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AHCPR Pub. No. 97-0030

August 1997 















































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U.S. Department of Health 

and Human Services

Public Health Service

Agency for Health Care Policy

and Research

2101 East Jefferson Street

Suite 501

Rockville, MD 20852








































































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Health Insurance Status of the 

Civilian Noninstitutionalized 

Population: 1996

U.S. Department of Health and Human Services 

Public Health Service

Agency for Health Care Policy and Research

Research Findings 

Research

Findings #1
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Health Care Information and Electronic Ordering 

Through the AHCPR Web Site

http://www.ahcpr.gov/

The Agency for Health Care Policy and

Research’s Web site—

http://www.ahcpr.gov/—makes practical,

science-based health care information

available in one convenient place.

Six buttons correspond to major categories of

available holdings on the Web site:

Offices/Centers, News & Resources,

Research Portfolio, Data & Methods,

Guidelines & Medical Outcomes, and

Consumer Health.

The Web site features an Electronic Catalog

to the more than 450 information products

generated by AHCPR, with information on

how to obtain these resources. Many

information products have an electronic

ordering form and are mailed free of charge

from the AHCPR Clearinghouse within 5

working days.

Abstract

This report from the 1996 Medical Expenditure

Panel Survey (MEPS) provides preliminary estimates of

the health insurance status of the civilian

noninstitutionalized U.S. population during the first half

of 1996, including the size and characteristics of the

population with private health insurance, with public

insurance, and without any health care coverage. During

this period, 83 percent of all Americans were covered by

private or public health insurance, leaving 17 percent of

the population, some 44.8 million persons, uninsured.

Among the non-elderly population, 80.8 percent of

Americans had either private or public coverage and 19.2

percent of the population (44.5 million persons) lacked

health care coverage. The probability that an individual

would be uninsured during this period was especially

high for young adults aged 19-24, members of racial and

ethnic minorities (especially Hispanic males), and nonelderly persons in good or fair health. Public health

insurance played an important role in ensuring that

persons in poor health, children, black Americans, and

Hispanic Americans obtained health care coverage.

Suggested citation

Vistnes JP, Monheit AC. Health insurance status of the civilian

noninstitutionalized population: 1996. Rockville (MD):

Agency for Health Care Policy and Research; 1997. MEPS

Research Findings No. 1. AHCPR Pub. No. 97-0030.
Research Findings 

Health Insurance Status of the 

Civilian Noninstitutionalized 

Population: 1996

U.S. Department of Health and Human Services 

Public Health Service

Agency for Health Care Policy and Research

Research

Findings #1

AHCPR Pub. No 97-0030

August 1997
II

Background

The Medical Expenditure Panel Survey (MEPS) is

conducted to provide nationally representative estimates

of health care use, expenditures, sources of payment,

and insurance coverage for the U.S. civilian

noninstitutionalized population. MEPS also includes a

nationally representative survey of nursing homes and

their residents. MEPS is cosponsored by the Agency for

Health Care Policy and Research (AHCPR) and the

National Center for Health Statistics (NCHS).

MEPS comprises four component surveys: the

Household Component (HC), the Medical Provider

Component (MPC), the Insurance Component (IC), and

the Nursing Home Component (NHC). The HC is the

core survey, and it forms the basis for the MPC sample

and part of the IC sample. The separate NHC sample

supplements the other MEPS components. Together

these surveys yield comprehensive data that provide

national estimates of the level and distribution of health

care use and expenditures, support health services

research, and can be used to assess health care policy

implications.

MEPS is the third in a series of national probability

surveys conducted by AHCPR on the financing and use

of medical care in the United States. The National

Medical Care Expenditure Survey (NMCES) was

conducted in 1977, the National Medical Expenditure

Survey (NMES) in 1987. Beginning in 1996, MEPS

continues this series with design enhancements and

efficiencies that provide a more current data resource to

capture the changing dynamics of the health care

delivery and insurance system.

The design efficiencies incorporated into MEPS are

in accordance with the Department of Health and

Human Services (DHHS) Survey Integration Plan of

June 1995, which focused on consolidating DHHS

surveys, achieving cost efficiencies, reducing

respondent burden, and enhancing analytical capacities.

To accommodate these goals, new MEPS design

features include linkage with the National Health

Interview Survey (NHIS), from which the sample for

the MEPS HC is drawn, and enhanced longitudinal data

collection for core survey components. The MEPS HC

augments NHIS by selecting a sample of NHIS

respondents, collecting additional data on their health

care expenditures, and linking these data with additional

information collected from the respondents’ medical

providers, employers, and insurance providers.

Household Component

The MEPS HC, a nationally representative survey

of the U.S. civilian noninstitutionalized population,

collects medical expenditure data at both the person and

household levels. The HC 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.

The HC uses an overlapping panel design in which

data are collected through a preliminary contact

followed by a series of six rounds of interviews over a 

2 1/2-year period. Using computer-assisted personal

interviewing (CAPI) technology, data on medical

expenditures and use for 2 calendar years are collected

from each household. This series of data collection

rounds is launched each subsequent year on a new

sample of households to provide overlapping panels of

survey data and, when combined with other ongoing

panels, will provide continuous and current estimates of

health care expenditures.

The sampling frame for the MEPS HC is drawn

from respondents to NHIS, conducted by NCHS. NHIS

provides a nationally representative sample of the U.S.

civilian noninstitutionalized population, with

oversampling of Hispanics and blacks. A subsample of

10,500 households was drawn from the NHIS sampling

frame for the initial 1996 MEPS HC panel. Every 5

years the HC sample size is increased. Beginning with

the 1997 panel, policy-relevant population subgroups

are oversampled. The subgroups initially targeted

include adults with functional impairments, children

with functional limitations in their activities, individuals

aged 18-64 who are predicted to have high levels of

medical expenditures, and individuals with family

income less than 200 percent of the poverty level.

The Medical Expenditure Panel

Survey (MEPS)
III

Medical Provider Component

The MEPS MPC supplements and validates

information on medical care events reported in the

MEPS HC by contacting medical providers identified

by household respondents. The MPC sample includes

all hospitals, hospital physicians, home health agencies,

and pharmacies reported in the HC. Also included in the

MPC are all office-based physicians: 

• Providing care for HC respondents receiving

Medicaid.

• Associated with a 75-percent sample of households

receiving care through an HMO (health maintenance

organization) or managed care plan. 

• Associated with a 25-percent sample of the

remaining households.

The 1996 sample is projected to provide data from

approximately 2,700 hospitals, 12,400 office-based

physicians, 7,000 separately billing hospital physicians,

and 500 home health providers.

Data are collected on medical and financial

characteristics of medical events reported by HC

respondents, including:

• Diagnoses coded according to ICD-9 (9th Revision,

International Classification of Diseases) and DSMIV (Fourth Edition, Diagnostic and Statistical

Manual of Mental Disorders).

• Physician procedure codes classified by CPT-4

(Current Procedural Terminology, Version 4).

• Inpatient stay codes classified by DRGs (diagnosisrelated groups).

• Charges, payments, and the reasons for any

difference between charges and payments.

The MPC is conducted through telephone

interviews and mailed survey materials.

Insurance Component

The MEPS IC collects data on health insurance

plans obtained through employers, unions, and other

sources of private health insurance. Data obtained in the

IC include the number and types of private insurance

plans offered, benefits associated with these plans,

premiums, contributions by employers and employees,

and employer characteristics.

Establishments participating in the MEPS IC are

selected through four sampling frames:

• A list of employers or other insurance providers

identified by MEPS HC respondents who report

having private health insurance at the Round 1

interview.

• A Bureau of the Census list frame of private-sector

business establishments.

• The Census of Governments from the Bureau of the

Census.

• An Internal Revenue Service list of the selfemployed.

To provide an integrated picture of health insurance,

data collected from the first sampling frame (employers

and other insurance providers) are linked back to data

provided by the MEPS HC respondents. Data from the

other three sampling frames are collected to provide

annual national and State estimates of the supply of

private health insurance available to American workers

and to evaluate policy issues pertaining to health

insurance.

The MEPS IC is an annual panel survey. For the

survey conducted in 1997, the sample includes

approximately 7,000 establishments identified through

the MEPS HC, 27,000 identified through the business

establishments list frame, 1,900 from the Census of

Governments, and 1,000 identified through the list of

the self-employed. Data are collected from the selected

organizations through a prescreening telephone

interview, a mailed questionnaire, and a telephone

followup for nonrespondents.

Nursing Home Component

The 1996 MEPS NHC is a survey of nursing homes

and persons residing in or admitted to nursing homes at

any time during calendar year 1996. The NHC gathers

information on the demographic characteristics,

residence history, health and functional status, use of

services, use of prescription medications, and health

care expenditures of nursing home residents. Nursing

home administrators and designated staff also provide

information on facility size, ownership, certification






























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status, services provided, revenues and expenses, and

other facility characteristics. Data on the income, assets,

family relationships, and care-giving services for

sampled nursing home residents are obtained from nextof-kin or other knowledgeable persons in the

community. In keeping with the DHHS Survey

Integration Plan, the NHC is designed to be conducted

every 5 years.

The 1996 MEPS NHC sample was selected using a

two-stage stratified probability design. In the first stage,

facilities were selected; in the second stage, facility

residents were sampled, selecting both persons in

residence on January 1, 1996, and those admitted during

the period January 1 through December 31. 

The sample frame for facilities was derived from the

National Health Provider Inventory, which is updated

periodically by NCHS. The MEPS NHC data are

collected in person in three rounds of data collection

over a 1 1/2-year period using the CAPI system.

Community data are collected by telephone using

computer-assisted telephone interviewing (CATI)

technology. At the end of three rounds of data collection,

the sample will consist of approximately 800 responding

facilities, 3,100 residents in the facility on January 1,

and approximately 2,200 eligible residents admitted

during 1996. 

Survey Management

MEPS data are collected under the authority of the

Public Health Service Act. They are edited and

published in accordance with the confidentiality

provisions of this act and the Privacy Act. NCHS

provides consultation and technical assistance.

Data collection is conducted under contract by

Westat, Inc., Rockville, MD, and the National Opinion

Research Center at the University of Chicago, as well as

through an interagency agreement with Bureau of the

Census. Technical consultation is provided by Medstat,

Inc., Boston, MA. Data processing support is provided

under contract by Social & Scientific Systems, Inc.,

Bethesda, MD.

As soon as data collection and editing are

completed, the MEPS survey data are released to the

public in staged releases of summary reports and

microdata files. Summary reports are released as printed

documents and electronic files. Microdata files are

released on CD-ROM and/or as electronic files.

Printed documents and CD-ROMs are available

through the AHCPR Publications Clearinghouse. Write

or call:

AHCPR Publications Clearinghouse

Attn: (publication number)

P.O. Box 8547

Silver Spring, MD 20907

800/358-9295

410/381-3150 (callers outside the 

United States only)

888/586-6340 (toll-free TDD service; 

hearing impaired only)

Be sure to specify the AHCPR number of the

document or CD-ROM you are requesting. Selected

electronic files are available on the Internet in the MEPS

section of the AHCPR home page: 

http://www.ahcpr.gov/

Additional information on MEPS is available from

the MEPS project manager or the MEPS public use data

manager at the Center for Cost and Financing Studies,

Agency for Health Care Policy and Research, 2101 East

Jefferson Street, Suite 500, Rockville, MD 20852

(301/594-1406).

IV
V

Table of Contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Young Adults:Those Least Likely To Be Covered . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Characteristics of Uninsured Americans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Tables showing:

1. Health insurance coverage and population characteristics—all ages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

2. Health insurance coverage and population characteristics—under age 65 . . . . . . . . . . . . . . . . . . . . . . . . 9

3. Health insurance coverage and perceived health status—all ages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

4. Health insurance coverage and population characteristics—ages 19-24 . . . . . . . . . . . . . . . . . . . . . . . . . 11

5. Population characteristics—total population and the uninsured, under age 65 . . . . . . . . . . . . . . . . . . . . 12

Technical Appendix

Derivation of Insurance Status Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Health Insurance Edits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Population Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Sample Design and Accuracy of Estimates. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Rounding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Comparisons With Other Data Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Population and Standard Error Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

VI
1

Introduction

The health insurance status of the U.S. population,

especially the size and composition of the uninsured

population, has become an issue of perennial public

policy concern for several reasons. First, health

insurance is viewed as essential to ensure that

individuals obtain timely access to medical care and

protection against the risk of expensive and

unanticipated medical events. Compared to people

without health care coverage, insured individuals are

more likely to have a regular source of medical care, to

spend less out of pocket on health services, and to

experience different treatment patterns, quality, and

continuity in their health care (Lefkowitz and Monheit,

1991; U.S. Congress, Office of Technology Assessment,

1992). 

Second, concern over the population’s health

insurance status reflects a variety of equity and

efficiency considerations. These include the magnitude

and appropriate mix of private and public sector

responsibility for financing health care, the impact of

health insurance on the efficient use of health care, and

the manner in which health insurance affects the

distribution of health care among the general population

and across groups of specific policy interest.

Third, timely and reliable estimates of the

population’s health insurance status are essential to

evaluate the costs and expected impact of public policy

interventions to expand coverage or to alter the manner

in which private and public insurance is financed.

Identification of how individual and household

demographic characteristics, health status, and

economic circumstances are associated with the

population’s health insurance status is of critical

importance in developing efficient and targeted policy

interventions. This is especially relevant given the

current emphasis on incremental health care reform that

is focused on particular health care markets and

population groups.

Finally, comparisons of the characteristics of

insured and uninsured populations over time provide

information on whether greater equity has been

achieved in the ability of specific population groups to

obtain health insurance or whether serious gaps remain.

In this regard, estimates of the population’s health

insurance status from the 1996 Medical Expenditure

Panel Survey (MEPS) provide a critical baseline to help

evaluate the health insurance implications of two recent

legislative initiatives: the 1996 Health Insurance

Portability and Accountability Act (HIPAA), Public Law

104-191, and welfare reform under the 1996 Personal

Responsibility and Work Opportunity Reconciliation

Act, Public Law 104-193. A primary goal of HIPAA is

to reduce the impact of preexisting health conditions on

the continuity of health insurance during employment

transitions. Under welfare reform, mandated work

requirements and time limitations governing the receipt

of public assistance may have consequences for a

recipient’s health insurance status.

This report presents preliminary estimates of the

number and characteristics of people with private and

public health insurance at any time during the first half

of 1996, on average. Particular emphasis is directed

toward estimating the size of the population that was

uninsured throughout the first half of 1996 and

identifying groups especially at risk of lacking health

insurance. 

Overview

During the first half of 1996, on average, 83 percent

of all Americans in the civilian noninstitutionalized

population had some type of private or public health

insurance coverage (Table 1). Roughly 68 percent of

Americans obtained health insurance from private

sources, with 60.7 percent of all persons covered by

employment-related health insurance. Another 15.2

percent obtained public sources of coverage, primarily

from the Medicare and Medicaid programs. The

Health Insurance Status of the Civilian Noninstitutionalized 

Population: 1996

by Jessica P. Vistnes, Ph.D., and Alan C. Monheit, Ph.D.,

Agency for Health Care Policy and Research
2

remaining 17.0 percent of Americans, 44.8 million

persons, were without health insurance throughout the

first half of 1996. Among the non-elderly population,

68.7 percent were covered by private insurance (64.1

percent by employment-based insurance) and 12.1

percent by public insurance. Almost a fifth of the nonelderly population (19.2 percent), an estimated 44.5

million persons, were uninsured. Table

2 gives more detailed information on

the non-elderly population. 

The data in Tables 1-3 provide

estimates of the population’s health

insurance status according to selected

demographic characteristics, perceived

health status, employment status, and

residential location. Table A in the

Technical Appendix provides estimates

of the number of persons by health

insurance status. Some of the key findings and

relationships revealed by these data are discussed below.

Age

MEPS data reveal that, in general, children are

more likely than adults to have health insurance

coverage. The main findings among age groups are

described below.

Children

There has been considerable interest in the health

insurance status of children. This interest stems from

the role health care coverage plays in ensuring that

children obtain the medical care appropriate to their

specific stage of development. In addition, expansions

of the Medicaid program during the late 1980s and early

1990s have focused attention on whether the role of the

public and private sectors in financing health care for

low-income children has been altered. Specifically,

expansions of the Medicaid program through the

Omnibus Budget Reconciliation Acts of 1987-1990 and

other legislation eliminated categorical eligibility for

Aid to Families with Dependent Children (AFDC) as a

requirement for Medicaid enrollment and raised the age

and income ceilings under which children could receive

Medicaid. For a discussion of the impact of these

expansions on the enrollment of children in

employment-based coverage, see Cutler and Gruber

(1996) and Dubay and Kenny (1996).

MEPS data indicate that public health insurance

played an important role in reducing the risk that a child

would be uninsured during the first half of 1996: One

in four children under age 4, nearly the same

proportion of children ages 4-6, and one in five children

ages 7-12 obtained public coverage, primarily through

Medicaid. As a result, children under age 18 were less

likely to be uninsured than were adults in general.

Despite this finding, nearly 11 million children lacked

health care coverage.

Adults

Young adults ages 19-24 were most likely to lack

health insurance. For example, over a third of young

adults (37.8 percent) were uninsured, more than twice

the rate at which all Americans lacked coverage. Young

adults ages 19-24 also had the lowest rate of private

health insurance coverage among the non-elderly

population.

On the other hand, 6 out of 10 elderly Americans

(61.5 percent) were covered by private health insurance.

Nearly 4 out of 10 elderly Americans (37.6 percent)

held only public coverage (Medicare alone or in

conjunction with Medicaid). 

Employment Status

Since most private health insurance in the United

States is provided through the workplace, employment

status is an important indicator of access to private

health insurance. MEPS data reveal the following for

the non-elderly population (Table 2):

• Over three-quarters (78.3 percent) of workers were

covered by private health insurance, compared to

close to half (49.8 percent) of individuals who were

not employed.

• Individuals who were not employed were more likely

than those who were employed to be covered by

public insurance (23.8 and 3.3 percent, respectively). 

• Workers were less likely than individuals who were

not employed to be uninsured (18.4 and 26.4

percent, respectively).

In 

early 1996,

17 percent 

of all

Americans

were 

uninsured.
3

Race/Ethnicity

MEPS data indicate that significant disparities exist

in the rate at which racial and ethnic minorities are

covered by private and public health insurance

compared to white Americans. For example:

• Less than half of all Hispanic and black Americans

(44.0 and 48.6 percent, respectively) were covered

by private health insurance, compared to threequarters of whites (75.3 percent). Over a third of

Hispanics (33.5 percent) and over a fifth of blacks

(22.9 percent) were uninsured. In contrast, just over

one-tenth of white Americans (13.1 percent) were

uninsured.

• Among all racial/ethnic groups, Hispanic males were

the most likely to be uninsured; 37.2 percent lacked

coverage.

• Hispanic and black Americans were more likely than

white Americans to be covered by public health

insurance (22.5 percent and 28.4 percent,

respectively, compared to 11.6 percent).

Marital Status

Married individuals were more likely than others to

have private and employment-related health insurance

(Table 1). Of those who were not married at the time of

the survey:

• Persons who were widowed were the least likely to

be uninsured because of their higher rate of

coverage from private, nonemployment-related

sources (23.8 percent) and public programs (38.4

percent). 

• Almost a third of Americans who never married or

were separated were uninsured (29.1 percent and

28.4 percent, respectively). 

• Almost a quarter of all divorced persons (23.8

percent) were uninsured.

Residential Location

The type of health care coverage obtained by

Americans and the likelihood of being uninsured also

varied by region and whether they lived in a

metropolitan statistical area (MSA). MEPS data 

show that:

• Persons residing in the South and West were less

likely than residents of other regions to have

employment-related health insurance (58.3 percent

and 55.6 percent in the South and West, respectively,

compared to 64.3 percent and 66.3 percent of

residents in the Northeast and Midwest). Nearly one

out of five persons in the South and West were

uninsured (19.9 percent and 18.9 percent,

respectively) compared to just under 14 percent in

both the Northeast and Midwest.

• Persons living outside MSAs were less likely than

those residing within MSAs to be covered by

employment-related health insurance (53.7 percent

vs. 62.5 percent). They also were more likely to be

uninsured (19.8 percent vs. 16.3 percent).

Health Status 

There is considerable public policy interest in

determining whether persons with health problems are

able to obtain health insurance and, if so, the source of

such coverage. MEPS respondents were asked to rate

their health and family members’ health as excellent,

very good, good, fair, or poor. The data in Table 3

reveal the relationships described below between health

status and insurance coverage.

Non-elderly Persons

More than one in five non-elderly Americans in

good health (22.8 percent), fair health (25.1 percent), or

poor health (21.4 percent) were uninsured throughout

the first half of 1996. Among the non-elderly:

• Persons in fair or poor health were less likely than

those in better health to have private health

insurance. Only 35.1 percent of those in poor health

and 45.9 percent of those in fair health had any

employment-related coverage.

• Public insurance helped to reduce the health-related

disparities in private coverage. Nearly 25 percent of
4

persons in fair health and almost 40 percent of

persons in poor health obtained public coverage.

Elderly Persons

More than 4 in 10 elderly persons in fair or poor

health were covered by insurance from public sources

only (Medicare or both Medicare and Medicaid).

Elderly Americans in fair or poor health also were less

likely to have employment-related coverage than those

in excellent or very good health. However, the percent

of elderly Americans covered by privately purchased

nonemployment-based coverage did not decline as

health status worsened.

Young Adults:Those Least Likely

To Be Covered

Among all age groups in the non-elderly

population, persons ages 19-24 were most at risk of

lacking private and employment-related health insurance

and of being uninsured (Table 1). In part, this reflects

the fact that young adults who were not full-time

students were likely to lose their eligibility for

dependent coverage on their parents’ health plan. In

addition, since many young adults have limited work

experience or transitory employment,

they frequently obtain low-wage jobs

that do not provide health insurance.

Finally, young adults may not value

health insurance, since they tend to be

in relatively good health, expect to

incur small health care expenditures,

and are less likely than older workers to

have dependents who require medical

care. In this section, selected

characteristics of this age cohort are

examined (Table 4) to identify demographic

characteristics associated with young adults’ health

insurance status during the first half of 1996. 

Student Status

Over two-thirds (69.0 percent) of young adults who

were full-time students had private health insurance,

compared to only half (50.7 percent) of young adults

who were part-time students and less than half (45.2

percent) of young adults who were not in school. The

latter two groups were nearly twice as likely as full-time

students to be uninsured.

Race/Ethnicity and Gender

When racial/ethnic background is considered, the

health insurance status of young adults reveals striking

disparities. For example, over half of all Hispanic and

black young adults were uninsured (52.8 percent and

50.2 percent, respectively), compared to 31.1 percent of

white young adults.

Gender also plays an important role in health

insurance status. Although young adult minority men

and women had similarly low rates of private health

insurance, women were far more likely than men to

obtain public insurance. Overall, the disparity in health

insurance coverage by racial/ethnic groups was more

pronounced for men than for women. MEPS data show

the following:

• Among young adults, 6 out of 10 minority males

were without coverage (58.5 percent of Hispanic

males and 61.1 percent of black males), compared to

3 out of 10 white males (33.5 percent). Among

young adult women, 45.9 percent of Hispanics and

41.7 percent of blacks were uninsured, compared to

28.9 percent of whites.

• Young adult women obtained public insurance at

more than twice the rate of young adult males: 12.4

percent of women, compared to only 5.0 percent of

men. As a result, young adult men were more likely

than women to be uninsured: 41.9 percent to 33.9

percent. 

• Among young adults, Hispanic women were more

than four times as likely as Hispanic men to have

public coverage, and black women were more than

five times as likely as black men. As a result,

minority young adult women were less likely than

men to be uninsured.

Other Factors

Health status and residential location were

associated with the insurance status of young adults:

• Half of the 1.3 million young adults in fair or poor

health were uninsured, compared to just over a third

of those in excellent or very good health.

Young adults

ages 19-24

were the age

group most

likely to lack

health 

insurance.
5

• Among young adults, those in the South were most

at risk of being uninsured, whereas in the general

U.S. population, persons residing in the South and

West were most likely to be uninsured. 

Characteristics of Uninsured

Americans

Previous sections of this report have described the

health insurance status of Americans by focusing on

demographic, health status, and geographic

characteristics associated with the likelihood that

particular groups obtained private or public health

insurance or were more at risk of being uninsured. To

put this discussion in perspective, data displayed in

Table 5 characterize the uninsured population by

considering the representation of specific groups in the

general population of non-elderly Americans relative to

their representation among the uninsured population.

By examining the composition of the uninsured in this

way, one can assess whether certain population groups

are disproportionately represented among the uninsured.

Such information can be useful in formulating targeted

policy interventions on behalf of persons without health

insurance.

Age

Young adults ages 19-24 composed less than a tenth

of the non-elderly population but nearly a fifth of the

uninsured population. Among all age groups, young

adults also displayed the greatest risk of being

uninsured.

Race/Ethnicity

Racial and ethnic minorities were more at risk of

lacking health insurance than were white Americans.

As a result, minority representation among the

uninsured exceeded their representation among the

general population. For example: 

• Although Hispanics represented only 11.6 percent of

the non-elderly U.S. population, they accounted for

21.2 percent of the uninsured population. 

• Hispanic males represented only 5.9 percent of all

non-elderly Americans but were the racial/ethnic

group most likely to be uninsured, comprising 12.0

percent of the uninsured population. 

• Although 7 out of 10 non-elderly Americans were

white, whites accounted for less than 6 out of 10

uninsured persons.

• When the uninsured are categorized by race/ethnicity

and sex, white males represent the largest proportion

of the uninsured population.

Other Factors

Persons with specific residential locations and

marital status were also disproportionately represented

among the uninsured:

• Persons residing in the South represented about a

third (34.8 percent) of all non-elderly Americans but

more than 40 percent of all uninsured Americans.

• Persons who never married accounted for over a fifth

of the non-elderly population but over a third of the

uninsured population.

Finally, more than 1 out of 10 uninsured persons

(11.5 percent of the uninsured population) were in fair

or poor health. These individuals are of particular

policy concern because of the importance of health

insurance in assuring timely access to needed health

care services.

Conclusions

Preliminary estimates from the 1996 MEPS reveal

that, during the first half of 1996, 67.9 percent of

Americans received health insurance from private

sources, 15.2 percent obtained coverage through public

programs, and 17.0 percent of the population (44.8

million persons) lacked any health care coverage.

Nearly 61 percent (60.7 percent) of the U.S. population

was covered by employment-related insurance, so that

coverage from the workplace represented 89.4 percent

of all private insurance. Among the non-elderly

population, nearly one in five persons was uninsured.

The tabulations presented in this report indicate that

the health insurance status of the U.S. population is

strongly associated with specific demographic
6

characteristics, health status, and employment status.

Thus, important disparities in health care coverage exist

for particular groups. Among the groups especially at

risk of lacking health care coverage are young adults

ages 19-24 and members of racial and ethnic

minorities (especially Hispanic males). Disparities in

rates of insurance coverage also exist by health status,

with non-elderly persons in good or fair health being the

most likely to be uninsured. Because of their high rate

of public coverage, persons in poor health were no more

likely to be uninsured than other persons. Public health

insurance also continues to play an important role in

insuring children, black Americans, and Hispanic

Americans. 

Subsequent releases of MEPS data will characterize

dynamic aspects of health insurance status, including

annual and 2-year estimates of the population’s health

insurance coverage, the length of uninsured spells, and

changes in the type of coverage held. In this way the

1996 MEPS will provide a baseline for timely and

continuous monitoring of the Nation’s health 

insurance status.

References

Cohen JW, Monheit AC, Beauregard KM, et al. The

Medical Expenditure Panel Survey: a national health

information resource. Inquiry 1996;33:373-89.

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.

Cutler D, Gruber J. Does public insurance crowd

out private insurance? Quarterly Journal of Economics

1996;CXI(2):391-430.

Dubay LC, Kenny GM. The effects of Medicaid

expansion on insurance coverage of children. The

Future of Children 1996;6(1):152-61.

Lefkowitz D, Monheit AC. Health insurance, use

of health services, and health care expenditures.

Rockville (MD): Agency for Health Care Policy and

Research; 1991. National Medical Expenditure Survey

Research Findings 14. AHCPR Pub. No. 92-0017.

U.S. Congress, Office of Technology Assessment.

Does health insurance make a difference? Background

paper. Washington: U.S. Government Printing Office;

1992. Report No.: OTA-BP-H-99.
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Table 1. Health insurance coverage of the civilian noninstitutionalized

population: Percent distribution by type of coverage and selected population

characteristics, United States, first half of 1996

Private

Total NonPopulation population Total Employment- employment- Public

characteristic in thousands private related related only Uninsured

Percent distribution

Totala 263,516 67.9 60.7 7.1 15.2 17.0 

Total under age 65a 231,676 68.7 64.1 4.6 12.1 19.2

Age in years

Under 4 15,577 60.6 57.8 2.8 25.6 13.8

4-6 12,716 63.0 59.7 3.4 23.7 13.3

7-12 24,092 64.1 60.3 3.8 20.4 15.5

13-17 19,036 66.8 62.4 4.4 15.3 17.9

Total under 18 71,421 63.9 60.2 3.7 20.8 15.4

18 3,445 61.5 57.4 4.1 10.1 28.4

19-24 21,643 53.4 47.3 6.2 8.7 37.8

25-29 18,703 64.8 60.1 4.7 8.4 26.8

30-34 21,383 72.8 69.8 3.0 7.9 19.3

35-54 74,423 76.4 71.9 4.5 7.3 16.4

55-64 20,658 74.6 66.6 8.0 10.7 14.7

65 and over 31,839 61.5 36.0 25.5 37.6 0.9

Employment statusb

Employed 128,619 78.0 72.4 5.6 4.2 17.8

Not employed 69,810 53.9 40.8 13.1 29.6 16.4

Sex

Male 128,383 67.9 61.3 6.6 13.4 18.6

Female 135,133 67.8 60.2 7.6 16.8 15.4

Race/ethnicity

Total Hispanic 28,384 44.0 41.1 2.9 22.5 33.5

Total black 32,975 48.6 46.0 2.7 28.4 22.9

Total white 190,235 75.3 66.7 8.6 11.6 13.1

Total other 11,922 59.2 53.5 5.6 18.0 22.9

Hispanic male 14,327 43.1 39.8 3.3 19.7 37.2 

Black male 15,356 50.0 47.2 2.7 25.1 25.0

White male 92,647 75.3 67.6 7.7 10.3 14.4

Hispanic female 14,057 44.9 42.5 2.4 25.5 29.6

Black female 17,618 47.5 44.8 2.7 31.3 21.2

White female 97,588 75.3 65.9 9.4 12.8 11.9

Continued
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Private

Total NonPopulation population Total Employment- employment- Public

characteristic in thousands private related related only Uninsured

Percent distribution

Marital statusb

Married 109,022 79.1 71.0 8.1 9.1 11.8

Widowed 13,890 55.1 31.3 23.8 38.4 6.5

Divorced 19,087 58.4 52.6 5.8 17.8 23.8

Separated 4,629 43.0 40.9 2.1 28.6 28.4

Never married 52,645 59.2 53.3 5.9 11.7 29.1

Metropolitan

statistical area (MSA)

MSA 210,640 69.1 62.5 6.5 14.7 16.3

Non-MSA 52,876 63.1 53.7 9.4 17.1 19.8

Census region

Northeast 51,464 70.3 64.3 6.0 16.0 13.7

Midwest 61,828 73.3 66.3 7.0 13.1 13.6

South 91,855 65.3 58.3 7.1 14.8 19.9

West 58,369 63.9 55.6 8.3 17.3 18.9

aIncludes persons with unknown employment status and marital status.

bFor individuals age 16 and over.

Note: Percents may not add to 100 due to rounding

Source: Center for Cost and Financing Studies, Agency for Health Care Research and Policy: Medical Expenditure 

Panel Survey Household Component, 1996 (Round 1).

Table 1. Health insurance coverage of the civilian noninstitutionalized

population: Percent distribution by type of coverage and selected population

characteristics, United States, first half of 1996—Continued
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Table 2. Health insurance coverage of the civilian noninstitutionalized

population under age 65: Percent distribution by type of coverage and

selected population characteristics, United States, first half of 1996

Private

Total NonPopulation population in Total Employment- employment- Public

characteristic thousands private related related only Uninsured

Percent distribution

Totala 231,676 68.7 64.1 4.6 12.1 19.2

Employment statusb

Employed 124,218 78.3 73.6 4.7 3.3 18.4

Not employed 42,469 49.8 44.2 5.6 23.8 26.4

Sex

Male 115,104 68.3 63.6 4.7 11.0 20.7

Female 116,572 69.2 64.7 4.5 13.1 17.7

Race/ethnicity

Total Hispanic 26,898 44.6 42.1 2.5 20.3 35.1

Total black 30,297 49.9 47.9 2.1 25.2 24.8

Total white 163,378 76.7 71.4 5.3 8.1 15.2

Total other 11,104 61.4 55.9 5.5 14.2 24.3

Hispanic male 13,671 43.7 40.6 3.1 17.4 38.9

Black male 14,297 50.9 48.6 2.3 22.5 26.6

White male 81,443 75.9 70.7 5.2 7.7 16.3

Hispanic female 13,227 45.6 43.6 1.9 23.2 31.2

Black female 16,000 49.0 47.2 1.8 27.7 23.2

White female 81,934 77.4 72.0 5.4 8.5 14.0

Marital statusb

Married 91,323 80.9 76.2 4.7 5.2 13.9

Widowed 3,412 58.7 50.3 8.4 17.2 24.1

Divorced 16,952 60.6 56.2 4.4 12.9 26.6

Separated 4,291 45.0 43.4 1.6 24.5 30.5

Never married 51,495 59.3 53.6 5.7 11.0 29.8

Metropolitan 

statistical area (MSA)

MSA 186,152 70.2 65.9 4.3 11.5 18.3 

Non-MSA 45,524 62.7 57.0 5.7 14.3 23.0

Census region

Northeast 44,555 72.1 68.4 3.7 12.3 15.6

Midwest 54,045 74.3 70.3 4.0 10.2 15.5

South 80,707 65.7 61.2 4.5 11.7 22.6 

West 52,370 64.8 58.7 6.0 14.4 20.9

a Includes persons with unknown employment status and marital status.

b For individuals age 16 and over.

Note: Percents may not add to 100 due to rounding.

Source: Center for Cost and Financing Studies, Agency for Health Care Policy and Research: Medical Expenditure Panel 

Survey Household Component, 1996 (Round 1).


















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10

Table 3. Health insurance coverage of the civilian noninstitutionalized

population: Percent distribution by type of coverage and perceived health

status, United States, first half 1996

Private

Total NonPopulation population in Total Employment- employment- Public

characteristic thousands private related related only Uninsured

Percent distribution

Total under age 65a 231,676 68.7 64.1 4.6 12.1 19.2

Total age 65 and overa 31,839 61.5 36.0 25.5 37.6 0.9

Perceived health 

status, under age 65

Excellent 89,770 74.4 69.3 5.1 8.2 17.4

Very good 70,584 73.1 68.3 4.8 10.1 16.9

Good 49,509 62.3 58.8 3.6 14.9 22.8

Fair 15,400 50.1 45.9 4.2 24.9 25.1

Poor 5,588 38.8 35.1 3.7 39.8 21.4

Perceived health 

status, age 65 and over

Excellent 5,832 66.4 40.8 25.6 32.6 1.0

Very good 7,940 67.8 40.9 26.9 31.4 0.8

Good 9,131 60.9 35.6 25.3 38.1 1.1

Fair 5,921 55.4 30.1 25.4 44.1 0.5

Poor 2,638 52.0 28.2 23.8 47.6 0.3

aIncludes persons with unknown perceived health status.

Note: Percents may not add to 100 due to rounding.

Source: Center for Cost and Financing Studies, Agency for Health Care Policy and Research: Medical Expenditure Panel Survey 

Household Component, 1996 (Round 1).
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Table 4. Health insurance coverage of the civilian noninstitutionalized

population ages 19-24: Percent distribution by type of coverage and selected

population characteristics, United States, first half of 1996

Private

Total 

Population population in Total Employment- Public

characteristic thousands private related only Uninsured

Percent distribution

Totala 21,643 53.4 47.3 8.7 37.8

Employment status

Employed 14,728 59.2 53.1 5.2 35.5

Not employed 6,520 42.7 36.8 17.2 40.1

Sex

Male 10,661 53.2 46.8 5.0 41.9

Female 10,982 53.7 47.7 12.4 33.9

Race/ethnicity

Total Hispanic 2,854 36.5 33.6 10.6 52.8

Total black 3,577 34.9 32.1 14.9 50.2

Total white 13,662 62.5 54.8 6.3 31.1

Total other 1,550 47.0 41.3 12.3 40.7

Hispanic male 1,568 37.4 33.0 4.1 58.5

Black male 1,559 34.6 30.1 4.4 61.1

White male 6,618 61.8 54.5 4.6 33.5

Hispanic female 1,287 35.5 34.4 18.5 45.9

Black female 2,018 35.2 33.7 23.1 41.7

White female 7,044 63.2 55.1 7.9 28.9

Perceived health 

status

Excellent 8,429 59.7 53.1 6.1 34.2

Very good 6,754 56.6 48.5 7.8 35.5

Good 4,927 46.1 42.4 12.1 41.7

Fair or poor 1,335 32.3 29.1 17.5 50.2

Census region

Northeast 3,806 51.2 44.3 9.4 39.4

Midwest 5,323 63.7 58.2 7.3 29.0

South 7,344 46.5 42.7 8.3 45.2

West 5,170 54.2 44.7 10.4 35.4

Student statusb

Full-time 5,914 69.0 57.0 8.7 22.4

Part-time 1,578 50.7 45.7 9.5 39.9

Not a student 10,447 45.2 41.6 9.2 45.6

aIncludes persons with unknown employment status and perceived health status.

bFor individuals ages 19-23 years.

Note: Percents may not add to 100 due to rounding.

Source: Center for Cost and Financing Studies, Agency for Health Care Policy and Research: Medical Expenditure Panel Survey

Household Component, 1996 (Round 1).
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Table 5.Total population and uninsured persons under age 65: Percent

distribution of population and percent uninsured by selected characteristics,

United States, first half of 1996

Total Percent Percent

Population population in distribution Percent distribution of

characteristic thousands of population uninsured uninsured population

Totala 231,676 100.0 19.2 100.0

Age in years

Under 4 15,577 6.7 13.8 4.8

4-6 12,716 5.5 13.3 3.8 

7-12 24,092 10.4 15.5 8.4

13-17 19,036 8.2 17.9 7.7

18 3,445 1.5 28.4 2.2

19-24 21,643 9.3 37.8 18.4

25-29 18,703 8.1 26.8 11.3

30-34 21,383 9.2 19.3 9.3

35-54 74,423 32.1 16.4 27.4

55-64 20,658 8.9 14.7 6.8

Race/ethnicity

Total Hispanic 26,898 11.6 35.1 21.2

Total black 30,297 13.1 24.8 16.9

Total white 163,378 70.5 15.2 55.8

Total other 11,104 4.8 24.3 6.1

Hispanic male 13,671 5.9 38.9 12.0

Black male 14,297 6.2 26.6 8.6

White male 81,443 35.2 16.3 29.9

Hispanic female 13,227 5.7 31.2 9.3 

Black female 16,000 6.9 23.2 8.4

White female 81,934 35.4 14.0 25.8

Marital statusb

Married 91,323 39.5 13.9 28.8

Widowed 3,412 1.5 24.1 1.9

Divorced 16,952 7.3 26.6 10.2

Separated 4,291 1.9 30.5 3.0

Never married 51,495 22.3 29.8 34.7

Census region

Northeast 44,555 19.2 15.6 15.7

Midwest 54,045 23.3 15.5 18.8

South 80,707 34.8 22.6 41.0

West 52,370 22.6 20.9 24.6

Continued
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Total Percent Percent

Population population in distribution Percent distribution of

characteristic thousands of population uninsured uninsured population

Perceived health 

status

Excellent 89,770 38.9 17.4 35.6

Very good 70,584 30.6 16.9 27.1

Good 49,509 21.4 22.8 25.7

Fair 15,400 6.7 25.1 8.8

Poor 5,588 2.4 21.4 2.7

aIncludes persons with unknown perceived health status and marital status.

bFor individuals age 16 and over. Excludes unknown marital status. As a result, percents do not sum to 100.

Note: Percent distributions may not add to 100 due to rounding.

Source: Center for Cost and Financing Studies, Agency for Health Care Policy and Research: Medical Expenditure Panel Survey 

Household Component, 1996 (Round 1).

Table 5.Total population and uninsured persons under age 65: Percent

distribution of population and percent uninsured by selected characteristics,

United States, first half of 1996—Continued
14

Technical Appendix

The data in this report were obtained in the first

round of interviews for the Household Component (HC)

of the 1996 Medical Expenditure Panel Survey (MEPS).

MEPS is cosponsored by the Agency for Health Care

Policy and Research (AHCPR) and the National Center

for Health Statistics (NCHS). The MEPS HC is a

nationally representative survey of the U.S. civilian

noninstitutionalized population that collects medical

expenditure data at both the person and household

levels. The focus of the MEPS HC is to collect 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. In other

components of MEPS, data are collected on residents of

licensed or certified nursing homes and the supply side

of the health insurance market.

The sample for the MEPS HC was selected from

respondents to the National Health Interview Survey

(NHIS), which was conducted by NCHS. NHIS

provides a nationally representative sample of the U.S.

civilian noninstitutionalized population and reflects an

oversampling of Hispanics and blacks. The MEPS HC

collects data through an overlapping panel design. In

this design, data are collected through a precontact

interview that is followed by a series of six rounds of

interviews over 2-1/2 years. Two calendar years of

medical expenditure and utilization data are collected

from each household and captured using computerassisted personal interviewing (CAPI). This series of

data collection rounds is launched again each

subsequent year on a new sample of households to

provide overlapping panels of survey data which, when

combined with other ongoing panels, will provide

continuous and current estimates of health care

expenditures. The reference period for Round 1 of the

MEPS HC was from January 1, 1996, to the date of the

first interview. Interviews were conducted from March

to July 1996. 

Derivation of Insurance Status

Information

The household respondent was asked if, between

January 1, 1996, and the time of the Round 1 interview,

anyone in the family was covered by any of the sources

of public and private health insurance coverage

discussed in the following paragraphs. For this report,

Medicare and CHAMPUS/CHAMPVA coverage were

measured at the time of the Round 1 interview.

(CHAMPUS and CHAMPVA are the Civilian Health

and Medical Programs for the Uniformed Services and

Veterans’Affairs.) All other sources of insurance were

measured for any time in the Round 1 reference period.

Persons counted as uninsured were uninsured

throughout the Round 1 reference period.

Public Coverage

For this report, individuals were considered to have

public coverage only if they met both of the following

criteria: 

• They were not covered by private insurance. 

• They were covered by one of the public programs

discussed below.

Medicare

Medicare is a federally financed health insurance

plan for the elderly, persons receiving Social Security

disability payments, and most persons with end-stage

renal disease. Medicare Part A, which provides hospital

insurance, is automatically given to those who are

eligible for Social Security. Medicare Part B provides

supplementary medical insurance that pays for medical

expenses and may be purchased for a monthly premium. 

CHAMPUS/CHAMPVA

CHAMPUS covers retired members of the

Uniformed Services and the spouses and children of

active-duty, retired, and deceased members. Spouses

and children of veterans who died from a service-
15

connected disability, or who are permanently disabled

and are not eligible for CHAMPUS or Medicare, are

covered by CHAMPVA. In this report, CHAMPUS or

CHAMPVA coverage is considered to be public

coverage.

Medicaid

Medicaid is a means-tested government program

jointly financed by Federal and State funds that provides

health care to those who are eligible. Program

eligibility criteria vary significantly by State, but the

program is designed to provide health coverage to

families and individuals who are unable to afford

necessary medical care.

Other Public Hospital/Physician Coverage

Respondents who did not report Medicaid coverage

were asked if they were covered by any other public

hospital/physician coverage. These questions were

asked in an attempt to identify Medicaid recipients who

might not have recognized their coverage as Medicaid.

In this report, all coverage reported in this manner is

considered public coverage.

Private Health Insurance

Private health insurance was defined for this report

as insurance that provides coverage for hospital and

physician care. Insurance that provides coverage for a

single service only, such as dental or vision coverage,

was not counted. In addition, private insurance was

classified as either employment related or

nonemployment related. Employment-related coverage

includes private health insurance obtained through an

employer, union, or self-employed business. Insurance

also was classified as employment related when the

policyholder resided outside the reporting unit.

Individuals were classified as having nonemploymentrelated insurance if they did not have employmentrelated coverage but were covered by private

hospital/physician insurance obtained from another

source, such as directly from an insurance company or a

health maintenance organization (HMO) or through a

group or association.

Uninsured

The uninsured were defined as persons not covered

by Medicare, CHAMPUS/CHAMPVA, Medicaid, other

public hospital/physician programs, or private

hospital/physician insurance throughout the entire

Round 1 reference period. Individuals covered only by

noncomprehensive State-specific programs (e.g.,

Maryland Kidney Disease Program, Colorado Child

Health Plan) or private single-service plans (e.g.,

coverage for dental or vision care only, coverage for

accidents or specific diseases) were not considered to

be insured.

Health Insurance Edits

The Round 1 health insurance data were edited as

described below. Minimal editing was performed on the

Medicare and Medicaid variables; all other coverage

types are unedited and unimputed.

Medicare

Medicare coverage was edited for persons age 65

and over but not for persons under age 65. Persons age

65 and over were assigned Medicare coverage if they

met one of the following criteria: 

• They answered “yes” to a followup question on

whether they had received Social Security benefits.

• They were covered by Medicaid, other public

hospital/physician coverage, or Medigap coverage.

• Their spouse was covered by Medicare.

Medicaid

A small number of cases reporting Aid to Families

with Dependent Children (AFDC) or Supplemental

Security Income (SSI) coverage (questions included in

the Round 1 interview for editing purposes) were

assigned Medicaid coverage. In addition, the Medicaid

variable was edited to include persons who paid nothing

for their other public hospital/physician insurance when

such coverage was through a Medicaid HMO or
16

reported to include some other managed care

characteristics. Since this report does not distinguish

among sources of public insurance, no further edits

were performed using the other public

hospital/physician coverage variables. Other public

hospital/physician coverage was included, however,

when considering whether an individual was covered

only by public insurance. 

Private Health Insurance

Individuals were considered to be covered by

private insurance if the insurance provided coverage for

hospital/physician care. Medigap plans were included.

Individuals covered by single-service plans only (e.g.,

dental, vision, or drug plans) were not considered to be

privately insured. Sources of insurance with missing

information regarding the type of coverage were

assumed to contain hospital/physician coverage. 

As more information from other parts and

subsequent rounds of MEPS becomes available, it will

be used to correct missing or inconsistent information.

In particular, private coverage variables will be edited in

terms of the reporting of private insurance as a source

of payment for medical expenses. Finally, it should be

noted that these data were generally reported by a single

household respondent, who may not have been the most

knowledgeable source for other family members. The

employers and insurance companies of household

respondents are being contacted in a followup survey as

part of the MEPS data collection effort designed to

verify and supplement the information provided by the

household respondents.

Population Characteristics

Place of Residence

Individuals were identified as residing either inside

or outside a metropolitan statistical area (MSA) as

designated by the U.S. Office of Management and

Budget (OMB), which applied 1990 standards using

population counts from the 1990 U.S. census. An MSA

is a large population nucleus combined with adjacent

communities that have a high degree of economic and

social integration within the nucleus. Each MSA has

one or more central counties containing the area’s main

population concentration. In New England,

metropolitan areas consist of cities and towns rather

than whole counties. Regions of residence are in

accordance with the U.S. Bureau of the Census

definition.

Race/Ethnicity

Classification by race and ethnicity was based on

information reported for each household member.

Respondents were asked if their race was best described

as American Indian, Alaska Native, Asian or Pacific

Islander, black, white, or other. They were also asked if

their main national origin or ancestry was Puerto Rican;

Cuban; Mexican, Mexicano, Mexican American, or

Chicano; other Latin American; or other Spanish. All

persons who claimed main national origin or ancestry in

one of these Hispanic groups, regardless of racial

background, were classified as Hispanic. Since the

Hispanic grouping can include black Hispanic, white

Hispanic, and other Hispanic, the race categories of

black, white, and other do not include Hispanic.

Employment Status

Persons were considered to be employed if they

were age 16 and over, had a job for pay, owned a

business, or worked without pay in a family business at

the time of the Round 1 interview.

Sample Design and Accuracy of

Estimates

The sample selected for the 1996 MEPS, a

subsample of the 1995 National Health Interview

Survey (NHIS), was designed to produce national

estimates that are representative of the civilian

noninstitutionalized population of the United States.

Round 1 data were obtained for approximately 9,400

households in MEPS, resulting in a survey response rate

of 78 percent. This figure reflects participation in both

NHIS and MEPS.
17

The statistics presented in this report are affected by

both sampling error and sources of nonsampling error,

which include nonresponse bias, respondent reporting

errors, interviewer effects, and data processing

misspecifications. For a detailed description of the

MEPS survey design, the adopted sample design, and

methods used to minimize sources of nonsampling

error, see Cohen (1997) and Cohen, Monheit,

Beauregard, et al. (1996). The MEPS person-level

estimation weights include nonresponse adjustments and

poststratification adjustments to population estimates

derived from the March 1996 Current Population

Survey (CPS) based on cross-classifications by region,

age, race/ethnicity, and sex. 

Tests of statistical significance were used to

determine whether the differences between populations

exist at specified levels of confidence or whether they

occurred by chance. Differences were tested using Zscores having asymptotic normal properties at the 0.05

level of significance. Unless otherwise noted, only

statistical differences between estimates are discussed in

the text.

Rounding

Estimates presented in the tables were rounded to

the nearest 0.1 percent. Standard errors, presented in

Tables B-F, were rounded to the nearest 0.01.

Population estimates in Tables 1- 5 and Table A were

rounded to the nearest thousand. Therefore, some of the

estimates presented in the tables for population totals of

subgroups will not add exactly to the overall estimated

population total.

Comparisons with Other Data

Sources

Because of methodological differences, caution

should be used when comparing these data with data

from other sources. For example, CPS measures

persons who are uninsured for a full year; NHIS

measures persons who lack insurance at a given point in

time—the month before the interview. CPS is

conducted annually, and NHIS collects insurance data

on a continuous basis each year. In addition, unlike

MEPS, CPS counts as insured military veterans whose

source of health care is the Department of Veterans’

Affairs. CPS also counts children of adults covered by

Medicaid as insured. For these preliminary estimates,

MEPS did not consider these children insured unless

their families reported them as such.
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Table A. Health insurance coverage of the civilian noninstitutionalized

population: Population estimates by type of coverage and selected population

characteristics, United States, first half of 1996

Population Total Any Any private Public

characteristic population coverage coverage only Uninsured

Number in thousands

Totala 263,516 218,760 178,820 39,939 44,756

Total under age 65a 231,676 187,191 159,235 27,957 44,485

Age in years

Under 4 15,577 13,430 9,435 3,996 2,147

4-6 12,716 11,029 8,016 3,013 1,687

7-12 24,092 20,358 15,436 4,922 3,734

13-17 19,036 15,627 12,723 2,904 3,409

Total under 18 71,421 60,444 45,610 14,835 10,977

18 3,445 2,468 2,121 — —

19-24 21,643 13,454 11,563 1,891 8,189

25-29 18,703 13,692 12,128 1,564 5,011

30-34 21,383 17,257 15,570 1,687 4,126

35-54 74,423 62,252 56,834 5,418 12,171

55-64 20,658 17,625 15,410 2,215 3,033

65 and over 31,839 31,568 19,586 11,983 —

Employment statusb

Employed 128,619 105,766 100,343 5,424 22,853

Not employed 69,810 58,340 37,657 20,684 11,470

Sex

Male 128,383 104,440 87,217 17,223 23,943

Female 135,133 114,319 91,603 22,716 20,813

Race/ethnicity

Total Hispanic 28,384 18,886 12,492 6,394 9,498

Total black 32,975 25,407 16,041 9,366 7,567

Total white 190,235 165,272 143,234 22,038 24,962

Total other 11,922 9,194 7,053 2,141 2,729

Census region

Northeast 51,464 44,427 36,191 8,236 7,037

Midwest 61,828 53,400 45,328 8,072 8,428

South 91,855 73,574 60,012 13,562 18,281

West 58,369 47,359 37,289 10,069 11,010

a Includes persons with unknown employment status.

b For individuals age 16 and over.

— Sample size too small to produce reliable estimates.

Source: Center for Cost and Financing Studies, Agency for Health Care Policy and Research: Medical Expenditure Panel Survey 

Household Component, 1996 (Round 1).
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Table B. Health insurance coverage of the civilian noninstitutionalized

population: Standard errors by type of coverage and selected population

characteristics, United States, first half of 1996

Corresponds to Table 1

Private

Population Total Employment- Nonemployment- Public

characteristic private related related only Uninsured

Standard error

Totala 0.71 0.72 0.29 0.54 0.47

Total under age 65a 0.78 0.79 0.27 0.58 0.52

Age in years

Under 4 1.82 1.80 0.59 1.63 1.17

4-6 1.83 1.87 0.63 1.61 1.24

7-12 1.60 1.66 0.67 1.38 1.10

13-17 1.51 1.58 0.66 1.22 1.15

Total under 18 1.20 1.23 0.42 1.01 0.77

18 3.22 3.33 1.10 2.04 2.98

19-24 1.50 1.51 0.74 0.92 1.44

25-29 1.56 1.56 0.63 0.89 1.39

30-34 1.38 1.37 0.43 0.82 1.08

35-54 0.82 0.86 0.35 0.48 0.61

55-64 1.27 1.50 0.79 0.98 0.88

65 and over 1.24 1.25 1.12 1.22 0.23

Employment statusb

Employed 0.65 0.68 0.30 0.32 0.53

Not employed 0.86 0.85 0.57 0.79 0.60

Sex

Male 0.76 0.77 0.34 0.59 0.57

Female 0.76 0.78 0.31 0.57 0.48

Race/ethnicity

Total Hispanic 1.86 1.81 0.40 1.20 1.56

Total black 1.78 1.84 0.45 1.66 1.28

Total white 0.79 0.84 0.37 0.56 0.50

Total other 3.62 3.51 1.28 3.44 2.24

Hispanic male 1.94 1.88 0.55 1.18 1.71

Black male 2.12 2.15 0.52 1.91 1.61

White male 0.87 0.93 0.44 0.62 0.61

Hispanic female 2.07 2.01 0.39 1.54 1.68

Black female 1.98 2.07 0.51 1.84 1.61

White female 0.84 0.89 0.39 0.60 0.51

Continued
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Private

Population Total Employment- Nonemployment- Public

characteristic private related related only Uninsured

Standard error

Marital statusb

Married 0.66 0.80 0.43 0.47 0.50

Widowed 1.62 1.37 1.32 1.56 0.72

Divorced 1.53 1.55 0.63 1.13 1.22

Separated 2.83 2.81 *0.76 2.36 2.77

Never married 1.06 1.02 0.43 0.75 0.91

Metropolitan 

statistical area (MSA)

MSA 0.83 0.82 0.31 0.61 0.53

Non-MSA 1.57 1.63 0.71 1.22 1.10

Census region

Northeast 1.36 1.42 0.52 0.90 0.87

Midwest 1.59 1.67 0.68 1.13 0.98

South 1.22 1.18 0.45 0.92 0.84

West 1.45 1.46 0.67 1.20 0.99

a Includes persons with unknown employment and marital status.

b For individuals age 16 and over.

* Relative standard error is greater than or equal to 30 percent. 

Source: Center for Cost and Financing Studies, Agency for Health Care Policy and Research: Medical Expenditure Panel Survey 

Household Component, 1996 (Round 1).

Table B. Health insurance coverage of the civilian noninstitutionalized

population: Standard errors by type of coverage and selected population

characteristics, United States, first half of 1996—Continued
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Table C. Health insurance coverage of the civilian noninstitutionalized

population under age 65: Standard errors by type of coverage and selected

population characteristics, United States, first half of 1996

Corresponds to Table 2

Private

Population Total Employment- Nonemploymentcharacteristic private related related Public only Uninsured

Standard error

Totala 0.78 0.79 0.27 0.58 0.52

Employment statusb

Employed 0.66 0.67 0.28 0.31 0.54

Not employed 1.08 1.04 0.41 1.01 0.88

Sex

Male 0.81 0.82 0.34 0.61 0.62

Female 0.86 0.88 0.26 0.63 0.55

Race/ethnicity

Total Hispanic 1.97 1.92 0.39 1.24 1.59

Total black 1.92 1.94 0.41 1.74 1.34

Total white 0.87 0.92 0.34 0.59 0.57

Total other 3.67 3.59 1.32 3.49 2.43

Hispanic male 2.02 1.98 0.55 1.20 1.72

Black male 2.24 2.20 0.48 1.97 1.70

White male 0.94 1.01 0.45 0.63 0.68

Hispanic female 2.20 2.13 0.36 1.58 1.75

Black female 2.14 2.21 0.46 1.90 1.71

White female 0.94 0.99 0.33 0.65 0.60

Marital statusb

Married 0.72 0.82 0.34 0.40 0.58

Widowed 3.13 3.18 1.78 2.03 2.55

Divorced 1.59 1.59 0.59 1.06 1.34

Separated 2.95 2.94 *0.68 2.31 2.97

Never married 1.07 1.02 0.43 0.75 0.92

Metropolitan 

statistical area (MSA)

MSA 0.91 0.91 0.30 0.66 0.58

Non-MSA 1.72 1.78 0.60 1.31 1.30

Census region

Northeast 1.53 1.55 0.40 0.98 0.99

Midwest 1.70 1.74 0.63 1.17 1.11

South 1.37 1.31 0.37 1.02 0.91

West 1.54 1.66 0.73 1.25 1.09

a Includes persons with unknown employment and marital status.

b For individuals age 16 and over.

* Relative standard error is greater than or equal to 30 percent. 

Source: Center for Cost and Financing Studies, Agency for Health Care Policy and Research: Medical Expenditure Panel Survey

Household Component, 1996 (Round 1).
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Table D. Health insurance coverage of the civilian noninstitutionalized

population: Standard errors by type of coverage and perceived health status,

United States, first half of 1996

Corresponds to Table 3

Private 

Population Total Employment- Nonemploymentcharacteristic private related related Public only Uninsured

Standard error 

Total under age 65a 0.78 0.79 0.27 0.58 0.52

Total age 65 and overa 1.24 1.25 1.12 1.22 0.23

Perceived health 

status, under age 65

Excellent 0.89 0.93 0.46 0.55 0.74

Very good 0.89 0.91 0.39 0.68 0.67

Good 1.21 1.21 0.33 0.94 0.83

Fair 1.61 1.65 0.60 1.44 1.35

Poor 2.54 2.63 1.02 2.47 2.32

Perceived health 

status, age 65 and over

Excellent 2.61 2.56 2.59 2.56 *0.58

Very good 2.08 2.40 2.09 2.06 *0.43

Good 2.06 1.99 1.92 2.01 *0.36

Fair 2.66 2.53 2.22 2.67 *0.30

Poor 3.85 3.41 2.92 3.85 *0.35

a Includes persons with unknown perceived health status.

* Relative standard error is greater than or equal to 30 percent. 

Source: Center for Cost and Financing Studies, Agency for Health Care Policy and Research: Medical Expenditure Panel Survey 

Household Component, 1996 (Round 1).
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Table E. Health insurance coverage of the civilian noninstitutionalized

population ages 19-24: Standard errors by type of coverage and selected

population characteristics, United States, first half of 1996

Corresponds to Table 4

Private

Population Employmentcharacteristic Total private related Public only Uninsured 

Standard error

Totala 1.49 1.50 0.92 1.44

Employment status

Employed 1.82 1.81 0.90 1.78

Not employed 2.39 2.47 1.74 2.26

Sex

Male 1.95 2.01 0.86 1.89

Female 1.95 1.93 1.31 1.91

Race/ethnicity

Total Hispanic 2.82 2.87 1.54 2.77

Total black 3.63 3.45 2.94 4.02

Total white 1.80 1.94 0.87 1.74

Total other 6.06 6.68 *4.69 5.90

Hispanic male 3.28 3.23 *1.43 3.36

Black male 5.33 4.92 *1.78 4.93

White male 2.43 2.61 1.04 2.34

Hispanic female 4.06 4.07 2.87 4.12

Black female 4.73 4.81 4.26 5.58

White female 2.21 2.39 1.28 2.12

Perceived health status 

Excellent 2.39 2.43 0.97 2.31

Very good 2.31 2.33 1.21 2.26

Good 2.71 2.54 1.95 2.55

Fair or poor 5.22 5.17 3.87 5.54

Census region

Northeast 2.87 2.93 1.88 2.87

Midwest 2.66 2.89 1.53 2.41

South 2.71 2.48 1.72 2.82

West 3.30 3.39 1.89 2.77

Student statusb

Full-time 2.38 2.92 1.65 2.13

Part-time 5.86 5.77 2.78 4.86

Not a student 2.01 1.98 1.27 2.07

a Includes persons with unknown employment status and perceived health status.

b For individuals ages 19-23 years.

* Relative standard error is greater than or equal to 30 percent.

Source: Center for Cost and Financing Studies, Agency for Health Care Policy and Research: Medical Expenditure Panel Survey 

Household Component, 1996 (Round 1).












































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24

Table F. Total population and uninsured persons under age 65: Standard

errors by selected population characteristics, United States, first half of 1996

Corresponds to Table 5

Population Percent distribution Percent Percent distribution 

characteristic of population uninsured of uninsured population

Standard error

Totala — 0.52 —

Age in years

Under 4 0.22 1.17 0.40

4-6 0.18 1.24 0.34

7-12 0.26 1.10 0.57

13-17 0.21 1.15 0.44

18 0.10 2.98 0.27

19-24 0.27 1.44 0.82

25-29 0.28 1.39 0.57

30-34 0.25 1.08 0.50

35-54 0.38 0.61 0.77

55-64 0.28 0.88 0.41

Race/ethnicity

Total Hispanic 0.57 1.59 1.45

Total black 0.70 1.34 1.33 

Total white 0.86 0.57 1.73

Total other 0.40 2.43 0.73

Hispanic male 0.31 1.72 0.87

Black male 0.34 1.70 0.74

White male 0.49 0.68 1.11

Hispanic female 0.28 1.75 0.69

Black female 0.40 1.71 0.80

White female 0.50 0.60 1.00

Marital statusb

Married 0.46 0.58 0.86

Widowed 0.09 2.55 0.23

Divorced 0.25 1.34 0.55

Separated 0.12 2.97 0.34

Never married 0.40 0.92 1.01

Census region

Northeast 0.79 0.99 1.11

Midwest 0.97 1.11 1.45

South 1.26 0.91 1.87

West 0.81 1.09 1.29

Perceived health status

Excellent 0.59 0.74 1.13

Very good 0.43 0.67 0.93

Good 0.40 0.83 0.88

Fair 0.22 1.35 0.52

Poor 0.15 2.32 0.31

a Includes persons with unknown perceived health status and marital status.

b For individuals age 16 and over.

Source: Center for Cost and Financing Studies, Agency for Health Care Policy and Research: Medical Expenditure Panel Survey 

Household Component, 1996 (Round 1).