(69.9%).

ent enrolled among employees eligible for job-related single

rance coverage, 1996

l firms

nal average = 81.2%

Top third, 82.9%-88.4%Middle third, 79.4%-82.5%Bottom third, 69.9%-78.8%Significantly different from national average at5% levelSignificantly different from national average at1% levelData not available

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Medical Expenditure Panel Survey

Agency for Healthcare Research and Quality

19

Cost Many employers may not offer insurance because of the cost. Even

when they do offer coverage, theportion of the premium thatworkers must pay may place suchcoverage out of reach for manyAmericans.
Does the average total health insurance

premium for single coverage vary across

States?

Medical Expenditure Panel Survey

he total health insurance

m for job-related coverage

s of contributions by both the

yer and the employee. The 

variations by State reflect differences inmedical costs, enrollment patterns,State regulations, and the generosity ofhealth plan benefits and plan types.

• All of the States where the annual

premium was higher than thenational average were in theNortheast–Connecticut ($2,486),New Jersey ($2,380),Massachusetts ($2,316), and NewYork ($2,183).

• Premiums were below the

national average in nine States,including five where thepremiums were less than$1,800–South Carolina ($1,568),New Mexico ($1,714), Arkansas($1,724), Oklahoma ($1,736),and Arizona ($1,780).

otal premium for job-related single

 coverage, 1996

rage = $1,997

Top third, $1,998-$2,486Middle third, $1,910-$1,992Bottom third, $1,568-$1,905Significantly different from national averageat 5% levelSignificantly different from national averageat 1% levelData not available

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e employee contribution

s highest in Massachusetts

518), New Mexico ($513),

d Alabama ($478).

• In eight States, the employee

contribution was less thanthe national average of $338.The contribution in three of 

these States was less than$250–Hawaii ($198),Michigan ($205), andOregon ($237).

Agency for Healthcare Research and Quality

21

Medical Expenditure Panel Survey

here do workers pay the most for single

verage?

★

rage annual employee contribution for job-related single insurance

rage, 1996

nal average = $338

Top third, $372-$518Middle third, $303-$349Bottom third, $198-$299Significantly different from national averageat 5% levelSignificantly different from national averageat 1% levelData not available

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Note: Estimate for Washington does not meetstandard of reliability or precision.
Does the average total health insurance

premium for family coverage vary among

States?

alth insurance

related coverage

butions by both the

 employee. The

variations by State reflect differencesin medical costs, enrollment patterns,State regulations, and the generosityof health plan benefits and plantypes.

• The family premiums exceeded

the national average in sevenStates–Massachusetts ($6,016),New Jersey ($5,870),Connecticut ($5,656), New York($5,360), Hawaii ($5,350),Illinois ($5,338), and Maine($5,142).

•The family premiums were below

the national average in 14 States,including 6 where the premiumswere less than $4,500–SouthCarolina ($4,041), New Mexico($4,142), Arkansas ($4,197),Nevada ($4,455), Oregon($4,462), and Washington($4,468).

Medical Expenditure Panel Survey

tal annual premium for job-related family

overage, 1996

ge = $4,953

Top third, $5,026-$6,016Middle third, $4,720-$4,988Bottom third, $4,041-$4,708Significantly different from national average at 5% levelSignificantly different from national average at 1% levelData not available

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Note: The average in California is $4,782, which is significantly below the nationalaverage.

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e average employee

ntribution was above thetional average in Florida

2,165), Alabama ($1,920),

lorado ($1,703), North

Carolina ($1,695), andVirginia ($1,656).

• It was below the national

average in Michigan ($757), 

Ohio ($920), Utah($1,178), Wisconsin($1,180), and Arkansas($1,197).

Agency for Healthcare Research and Quality

23

Medical Expenditure Panel Survey

o workers in different States pay the same

r family coverage?

Average annual employee contribution for job-related familyinsurance coverage, 1996National average = $1,439

Top third, $1,550-$2,165Middle third, $1,320-$1,530Bottom third, $757-$1,308Significantly different fromnational average at 5% levelSignificantly different fromnational average at 1% levelData not available

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he average employee contribution for single

verage ranged from less than 10% of the total

emium (Hawaii) to nearly 30% (New

exico).

• For family coverage, employees contributed

anywhere from 15.9% (Michigan) to 43.4%(Florida).

Medical Expenditure Panel Survey

What percent of the premium for single and

family coverage do employees pay across

States?

otal premium for job-related insurance paid by worker, 1996

ge

ge = 16.9%

Top third, 17.9%-29.9%Middle third, 15.8%-17.8%

Bottom third, 9.8%-15.7%Significantly different from national average

at 5% levelSignificantly different from national averageat 1% levelData not available

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Note: Estimate for Washington does not meet standard of reliability or precision.
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e employee contribution

e was higher for family

verage than for singleverage in all but four States

assachusetts, New Mexico,

est Virginia, and

nnsylvania).

• The difference between the

employee contribution ratefor family coverage and singlecoverage was greatest inOregon (23.9 percentagepoints) and Oklahoma (20.6percentage points).

• Workers contributed less than

one-quarter of the totalpremiums for family coveragein Michigan, Ohio,Wisconsin, Connecticut,Illinois, New York, and Utah.

Agency for Healthcare Research and Quality

25

Medical Expenditure Panel Survey

ent of total premium for job-related insurance paid by worker,

6

ly coverage

nal average = 29.1%

Top third, 32.3%-43.4%Middle third, 28.0%-31.3%Bottom third, 15.9%-26.7%Significantly different from national average at5% levelSignificantly different from national average at1% levelData not available

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Medical Expenditure Panel Survey

Agency for Healthcare Research and Quality

27

Choice Health insurance plans differ in important ways. Some restrict

enrollees’ choice of providers, whileothers do not. Some plans require ahigher fee for a doctor’s visit thanothers do. With a choice of plans,workers can choose the plan thatbest meets their needs in terms ofboth benefits and cost.
which States are establishments most likely

offer a choice of health insurance plans?

Medical Expenditure Panel Survey

tablishments were most

ely to offer a choice of

ans in California (28.9%),

nnessee (28.6%), New York

7.9%), Hawaii (27.6%), and

assachusetts (27.0%).

• They were least likely to offer

a choice of plans in theMidwest and South–Wisconsin (11.6%),Mississippi (11.7%), Alabama

(12.9%), Minnesota (13.0%),Kansas (15.4%), andMichigan (17.7%).

cent that have two or more plans among establishments offering

rance, 1996

onal average = 21.8%

Top third, 22.4%-28.9%Middle third, 18.5%-21.9%

Bottom third, 11.6%-18.1%Significantly different from national average

at 5% levelSignificantly different from national averageat 1% levelData not available

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conventional indemnity

 one in which enrollees

 to the physicians of their

 on a fee-for-service basis.

an does not have any

ers associated with it.

• Most of the States where

establishments were morelikely to offer indemnityplans were in the eastern partof the United States.

• Only in West Virginia

(51.7%) and Maine (51.0%)did more than half ofestablishments offeringinsurance have an indemnityplan.

• Most of the States where

indemnity plans were leastlikely to be offered were inthe West.

• Less than one in seven

establishments that offeredinsurance in California(13.6%) had indemnity plans.

Agency for Healthcare Research and Quality

29

Medical Expenditure Panel Survey

here are establishments most likely to offer

nventional indemnity plans?

ent that have at least one conventional

mnity plan among establishments offering

rance, 1996

nal average = 28.1%

Top third, 32.3%-51.7%Middle third, 25.3%-32.1%Bottom third, 13.6%-24.8%Significantly different from national averageat 5% levelSignificantly different from national averageat 1% levelData not available

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d care plan,

ricted in their choice

ave a financial

o a preferred

ed care plans

include both exclusive provider planssuch as health maintenanceorganizations (HMOs) and preferredprovider plans such as preferredprovider organizations (PPOs) andpoint-of-service plans (POSs).

• Managed care plans were

available in more than 9 out of10 establishments in California(93.0%) and Massachusetts(92.7%) that offered insurance.

• They were least often available in

West Virginia (51.7%) and Maine(57.9%). In fact, in every Statebesides these two, establishmentswere significantly more likely tooffer a managed care plan than aconventional indemnity plan.

Where are establishments most likely to

offer managed care plans?

Medical Expenditure Panel Survey

t have at least one managed care plan

blishments offering insurance, 1996

ge = 79.0%

Top third, 82.9%-93.0%Middle third, 74.7%-82.1%Bottom third, 51.7%-74.2%Significantly different from national averageat 5% levelSignificantly different from national averageat 1% levelData not available

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Agency for Healthcare Research and Quality

31

Medical Expenditure Panel Survey

here are establishments most likely to offer

clusive provider plans?

xclusive provider plans (for

le, HMOs) require that

ees go to providers

ted with the plan except in

ergency. There is typically

no cost or a small fixed cost foreach physician visit.• Establishments offering

insurance in Massachusetts 

(61.8%) and California(60.5%) were nearly twice aslikely as establishmentsnationwide to offer an exclusive provider plan.

• In general, those in the

South and Midwest weremuch less likely to offer suchplans to their workers.

• In Mississippi, exclusive

provider plans were availablein only a tenth ofestablishments that offeredinsurance.

ent that have at least one exclusive

der plan among establishments offering

rance, 1996

nal average = 32.7% 

Top, 38.2%-61.8%Middle, 26.7%-36.4%Bottom, 10.1%-25.2%Significantly different from national averageat 5% levelSignificantly different from national averageat 1% levelData not available

★

‡

‡

‡

‡

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‡

‡

‡

‡

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Medical Expenditure Panel Survey

Where are establishments most likely to

offer preferred provider plans?

d provider plan (for

 POS), enrollees can

referred” providers

he plan or to other

providers of their choice. If they goto a nonpreferred provider, they facehigher out-of-pocket costs.

• The four States in which

establishments offering insuranceare most likely to offer preferredprovider plans are located in thecentral United States–Missouri(72.2%), Oklahoma (70.5%),Texas (68.9%), and Illinois(67.8%).

• Of the six States in which

establishments are least likely tooffer such plans, five are in theeastern United States–WestVirginia (40.2%), Maine (41.4%),Massachusetts (42.4%),Pennsylvania (45.6%), andConnecticut (46.2%).

t have at least one preferred provider

 establishments offering insurance, 1996

ge = 55.5%

Top third, 61.6%-72.2%Middle third, 53.2%-61.0%Bottom third, 40.2%-52.9%Significantly different from national averageat 5% levelSignificantly different from national averageat 1% levelData not available

★

‡

‡

‡ 

‡

★

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★

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★

‡

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★

★

‡

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Medical Expenditure Panel Survey

Agency for Healthcare Research and Quality

33

Future MEPS

Data on State

Differences in

Job-Related

Health

Insurance

These data provide a snapshot of

State differences in job-related healthinsurance in 1996. Future MEPS datacan be used to follow trends overtime, as well as to provide additionalinsights into differences betweenStates.
Medical Expenditure Panel Survey

All the data shown in this

chartbook appear on the MEPSWeb site<http://www.meps.ahrq.gov/data.htm> and are available free on CDROM (AHCPR No. 99-DP07).The following references were usedfor the description and discussion.

Branscome JM, Cooper PF, Sommers J, et

al. Private employer-sponsored healthinsurance: new estimates from the 1996MEPS-IC. Health Affairs 2000 Jan.-Feb.;19(1).

Cohen JW, Monheit AC, Beauregard KM,

et al. The Medical Expenditure PanelSurvey: a national health informationresource. Inquiry 1996;33:373-89.

Cooper PF, Schone BS. More offers, fewer

takers for employment-based healthinsurance: 1987 and 1996. HealthAffairs 1997;16(6):142-9.

Sommers JP. List sample design of the

1996 Medical Expenditure Panel SurveyInsurance Component. Rockville (MD):Agency for Health Care Policy andResearch; 1999. MEPS MethodologyReport No. 6. AHCPR Pub. No.99-0037.

State of Hawaii Department of Labor and

Industrial Relations. Digest of Chapters386, 392, and 393: Hawaii Workers’Compensation, Temporary DisabilityInsurance and Prepaid Health CareLaws. Form DC-1, revised Oct. 1992.

Vistnes JP, Monheit AC. Health insurance

status of the civilian noninstitutionalizedpopulation: 1996. Rockville (MD):Agency for Health Care Policy andResearch; 1997. MEPS ResearchFindings No. 1. AHCPR Pub. No.97-0030.
Medical Expenditure Panel Survey

Agency for Healthcare Research and Quality

35

Note 1: Private employers in Hawaii are not required to offer health

insurance to the following workers: Federal, State, and countyworkers; workers employed for less than 20 hours a week;agricultural seasonal workers; insurance and real estate salesmenpaid solely by commission; individuals working for son, daughter,or spouse; children under age 21 working for father or mother;workers covered as dependents under a qualified health care plan;workers covered by State-governed medical assistance; or workersreceiving public assistance. To be covered under the mandate,workers must have worked four consecutive weeks of 20 or morehours a week and earned monthly wages of at least 86.67 timesthe Hawaii minimum hourly wage, which is presently the Federalminimum wage of $5.25. Employers are required to pay at leasthalf of the premium cost. 

Note 2: The 1996 MEPS IC data were obtained prior to implementation

of the Health Insurance Portability and Accountability Act(HIPAA), which requires that insurers not deny coverage to aworker on the basis of health status. Employers may refuse tocover a pre-existing condition for up to 12 months for newemployees, but employees can reduce the length of that waitingperiod by the length of prior coverage.
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37

Medical Expenditure Panel Survey

Agency for Healthcare Research and Quality 

free CD-ROM: 

01: 1996 Employer-Sponsored Health Insurance Data Tables by State and by Establishment 

cs. 

blications Clearinghouse 

P07 

8547 

ng, MD 20907

8-9295 and ask for AHCPR 99-DP07.

nd other data, visit the MEPS Web site at:

w.meps.ahrq.gov