Age Race/Ethnicity Employment

www.ahrq.gov

Agency for Healthcare Research and Quality

MEPS Chartbook No. 9

Medical Expenditure Panel Survey

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The Uninsured in America:

1996-2000
Suggested citation:

Rhoades JA,Vistnes JP, Cohen JW.The uninsured in America: 1996-2000. Rockville (MD):Agency for Healthcare Research and

Quality; 2002. MEPS Chartbook No. 9.AHRQ Pub. No. 02-0027.

The estimates in this report are based on the most recent data available from MEPS at the time the report was written. However, selected

elements of MEPS data may be revised on the basis of additional analyses, which could result in slightly different estimates from those shown

here. Please check the MEPS Web site for the most current file releases—

www.meps.ahrq.gov

AHRQ is the lead Federal agency charged with supporting research designed to improve the quality of health care, reduce its cost, address

patient safety and medical errors, and broaden access to essential services.AHRQ sponsors and conducts research that provides evidence-based

information on health care outcomes; quality; and cost, use, and access.The information helps health care decisionmakers—patients and clinicians,

health system leaders, and policymakers—make more informed decisions and improve the quality of health care services.

MEPS Chartbook No. 9 by:

Jeffrey A. Rhoades, Ph.D.

Jessica P.Vistnes, Ph.D.

Joel W. Cohen, Ph.D.
Medical Expenditure Panel Survey Agency for Healthcare Research and Quality

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i The percent of the population

uninsured at some point during the year declined from 27.0% in 1996 to

25.1% in 1999.

The number of uninsured Americans

under age 65 varied up to twofold

depending on the time period used

to define being uninsured. Numbers

were highest for Americans

uninsured at some point during the year, lowest for those uninsured all year, and in between for those

uninsured throughout the first half of

the year.

The percent of children who were

uninsured all year declined from

10.4% in 1996 to 7.8% in 1999.

Of all age groups, young adults (ages

18-24) are the most likely to be

uninsured. In each year 1996-99,

5 to 6 million young adults were

uninsured all year and roughly 11

million were uninsured at some point

during the year.

executive summary

This report shows changes between 1996 and 2000 in the non-elderly

population's risk of being uninsured.

Overview

Age

Hispanics were the racial/ethnic

group most at risk of lacking

coverage. In 1996, close to 30% of

non-elderly Hispanics were

uninsured all year, compared to 10%

of whites.

Estimates for both whites and blacks

indicate an improvement from 1996

to 1999 in the risk of being

uninsured, but Hispanics did not experience any improvement.

Racial/Ethnic Groups

Employment

In early 2000, wage-earners with low

hourly wages were about 10 times

more likely to be uninsured than

those with high hourly wages.

In each year from 1996 through

2000, wage earners in small

establishments were at much greater

risk of being uninsured than those in

larger establishments.

1 Introduction

3 Source of Data

5 Section 1

Overview

9 Section 2

Age

17 Section 3

Racial/Ethnic Groups

25 Section 4

Employment

31 Conclusions

33 References

34 Definitions of Terms

Medical Expenditure Panel Survey Agency for Healthcare Research and Quality

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iii

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contents
Estimates of the health

insurance status of the U.S. civilian

noninstitutionalized (community)

population are critical to

policymakers and others concerned

with access to medical care and the

cost and quality of that care. Health

insurance helps people get timely

access to medical care and protects

them against the risk of expensive

and unanticipated medical events.

Compared to people with health

care coverage, uninsured people are

less likely to visit a doctor, have a

usual source of medical care, receive

preventive services, or have a recommended test or prescription

filled (Taylor, Cohen, and Machlin,

2001; Weinick, Zuvekas, and Drilea,

1997).

Timely and reliable estimates of

the population's health insurance

status are essential to evaluate the

costs and expected impact of public

policy interventions in this area,

such as efforts to expand coverage

or to alter the way in which private

and public insurance is financed.

Identification of population groups

particularly likely to lack coverage is

essential for developing efficient and

targeted policy interventions.

The Medical Expenditure Panel

Survey (MEPS), a household survey

that is conducted annually, provides

critical data for evaluating trends in

the health insurance status of the

population. This chartbook presents

data from the first year of the

survey, 1996, through 2000. Unless

otherwise noted, only differences

that are statistically significant at the

0.05 level are discussed in the text.

Following an overview of the

uninsured in America (Section 1),

this chartbook examines the

problem of lack of insurance in

terms of predictors of insurance

status: age (Section 2),

race/ethnicity (Section 3), and

employment status (Section 4). Visit the MEPS Web site for recent data and publications—

www.meps.ahrq.gov

MEPSnet, on the MEPS Web

site, provides easy access to statistics

on the Nation’s health care use,

expenses, sources of payment, and

insurance coverage.

Medical Expenditure Panel Survey Agency for Healthcare Research and Quality

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introduction

1
MEPS

The estimates presented in this

report come from the Medical

Expenditure Panel Survey (MEPS)

Household Component. MEPS is

cosponsored by the Agency for

Healthcare Research and Quality

(AHRQ) and the National Center

for Health Statistics (NCHS). It is a

nationally representative survey of

the U.S. civilian noninstitutionalized

population that collects data on

medical expenses for both

individuals and households. MEPS

collects detailed data on

demographic characteristics, health

conditions, health status, use of

medical care services, charges and

payments, access to care, satisfaction

with care, health insurance

coverage, income, and employment.

Other MEPS components collect

data on the use, charges, and

payments reported by medical care

providers; data on residents of

licensed or certified nursing homes;

and data on the supply side of the

health insurance market.

The sample for the MEPS

Household Component is representative of the U.S.

community population. It was

designed to sample enough

Hispanics and blacks to allow valid

estimates for these subpopulations.

For a detailed description of the

MEPS survey design, see J. Cohen

(1997) and S. Cohen (1997).

MEPS data are released to the

public in a number of formats,

including public use data files and

the printed MEPS Research Findings

and MEPS Highlights series. The

numbers shown in this chartbook

are drawn from analyses conducted

by the MEPS staff from the

following public use files:

1996-98 Full Year Consolidated

Data Files, HC-012, HC-020, and

HC-028, respectively; 1999 Full Year Population Characteristics Data

File HC-031; and 1996-2000 Point

in Time Data Files (HC-001,

HC-005, HC-009, HC-013,

HC-022).

Medical Expenditure Panel Survey Agency for Healthcare Research and Quality

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source of data

3
Agency for Healthcare Research and Quality

4

Medical Expenditure Panel Survey

Comparisons

with other

surveys

Estimates of the uninsured vary

among surveys depending on the

definition each survey uses of being

uninsured (e.g., the time period and

types of coverage counted as

insurance) and the methods by

which the data are collected.

Although estimates from MEPS, the

Census Bureau's Current

Population Survey (CPS), and the

National Health Interview Survey

(NHIS), conducted by the National

Center for Health Statistics, are

different for a given year, the trends

tend to be similar. For example,

both MEPS and the CPS show that

the percentage of the population

that was uninsured the entire year

declined from 1997 to 1999.

For a detailed explanation of

possible reasons for differences

among survey estimates, see

"Understanding Estimates of the

Uninsured: Putting the Differences

in Context" (Department of Health

and Human Services, 2002) at

http://aspe.hhs.gov/health/reports

/hiestimates.htm.
Overview MEPS produces estimates of

the uninsured for different periods

of time within a year. This

chartbook provides national

estimates of the percent and

number of non-elderly (under age

65) people in the U.S. community

population who were without health

insurance: • For the entire year. • At some point during the year. • Throughout the first half of the

year.

The estimates of the uninsured

are highest for people uninsured at

some point in the year, some of

whom are insured at other times

during the year. They are lowest for

people uninsured all year. Estimates

for people uninsured during the first

half of the year fall somewhere in

between.

Medical Expenditure Panel Survey Agency for Healthcare Research and Quality

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section 1

5
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Agency for Healthcare Research and Quality

6

Medical Expenditure Panel Survey

What percent of the non-elderly U.S. population

were uninsured each year from 1996 to 2000?

• The estimate of the percent of

the population who were

uninsured depends heavily on the

time period used in calculating

the estimates—the first

half of the year, some time

during the year, or the entire

year.

• In 1999, the latest year for which

all three measures are available,

MEPS data indicate that 25.1%

of the population under age 65

were uninsured at some point

during the year, 17.9% were

uninsured throughout the first

half of the year, and 12.2% were

uninsured throughout the entire

year.

• From 1996 to 1999, the percent

of the population uninsured at

some point during the year

declined from 27.0% to 25.1%

and the percent uninsured all

year declined from 13.8% to

12.2%. From 1996 to 1998, the

percent of the population

uninsured during the first half of

the year declined from 19.2% to

17.8%.

0

5

10

15

20

25

30

13.8%

19.2%

27.0%

18.9%

13.9%

26.8%

Percent uninsured

17.8%

13.3%

25.3%

17.9%

12.2%

25.1%

18.2%

1996 1997 1998 1999 2000

Percent

Any time in year

First half of year

Full year
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Agency for Healthcare Research and Quality

7

Medical Expenditure Panel Survey

How many non-elderly people in the U.S.

were uninsured each year?

• The number of people uninsured

varied up to twofold, depending

on the time period used to

define being uninsured. In 1999,

28.9 million people were

uninsured all year, while 59.2

million were uninsured at some

point during the year. The

number uninsured throughout

the first half of 1999 fell between

these two estimates (42.6

million).

• Although the percent uninsured

declined from 1996 to 1999,

there was no statistically

significant decline in the number

of uninsured people over this

time period.

0

10

20

30

40

50

60

70

31.6

44.5

62.0

44.2

32.1

62.2

Number uninsured in millions

42.0

31.0

59.1

42.6

28.9

59.2

43.8

1996 1997 1998 1999 2000

Millions

Any time in year

First half of year

Full year
Age Policymakers have focused their

attention on the insurance status of

a number of different age groups in

recent years, including children

under age 18 and the near-elderly

(ages 55-64). For example, in 1997,

Congress passed the State

Children's Health Insurance

Program (SCHIP), which was

designed to reduce the number of

uninsured children. Because the

period 1997-99 covered the early

stages of implementation of the

SCHIP program, examination of

these data provides some indication

of how the number of uninsured

children changed during the early

phase of the program. Policymakers

have also been concerned about the

difficulties near-elderly people may

face in getting and keeping health

insurance coverage, given the

increased risk of illness with age.

The next set of charts examines

the risk of being uninsured by age

and shows whether the decline for

the overall non-elderly population

was experienced by all or only some

age groups.

Medical Expenditure Panel Survey Agency for Healthcare Research and Quality

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section 2

9
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• Young adults, ages 18-24, were

most likely to be uninsured in

1996. Close to one-quarter of

young adults lacked coverage

throughout 1996 and a little

over 45% were uninsured any

time during the year. The

comparable figures for all nonelderly people were 13.8% and

27.0%, respectively.

• Children under age 18 and nearelderly people (55-64) had the

lowest rates of being uninsured

all year: 10.4% and 10.8%,

respectively.

Agency for Healthcare Research and Quality

10

Medical Expenditure Panel Survey

Which age groups were most likely to lack

health insurance in 1996?

0

10

20

30

40

50

13.8%

10.4%

Percent uninsured all year

Total Under 18 18-24 25-54

Percent

14.4%

10.8%

55-64

22.7%

27.0%

24.0%

45.5%

26.5%

17.9%

Any time in year

Full year
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Agency for Healthcare Research and Quality

11

Medical Expenditure Panel Survey

How has the percent of children who are

uninsured changed from 1996 to 1999?

• The percent of children

uninsured all year declined from

10.4% in 1996 to 7.8% in 1999.

The number of uninsured

children declined by 1.6 million,

from 7.0 million in 1996 to 5.4

million in 1999.

• The number and percent of

children uninsured at some point

during the year also declined over

this time period, but these

changes were not statistically

significant.

• In each year, the number and

percent of children uninsured

sometime during the year were

more than double the estimates

for children uninsured all year.

For example, in 1999, 14.8

million children were uninsured

at some point during the year but

only 5.4 million children were

uninsured all year.

0

5

10

15

20

25

30

24.0%

10.4%

23.5%

10.4% 9.4%

21.8%

1996 1997 1998 1999

Percent

Any time in year

Full year

21.6%

7.8%

0

2

4

6

8

10

12

14

16

18

7.0

16.2

7.1

16.0

6.5

15.0

5.4

14.8

1996 1997 1998 1999

Millions

Any time in year

Full year

Percent of children uninsured Number of uninsured children in millions
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Agency for Healthcare Research and Quality

12

Medical Expenditure Panel Survey

Did the decline in the number of uninsured

children between 1996 and 1999 come from a

change in public or private coverage?

• The percent of children under age 18 who were

uninsured all year declined by 2.5 percentage points,

with public coverage and private coverage

contributing 1.2 and 1.3 percentage points,

respectively, to that decline. While the overall decline

was significant, the individual changes in public and

private coverage were not statistically significant.

• The increase in the number of insured children came

from increases in both public and private coverage:

1.0 million and 1.4 million, respectively. Again,

however, the individual changes for public and

private coverage were not statistically significant.

0

10

20

30

40

50

60

70

10.4%

16.9%

58.8%

18.4%

10.4%

58.3%

18.4%

9.4%

60.2%

18.1%

7.8%

60.1%

1996 1997 1998 1999

Percent

Private

Public

Uninsured

Note: Percents add to less than 100 because people who did not have the same insurance 

status all year were not included.

0

5

10

15

20

25

30

35

40

45

7.0

11.4

39.8

12.6

7.1

39.7

12.7

6.5

41.4

12.4

5.4

41.2

1996 1997 1998 1999

Millions

Private

Public

Uninsured

Note: People who did not have the same insurance status all year were not included.

Percent of children by all-year insurance status Number of children by all-year insurance status
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Agency for Healthcare Research and Quality

13

Medical Expenditure Panel Survey

Has the insurance status of the age group most

at risk of being uninsured, young adults,

improved over time?

• In 1996, close to one-half of all

young adults ages 18-24

experienced a period of being

uninsured during the year and

close to one-quarter were

uninsured all year.

• There was no significant change

in the health insurance status of

this age group from 1996 to

1999.

• In each year from 1996 to 1999,

about 51/2 million young adults

were uninsured all year and

roughly 11 million were

uninsured at some point during

the year.

0

10

20

30

40

50

22.7%

45.5%

21.5%

44.9%

22.5%

42.8%

21.2%

43.8%

1996 1997 1998 1999

Percent

Any time in year

Full year

0

2

4

6

8

10

12

5.6

11.3

5.3

11.0

5.6

10.6

5.5

11.3

1996 1997 1998 1999

Any time in year

Full year

Percent of young adults uninsured Number of uninsured young adults in millions Millions
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Agency for Healthcare Research and Quality

14

Medical Expenditure Panel Survey

Has the insurance status of adults ages

25-54 changed between 1996 and 1999?

• In each year from 1996 to 1999,

about one-quarter of all adults

ages 25-54 experienced a period

of being uninsured during the

year. Between 13% and 15% were

uninsured throughout the year.

• Roughly 29 to 31 million adults

this age were without insurance

at some point during the year,

and 15-17 million were

uninsured all year. These

numbers represent close to half

of the total non-elderly uninsured

population.

• The percent of adults ages 25-54

uninsured either all year or at

some point during the year

declined between 1997 and

1999. There was no significant

change in the number of

uninsured adults in this age

group.

0

5

10

15

20

25

30

14.4%

26.5%

14.7%

26.6%

14.1%

25.3%

13.0%

24.6%

1996 1997 1998 1999

Percent

Any time in year

Full year

0

5

10

15

20

25

30

35

16.8

30.8

17.3

31.2

16.6

29.8

15.4

29.2

1996 1997 1998 1999

Any time in year

Full year

Millions

Percent of adults ages 25-54 uninsured Number of uninsured adults ages 25-54 in millions
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Agency for Healthcare Research and Quality

15

Medical Expenditure Panel Survey

Did the insurance status of near-elderly people,

ages 55-64, change between 1996 and 1999?

• There was no change in the

insurance status of the nearelderly population over the 4-year

period examined. About 10% to

11% of near-elderly people were

uninsured throughout the year

and 16% to 18% were uninsured

at some point during the year.

• Roughly 2 to 3 million nearelderly individuals were

uninsured throughout each year

and about 4 million were

uninsured at some point during

each year. These numbers do not

represent a large proportion of

the total uninsured population.

However, people ages 55-64

have attracted policy interest

because a lack of insurance

coverage could be particularly

serious given the increased risk of

illness with age.

0

5

10

15

20

10.8%

17.9%

11.3%

18.0%

10.4%

16.4%

11.1%

16.9%

1996 1997 1998 1999

Percent

Any time in year

Full year

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

2.2

3.7

2.4

3.9

2.3

3.7

2.6

3.9

1996 1997 1998 1999

Any time in year

Full year

Percent of near-elderly people uninsured Number of uninsured near-elderly people in millions Millions
Racial/Ethnic

Groups

Historically, there have been

significant disparities in rates of

insurance coverage for different

racial/ethnic groups. Previous

research has shown that Hispanics,

especially Hispanic males, are at

particularly high risk of being

uninsured (Monheit and Vistnes,

2000; Fronstin, Goldberg, and

Robins, 1997). Previous charts

indicated that the risk of being

uninsured throughout an entire year

declined for the population as a

whole. The next set of charts

examines levels of risk by

race/ethnicity and whether the

decline for the overall population

was experienced by all or only some

racial/ethnic groups.

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section 3

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• Hispanics were the most likely to

lack coverage both throughout

1996 and any time during 1996.

Nearly 30% of Hispanics were

uninsured all year, and 46.4%

were uninsured any time during

the year.

• Rates of being uninsured all year

for other racial/ethnic groups

were substantially lower than

rates for Hispanics: 17.4% for

blacks, 10.5% for whites, and

16.6% for other racial/ethnic

groups.

Agency for Healthcare Research and Quality

18

Medical Expenditure Panel Survey

Which racial/ethnic group was most likely

to lack coverage in 1996?

0

10

20

30

40

50

13.8%

10.5%

Percent uninsured all year

Total White Black Hispanic

Percent

28.7%

16.6%

Other

17.4%

28.2%

46.4%

35.9%

22.1%

27.0%

Any time in year

Full year
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• The risk of being uninsured all

year declined for whites from

10.5% in 1996 and 10.8% in

1997 to 8.8% in 1999. The

estimate for being uninsured at

some point during the year also

fell, from 22.3% in 1997 to

20.4% in 1999.

• The number of non-elderly white

people uninsured the entire year

fell from 17.5 million in 1997 to

14.4 million in 1999.

Agency for Healthcare Research and Quality

19

Medical Expenditure Panel Survey

How has the risk of being uninsured changed

for white Americans between 1996 and 1999?

0

5

10

15

20

25

10.5%

22.1%

10.8%

22.3%

10.0%

20.9%

8.8%

20.4%

1996 1997 1998 1999

Percent

Any time in year

Full year

0

5

10

15

20

25

30

35

40

16.9

35.8

17.5

36.4

16.4

34.3

14.4

33.6

1996 1997 1998 1999

Any time in year

Full year

Millions

Percent of white Americans uninsured Number of uninsured white Americans in millions
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• For blacks the risk of being

uninsured at some point during

the year declined from 35.9% in

1996 to 29.4% in 1999.

• There was no significant change

between 1996 and 1999 in the

number of non-elderly black

people uninsured either at some

point during the year or all year. 

Agency for Healthcare Research and Quality

20

Medical Expenditure Panel Survey

How has the risk of being uninsured changed

for black Americans between 1996 and 1999?

0

5

10

15

20

25

30

35

40

17.4%

35.9%

16.3%

32.7%

16.4%

30.3%

15.8%

29.4%

1996 1997 1998 1999

Percent

Any time in year

Full year

0

2

4

6

8

10

12

5.2

10.7

4.9

9.9

5.0

9.3

4.9

9.1

1996 1997 1998 1999

Any time in year

Full year

Percent of black Americans uninsured Number of uninsured black Americans in millions Millions
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• Hispanics, the racial/ethnic

group most at risk of being

uninsured, did not experience a

statistically significant change in

the percent uninsured (either all

year or any time during the year)

over this time period.

• There was no statistically

significant change between 1996

and 1999 in the number of nonelderly Hispanic people

uninsured at some point during

the year or all year.

Agency for Healthcare Research and Quality

21

Medical Expenditure Panel Survey

How has the risk of being uninsured changed

for Hispanic Americans between 1996 and

1999?

0

10

20

30

40

50

28.7%

46.4%

29.1%

46.1%

28.0%

43.8%

27.3%

45.5%

1996 1997 1998 1999

Percent

Any time in year

Full year

0

2

4

6

8

10

12

14

16

7.8

12.6

8.3

13.1

8.1

12.7

8.2

13.7

1996 1997 1998 1999

Any time in year

Full year

Percent of Hispanic Americans uninsured Number of uninsured Hispanic Americans in millions Millions
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• There was no significant change

from 1996 to 1999 in the

percent uninsured (either all year

or any time during the year) for

other racial/ethnic groups, which

include American Indians, Alaska

Natives, Asians or Pacific

Islanders, and other groups.

• There were no significant

changes in the number of

uninsured non-elderly people in

other racial/ethnic groups over

this time period.

Agency for Healthcare Research and Quality

22

Medical Expenditure Panel Survey

How has the risk of being uninsured changed

for other racial/ethnic groups between 1996

and 1999?

0

5

10

15

20

25

30

16.6%

28.2%

14.2%

27.6%

13.6%

28.1%

1996 1997 1998 1999

Percent

Any time in year

Full year

27.5%

12.5%

2000

0.0

0.5

1.0

1.5

2.0

2.5

3.0

1.7

2.8

1.4

2.7

1.3

2.8

1996 1997 1998 1999

Any time in year

Full year

2.8

1.3

Percent of Americans of other races uninsured Number of uninsured Americans of other races in millions Millions
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• Overall, women were less likely

to be uninsured all year than men

in both 1996 and 1999. For

example, in 1999, 10.9% of

women were uninsured

compared to 13.6% of men.

• In both years, Hispanic and

white women were less likely to

be uninsured than their male

counterparts. In 1999, 24.6% of

Hispanic women were uninsured

all year compared to 30.0% of

Hispanic men, and 7.7% of white

women were uninsured

compared to 9.9% of white men.

The differences between black

women and men and between

women and men of other

racial/ethnic groups were not

statistically significant in either

1996 or 1999.

Agency for Healthcare Research and Quality

23

Medical Expenditure Panel Survey

Within racial/ethnic groups, were men or

women more likely to be uninsured?

0

5

10

15

20

25

30

35

15.3%

11.4%

Total White Black Hispanic

Percent

33.8%

16.4%

Other

19.3%

12.3%

9.6%

15.6%

23.3%

16.7%

Males

Females

0

5

10

15

20

25

30

35

13.6%

9.9%

Total White Black Hispanic

Percent

30.0%

13.5%

Other

17.6%

10.9%

7.7%

14.3%

24.6%

11.6%

Males

Females

Percent uninsured all year, 1996 Percent uninsured all year, 1999
Employment The primary source of health

insurance coverage for Americans is

the workplace. However, despite the

fact that most Americans obtain

their health insurance through

employers, employment does not

necessarily lead to health insurance

for many working Americans and

their families. Policymakers have

been particularly concerned about

the difficulties in obtaining health

insurance faced by workers who

earn low wages or are employed by

small firms. The following charts

examine the risk of being uninsured

throughout the first half of the year

in 1996 through 2000 for workingage adults (ages 16-64).

Concentrating on this one type of

estimate of the uninsured makes it

easier to classify workers according

to employment characteristics and

allows the use of the most recent

MEPS data available.

Medical Expenditure Panel Survey Agency for Healthcare Research and Quality

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section 4

25
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• In each year, working-age adults

who were not employed were

more likely to be uninsured than

those who were employed. In

2000, the percent uninsured

throughout the first half of the

year was about 10 percentage

points higher for people who

were not employed (27.2%) than

for those who were (17.3%). 

• Between 1996 and 2000, the risk

of being uninsured throughout

the first half of the year did not

change for working-age adults

who were not employed.

However, it declined from 18.4%

in 1996 to 16.7% in 1998 for

employed individuals.

• Many more working-age

Americans are employed than not

employed (132.5 million vs. 43.2

million individuals in 2000, data

not shown). As a result, the

number of people uninsured was

about twice as high for employed

people (22.9 million in 2000) as

for people who were not

employed (11.7 million).

Agency for Healthcare Research and Quality

26

Medical Expenditure Panel Survey

How is employment status associated with

uninsured status from 1996 to 2000?

0

5

10

15

20

25

30

18.4%

26.4%

18.0%

25.9%

Percent of w orking-a ge America ns uninsured for first half of y ear

16.7%

25.6%

16.8%

27.0%

1996 1997 1998 1999

Percent

Not employed

Employed

27.2%

17.3%

2000 0

5

10

15

20

25

11.2

22.8

10.9

23.0

11.6

21.5

1996 1997 1998 1999

Not employed

Employed

22.9

11.7 10.9

21.3

2000

Millions

Percent of working-age Americans uninsured for first half

of year

Number of working-age Americans uninsured for first half of year

in millions
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Agency for Healthcare Research and Quality

27

Medical Expenditure Panel Survey

• Because part-time workers are

less likely to be offered health

insurance, they are much more

likely than full-time workers to be

uninsured. This pattern is evident

in each year from 1996 to 2000,

with part-time workers about 8

to 10 percentage points more

likely to be uninsured than fulltime workers. 

• Many more workers are

employed full time than part time

(107.3 million vs. 24.5 million

individuals in 2000, data not

shown). As a result, there were

more than 21/2 times as many

full-time as part-time uninsured

workers in 2000 (16.5 million

and 5.9 million, respectively)

even though full-time workers

were at lower risk of being

uninsured.

• There were no statistically

significant changes in the percent

or number of either part-time or

full-time workers who were

uninsured over this period.

Has the risk of being uninsured changed

for part-time and full-time workers?

0

5

10

15

20

25

30

16.1%

26.2%

15.8%

25.2%

14.6%

23.1%

1996 1997 1998 1999

Hours worked per week:

Less than 35

35 or more

24.4%

15.5% 14.8%

22.9%

2000

Percent

0

2

4

6

8

10

12

14

16

18

6.6

15.4

6.4

15.7

5.6

15.2

1996 1997 1998 1999

Hours worked per week:

Less than 35

35 or more

16.5

5.8 5.9

15.1

2000

Millions

Percent of working-age wage-earners uninsured for first half

of year

Number of working-age wage-earners uninsured for first half of year

in millions
An establishment is a particular

workplace (as opposed to a firm,

which can have many establishments

or only one). A wage-earner is a

worker who is not self-employed.

• Each year from 1996 through

2000, wage-earners in small

establishments (less than 25

employees) were much more

likely to be uninsured

throughout the first half of the

year than those in larger

establishments. About onequarter of wage-earners in small

establishments were uninsured

each year, compared to 14-15%

of wage-earners in medium-size

establishments (25-99

employees) and 7-8% in large

establishments (100 or more

employees).

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Agency for Healthcare Research and Quality

28

Medical Expenditure Panel Survey

0

5

10

15

20

25

30

14.2%

26.7%

14.9%

25.2%

14.1%

24.6%

1996 1997 1998 1999

Establishment size:

Less than 25 employees

25-99 employees

100 or more employees

26.0%

14.0% 14.1%

22.6%

2000

8.0% 8.2% 8.0% 7.3% 7.1%

Percent

How does the risk of being uninsured differ

for wage-earners in establishments of different

sizes? Has that risk changed over time?

Percent of working-age wage-earners uninsured for first half of year
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• The percent of wage-earners in

small establishments who were

uninsured declined from 26.7%

in 1996 to 22.6% in 1999. By

2000, it had returned to about

the same level as in 1996.

• The percent uninsured among

wage-earners in medium-size and

large establishments did not

change significantly between

1996 and 2000.

• There were about two to three

times as many uninsured wage

earners in small establishments as

in medium-size or large

establishments.

Agency for Healthcare Research and Quality

29

Medical Expenditure Panel Survey

How does the risk of being uninsured differ for

wage-earners in establishments of different sizes?

Has that risk changed over time? (continued)

0

2

4

6

8

10

12

3.9

9.4

4.0

9.1

3.8

8.9

1996 1997 1998 1999

Establishment size:

Less than 25 employees

25-99 employees

100 or more employees

9.6

3.7 3.8

8.1

2000

3.3 3.5 3.6 3.2 3.2

Millions

Number of working-age wage-earners uninsured for first half of year

in millions
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Agency for Healthcare Research and Quality

30

Medical Expenditure Panel Survey

How does the risk of being uninsured differ

for low-wage and high-wage workers?

0

5

10

15

20

25

30

35

30.8%

Under $10 $10-$14.99 $15-$19.99

Percent

4.7%

2.5%

$20 or more

12.9%

28.5%

10.6%

6.7%

2.8%

1996

2000

0

2

4

6

8

10

12

14

12.5

Under $10 $10-$14.99 $15-$19.99

0.7 0.5

$20 or more

4.0

10.9

3.1

1.2

0.6

1996

2000

Millions

Number of working-age wage-earners uninsured for first half of year

in millions Percent of working-age wage-earners uninsured for first half of year

Hourly wage

Note:Wages adjusted for inflation to the year 2000.

• Being uninsured was about 10

times as likely for workers with

the lowest hourly wages (under

$10 per hour) as for those with

the highest hourly wages ($20 or

more per hour), 28.5% vs. 2.8%

in 2000.

• Low-wage workers accounted for

about two-thirds of all uninsured

wage-earners (10.9 million out of

a total of 16.7 million uninsured

wage-earners in 2000), although

they made up only roughly onethird of all wage-earners.

• Using inflation-adjusted wages

(adjusted to the year 2000), the

only group of wage-earners

whose risk of being uninsured

changed significantly were those

earning $10 to $14.99 per hour.

For this group, the likelihood of

being uninsured increased from

10.6% in 1996 to 12.9% in 2000.

However, the number of

uninsured wage-earners increased

for both those earning $10 to

$14.99 per hour (from 3.1

million to 4.0 million) and those

earning $15 to $19.99 per hour

(from 0.7 million to 1.2 million).

Hourly wage

Note:Wages adjusted for inflation to the year 2000.
The data presented in this

report show the following:

The percent of the population

that is uninsured depends heavily on

the time period used in calculating

the estimate. MEPS allows for

multiple definitions of time periods,

including the first half of the year,

on average; some point during the

year; and the entire year. In 1999,

the latest year for which all three

measures are available, MEPS data

indicate that 25.1% of the

population were uninsured at some

point during the year, 17.9% were

uninsured throughout the first half

of the year, and 12.2% were

uninsured throughout the entire

year.

Examining trends in insurance

status, the MEPS data indicate that

the percent of the population

uninsured at some point during the

year declined from 27.0% in 1996

to 25.1% in 1999. The percent

uninsured all year declined from

13.8% in 1996 to 12.2% in 1999.

The percent of children

uninsured all year declined from

10.4% in 1996 to 7.8% in 1999.

The number of children uninsured

all year declined by 1.6 million,

from 7.0 million in 1996 to 5.4

million in 1999. In each year from

1996 through 1999, the number

and percent of children who were

uninsured for at least one month

during the year were more than

double the number and percent

uninsured all year.

The risk of being uninsured all

year declined for white Americans,

from 10.5% in 1996 and 10.8% in

1997 to 8.8% in 1999. For black

Americans, the risk of being

uninsured at some point during the

year declined from 35.9% in 1996

to 29.4% in 1999. Neither measure

declined significantly over this time

period for Hispanics, the

racial/ethnic group most at risk of

being uninsured. Workers with the lowest hourly

wages (under $10 per hour) were

about 10 times as likely to be

uninsured as those with the highest

hourly wages ($20 or more per

hour), 28.5% vs. 2.8% in 2000. The

only wage-earners whose risk of

being uninsured changed

significantly were those earning $10

to $14.99 per hour. For this group,

the likelihood of being uninsured

increased from 10.6% in 1996 to

12.9% in 2000.

Medical Expenditure Panel Survey Agency for Healthcare Research and Quality

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conclusions

31
Cohen J. Design and methods of the

Medical Expenditure Panel Survey

Household Component. Rockville

(MD): Agency for Health Care Policy

and Research; 1997. MEPS

Methodology Report No. 1. AHCPR

Pub. No. 97-0026.

Cohen S. Sample design of the 1996

Medical Expenditure Panel Survey

Household Component. Rockville

(MD): Agency for Health Care Policy

and Research; 1997. MEPS

Methodology Report No. 2. AHCPR

Pub. No. 97-0027.

Department of Health and Human

Services [US], Assistant Secretary of

Planning and Evaluation. Understanding

Estimates of the Uninsured: Putting the

Differences in Context. Web site:

http://aspe.hhs.gov/health/reports/

hiestimates.htm. Accessed March 28,

2002.

Fronstin P, Goldberg L, Robins P.

Differences in private health insurance

coverage for working male Hispanics.

Inquiry 1997; 34(2):171-80.

Monheit A, Vistnes J. Race/ethnicity and

health insurance status: 1987 and 1996.

Med Care Res Rev 2000; 57(suppl

1):11-35.

Taylor A, Cohen J, Machlin S. Being

uninsured in 1996 compared to 1987:

how has the experience of the uninsured

changed over time? Health Serv Res

2001; 36:16-31.

Weinick R, Zuvekas S, Drilea S. Access to

health care—sources and barriers, 1996.

Rockville (MD): Agency for Health

Care Policy and Research; 1997. MEPS

Research Findings No. 3. AHCPR Pub.

No. 98-000l.

Please consult the MEPS Web

site at

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

for an updated publications list or

additional copies of this publication.

Contact the MEPS information

coordinator at AHRQ

(301-594-3075) for additional

information.

Medical Expenditure Panel Survey Agency for Healthcare Research and Quality

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references

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Agency for Healthcare Research and Quality

34
Medical Expenditure Panel Survey Agency for Healthcare Research and Quality

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35

Uninsured—People classified as uninsured

throughout the first half of the year did not

have coverage during the period from

January of the survey year through the time

of the first interview in that year.These

interviews were typically conducted from

March to July. People uninsured for the

entire year did not have insurance coverage

at any time during the survey year. People

classified as uninsured at some point during

the survey year lacked coverage for at least

1 month during the year

Insured—People were classified as insured

if they were covered by Medicare,TRICARE

(Armed-Forces-related coverage), Medicaid,

other public hospital/physician programs, or

private hospital/physician insurance

(including Medigap coverage). Individuals

covered only by noncomprehensive Statespecific 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 not considered insured.

Public coverage—For this chartbook,

people were considered to have public

coverage if they were covered by 

Medicare, Medicaid, TRICARE, or other

public hospital and physician coverage.

Private coverage—Private health

insurance was defined as nonpublic

insurance that provides coverage for

hospital and physician care (including

Medigap coverage).

Employment status—Working-age

people (ages 16-64) were considered to be

employed if they had a job for pay, owned a

business, or worked without pay in a family

business during the first half of the year.

Individuals with missing values on

employment status (less than 1% of people

ages 16-64 in 1996) are excluded from the numbers presented in this report.

Establishment size—An establishment is

a particular workplace location. (It differs

from a firm, which can have many

establishments or just one establishment.)

Establishment size is the number of

employees at one location rather than the number of employees at all locations for a

firm. Individuals with missing values on

establishment size (5-7% of wage-earners for each year) are excluded from the numbers presented in this report.

Hourly wages—Hourly wages are

presented for wage-earners only, not for

the self-employed.They are adjusted for

inflation (to the year 2000) using the

Consumer Price Index. Individuals with

missing values on hourly wages (5-7% of

wage-earners for each year) are excluded

from the numbers presented in this report.

definitions of terms
www.ahrq.gov

AHRQ Publication No. 02-0027

May 2002

ISBN 1-58763-112-1

ISSN 1531-5649

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