Medical Expenditure Panel Survey Agency for Healthcare 

Research and Quality

STATISTICAL BRIEF #161 

February 2007 

Highlights 

 In 2004, 10.7 percent of adults

agreed with the statement “I’m 

healthy enough that I really

don’t need health insurance,” 

and 24.1 percent of adults 

agreed with the statement 

“Health insurance is not worth 

the money it costs.” 

 There were no differences in the 

overall national estimates when

comparing the 2004 attitudes 

towards health insurance with

those observed in 2003; however, substantial shifts in preferences were noted for the same

individuals over this time period.

 Adults age 18–64 who were 

uninsured for all of 2004 were

twice as likely as their insured 

counterparts to indicate they

were healthy and did not need

health insurance. These uninsured adults were also more 

likely to agree that health insurance was not worth its cost, 

relative to those with coverage. 

 Adults with consistent attitudes 

toward health insurance in both 

2003 and 2004 had coverage

and expenditure behaviors in 

accordance with their expressed 

preferences. Those who consistently said they were healthy 

and did not need coverage were 

at least three times as likely not 

to have a medical expense in 

both years, relative to those 

who consistently disagreed 

with that classification. 

 In both years, adults under age 

65 who consistently indicated 

that health insurance was not 

worth the cost were at least two 

and a half times as likely to be

uninsured relative to those who 

consistently disagreed. 

Attitudes toward Health Insurance and 

Their Persistence over Time, Adults 

2003–2004 

Steven B. Cohen, PhD 

Introduction 

Health insurance helps individuals receive timely access to medical 

care and protects them against the risk of expensive and unanticipated medical events. In addition to the socioeconomic profiles 

that distinguish individuals with coverage from those who are 

uninsured, attitudes regarding the need for and value of health 

insurance coverage may also impact on coverage decisions. Given 

the potential for these health care preferences to influence health 

behaviors, it is important to measure the population’s attitudes 

towards health insurance coverage and to examine the persistence

of these attitudes over time. 

The Household Component of the Medical Expenditure Panel 

Survey (MEPS-HC) contains a series of self-administered questions that discern individual attitudes regarding the need for health 

insurance coverage and its cost. Adults age 18 and over are asked

whether they strongly agree, agree, are uncertain, disagree, or 

strongly disagree with each of the following statements: “I’m healthy 

enough that I really don’t need health insurance” and “Health 

insurance is not worth the money it costs.” 

This Statistical Brief provides a summary of the attitudes adults 

have regarding the need for health insurance coverage and its cost

over the time period 2003–2004, based on data from the 2003 and 

2004 MEPS-HC. A description of the variation in agreement levels

with these attitudes for adults further distinguished by demographic 

and socioeconomic characteristics is also provided. In addition, the 

persistence in these attitudes toward health insurance coverage is

examined. For this report, strongly agreed and agreed responses 

were combined into an “agreed” category while strongly disagreed 

and disagreed responses were combined into a “disagreed” category. All differences between estimates discussed in the text are 

statistically significant at the 0.05 level unless otherwise noted. 

Findings 

In 2004, 10.7 percent of adults age 18 and over (23.2 million 

people, estimate not shown) who were members of the U.S. civilian 

noninstitutionalized population agreed with the statement “I’m 
healthy enough that I really don’t need health insurance,” another 82.5 percent disagreed, and 6.7 

percent expressed uncertainty (figure 1). When restricted to the adult population under age 65, 11.6 

percent agreed with the statement (data not shown). Furthermore, no differences in the 2004 national 

estimates for this health care preference measure were observed, relative to the corresponding attitudinal 

profiles that characterized the nation in 2003. 

When focused on attitudes related to the cost of health insurance coverage, 24.1 percent of adults age 18 

and over in 2004 ( 52.0 million people, estimate not shown) agreed with the statement “Health insurance 

is not worth the money it costs,” another 62.9 percent disagreed, while 13.0 percent expressed 

uncertainty (figure 1). When restricted to the adult population under age 65, 25.8 percent agreed with the 

statement (data not shown). Again, no differences in national estimates for this health care preference 

measure were observed, relative to the corresponding attitudinal profiles that characterized the nation in 

2003. 

While the national estimates of these attitudinal items were relatively stable between 2003 and 2004, an 

examination of the persistence in attitudes over the two-year period revealed a substantial shift in 

preferences within individuals over time (figure 2). This assessment of the persistence in attitudes over 

time was restricted to adults who were in the civilian noninstitutionalized population for both years. With 

respect to the statement “I’m healthy enough that I really don’t need health insurance,” only 4.2 percent of 

individuals agreed with the statement in both years. Similarly, only 72.1 percent disagreed in both years. 

The remainder was characterized by a change in attitude over time or uncertainty in response. With 

respect to the statement “Health insurance is not worth the money it costs,” only 12.6 percent of individuals agreed with the statement in both years. Similarly, only 45.3 percent disagreed in both years. The 

remaining individuals were characterized by a change in attitude over time or uncertainty in response. 

In 2004, adults below the age of 45 were more likely than older individuals to indicate that they are 

healthy and do not need health insurance (figure 3) and to feel that health insurance was not worth the 

cost (figure 4). In comparisons by race/ethnicity, Hispanics were more likely than white non-Hispanics and 

black non-Hispanics to indicate they were healthy and not in need of coverage (16.9 percent versus 9.2 

percent and 11.5 percent, respectively; figure 3) and that insurance was not worth the cost (27.3 percent 

versus 23.6 and 23.9 percent, respectively; figure 4). In addition, adult males were more likely than 

females to indicate that they are healthy and do not need health insurance (13.7 percent versus 8.0 

percent, figure 3) and to feel that health insurance was not worth the cost (27.3 percent versus 21.1 

percent, figure 4). 

In 2004, adults with fewer than 12 years of education were more likely than individuals with 12 or more 

years of education to indicate they were healthy and not in need of coverage (12.8 percent versus 

approximately 10 percent, respectively; figure 3) and that insurance was not worth the cost (26.1 percent 

versus 23.8 and 23.5 percent, respectively; figure 4). In addition, adults who were classified as poor or 

near poor were more likely then their counterparts in the high income category to indicate they were 

healthy and not in need of coverage (figure 3) and to feel that health insurance was not worth the cost 

(figure 4). Furthermore, adults between the ages of 18 and 64 who were uninsured for all of 2004 were 

approximately twice as likely as their insured counterparts to agree with the statement “I’m healthy 

enough that I really don’t need health insurance” (19.7 percent versus 10.1 percent and 9.7 percent, 

respectively; figure 3). These uninsured adults were also more likely to agree with the statement “Health 

insurance is not worth the money it costs” (36.3 percent, figure 4) , relative to those with coverage (23.9 

percent and 22.3 percent, respectively). 

For adults with consistent attitudes regarding the need for coverage based on health status in both 2003 

and 2004, those indicating they were healthy and did not need coverage were at least three times as 

likely not to have a medical expense (31.9 percent, 2003; 34.4 percent, 2004; figure 5), relative to those 

who disagreed in both years (8.9 percent, 2003; 11.4 percent, 2004; figure 5). They were also substantially less likely to indicate they were in fair or poor health status (2.3 percent, 2003; 3.9 percent, 2004; 

figure 5), relative to those who disagreed (15.4 percent, 2003; 15.9 percent, 2004; figure 5). Furthermore, 

adults under the age of 65 who consistently indicated they were healthy and not in need of coverage were 

nearly three times as likely to be uninsured for an entire year (34.4 percent, 2003; 33.7 percent, 2004; 

figure 5), relative to those who disagreed (11.9 percent, 2003; 11.8 percent, 2004; figure 5). 
For adults with consistent attitudes regarding the cost of health insurance in both 2003 and 2004, those 

indicating health insurance was not worth the cost were approximately twice as likely not to have a 

medical expense (18.2 percent, 2003; 22.1 percent, 2004; figure 6), relative to those who disagreed in 

both years (8.8 percent, 2003; 10.9 percent, 2004; figure 6). Furthermore, adults under the age of 65 who 

consistently indicated that health insurance was not worth the cost were substantially more likely to be 

uninsured for an entire year (23.2 percent, 2003; 24.7 percent, 2004; figure 6), relative to those who 

disagreed (9.2 percent, 2003; 8.5 percent, 2004; figure 6). 

Data Source 

The estimates shown in this Statistical Brief are drawn from analyses conducted by the MEPS staff from 

the following public use files: 2003 Full-Year Consolidated Data File, HC-079, the 2004 Full-Year 

Consolidated Data File, HC-079, and the MEPS Panel 8 Longitudinal Weight File, HC-086. The level of 

item nonresponse associated with the attitude questions from the 2003 and 2004 SAQ (self-administered 

questionnaire) instruments was approximately 2 percent. 

Definitions 

Longitudinal classifications of attitudinal responses 

Individuals with responses of agree or strongly agree to the attitudinal items in both years were classified 

as “agree both years.” Individuals with responses of disagree or strongly disagree to the attitudinal items 

in both years were classified as “disagree both years.” Individuals with responses of disagree, strongly 

disagree, or uncertain in 2003 and with responses of agree or strongly agree to the attitudinal items in 

2004 were classified as “shift to agree.” Individuals with responses of agree, strongly agree, or uncertain 

in 2003 and with responses of disagree or strongly disagree to the attitudinal items in 2004 were 

classified as “shift to disagree.” All other responses were classified as “other uncertain.” The longitudinal 

analyses were conditioned on responses to the SAQ in 2003 and 2004 for the same individuals on the 

MEPS Panel 8 Longitudinal Weight File, HC-086. Over 89 percent of these longitudinal respondents in 

MEPS also responded to the SAQ in both years. 

Uninsured 

Individuals classified as uninsured throughout the year did not have public only or private health 

insurance coverage during that time interval. 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 considered to 

be uninsured. 

 

Public only coverage 

Individuals were considered to have public only health insurance coverage if they were not covered by 

private insurance and they were covered by Medicare, Medicaid, TRICARE, or other public only hospital 

and physician coverage. 

Private coverage 

Private health insurance coverage was defined as nonpublic insurance that provided coverage for 

hospital and physician care (including Medigap coverage). 

Race/ethnicity 

Classification by race/ethnicity was based on information reported for each family member. Respondents 

were asked if each family member's race was best described as American Indian, Alaska Native, Asian or 

Pacific Islander, black, white, or other. They also were asked if each family member's main national origin 

or ancestry was Puerto Rican; Cuban; Mexican, Mexicano, Mexican American, or Chicano; other Latin 

American; or other Spanish. All persons whose main national origin or ancestry was reported in one of 

these Hispanic groups, regardless of racial background, were classified as Hispanic. Since the Hispanic 

grouping can include black Hispanic, white Hispanic, Asian and Pacific Islanders Hispanic, and other 

Hispanic, the race categories of black, white, Asian and Pacific Islanders, and other do not include 

Hispanics. MEPS respondents who reported other single or multiple races and were non-Hispanic were 

included in the other category. For this analysis, the following classification by race and ethnicity was 
used: Hispanic (of any race), non-Hispanic blacks single race, non-Hispanic whites single race, and nonHispanic others. 

Poverty status 

Sample persons were classified according to the total yearly income of their family. Within a household, 

all people related by blood, marriage, or adoption were considered to be a family. Poverty status 

categories are defined by the ratio of family income to the Federal income thresholds, which control 

for family size and age of the head of family. Poverty status was based on annual income in 2003. 

Poverty status categories are defined as follows: 

– Poor: Persons in families with income less than or equal to the poverty line, including those who had 

negative income. 

– Near poor: Persons in families with income over the poverty line through 125 percent of the poverty 

line. 

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

– Middle income: Persons in families with income over 200 percent through 400 percent of the poverty 

line. 

– High income: Persons in families with income over 400 percent of the poverty line. 

Health status 

In each year of the administration of the MEPS SAQ, the respondent was asked the following question: 

“In general, would you say your health is excellent, very good, good, fair, or poor?” 

About MEPS-HC 

MEPS-HC is a nationally representative longitudinal survey that collects detailed information on health 

care utilization and expenditures, health insurance, and health status, as well as a wide variety of social, 

demographic, and economic characteristics for the civilian noninstitutionalized population. It is cosponsored by the Agency for Healthcare Research and Quality and the National Center for Health Statistics. 

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

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

References 

For a detailed description of the MEPS survey design, sample design, and methods used to minimize 

sources of nonsampling error, see the following publications: 

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

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

Research, 1997. 

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

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

Research, 1997. 

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

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

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

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

http://www.meps. ahrq.gov/mepsweb/data_files/publications/st87/stat87.pdf 

Suggested Citation 

Cohen, S. B. Attitudes toward Health Insurance and Their Persistence over Time, Adults 2003–2004. 

Statistical Brief #161. February 2007. Agency for Healthcare Research and Quality, Rockville, Md. 

http://www.meps. ahrq.gov/mepsweb/data_files/publications/st161/stat161.pdf 
∗ ∗ ∗

AHRQ welcomes questions and comments from readers of this publication who are interested in 

obtaining more information about access, cost, use, financing, and quality of health care in the United 

States. We also invite you to tell us how you are using this Statistical Brief and other MEPS data and 

tools and to share suggestions on how MEPS products might be enhanced to further meet your needs. 

Please e-mail us at mepspd@ahrq.gov or send a letter to the address below: 

Steven B. Cohen, PhD, Director 

Center for Financing, Access, and Cost Trends 

Agency for Healthcare Research and Quality 

540 Gaither Road 

Rockville, MD 20850 
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 

2003 and 2004.

Figure 1. Distribution of responses to health insurance

attitude items, adults age 18 and over, 2003 and 2004

83.2 82.5

63.3 62.9

6.4 6.7

12.5 13.0

10.4 10.7

24.2 24.1

0%

20%

40%

60%

80%

100%

2003 2004 2003 2004

Disagree Uncertain Agree

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

Perc

ent

 

Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 

2003 and 2004.

Figure 2. Distribution of level of persistence in response to health

insurance attitude items, adults age 18 and over, 2003 and 2004

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

8.5%

6.1%

4.2%

9.1%

72.1%

14.6%

12.7%

12.6%

14.9%

45.3%

Disagree both years Shift to disagree Shift to agree Agree both years Other
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 

2003 and 2004.

Figure 3. Percentage of adults who feel they are healthy and 

don’t need health insurance, by selected characteristics, 2004

17.7

11.9

7.4 6.1

9.2

16.9

11.5

14.2 13.7

8.0

12.8

9.9 10.4 12.8 11.4 11.4 9.3 10.1 9.7

19.7

0

10

20

30

40

50

18-29

30-44

45-64

65+

White non-Hispanic

Hispanic

Black non-Hispanic

Other non-Hispanic

Male

Female

<12 years

12 years

>12 years

Poor/near poor

Low

Middle

High

Any private

Public only 

Uninsured

Percent

Age Race/ethnicity Sex Family income Insurance status

(age 18-64 only)

Education

Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 

2003 and 2004.

Figure 4. Percentage of adults who feel that health insurance

is not worth the cost, by selected characteristics, 2004

26.3 28.2

23.3

15.3

23.6

27.3

23.9 23.9

27.3

21.1

26.1 23.8 23.5 26.2 24.3

27.1

20.9 22.3

36.3

23.9

0

10

20

30

40

50

18-29

30-44

45-64

65+

White non-Hispanic

Hispanic

Black non-Hispanic

Other non-Hispanic

Male

Female

<12 years

12 years

>12 years

Poor/near poor

Low

Middle

High

Any private

Public only

Uninsured

Percent

Age Race/ethnicity Sex Education Family income Insurance status

(age 18-64 only)
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 

2003 and 2004.

Figure 5. Characteristics of adults with consistent

attitudes to statement “I’m healthy enough that I really

don’t need health insurance,” 2003 and 2004

14.5 15.5

34.4

8.9

11.4 13.3 14.0

2.3 3.9

15.4 15.9 16.4 16.5

34.4 33.7

11.9 11.8

31.9

0

10

20

30

40

50

2003 2004 2003 2004 2003 2004 2003 2004 2003 2004 2003 2004 2003 2004 2003 2004 2003 2004

Percent

Percent without

expense

Percent in fair

or poor health status

Percent uninsured

age 18-64

All adults Agree both years Disagree both years

Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 

2003 and 2004.

Figure 6. Characteristics of adults with consistent

attitudes to statement “Health insurance is not

worth the money it costs,” 2003 and 2004

14.5 15.5

18.2

22.1

8.8

10.9

13.3 14.0

10.5 11.4 12.4 12.7

16.4 16.5

23.2 24.7

9.2 8.5

0

10

20

30

40

50

2003 2004 2003 2004 2003 2004 2003 2004 2003 2004 2003 2004 2003 2004 2003 2004 2003 2004

Percent

Percent without

expense

Percent in fair

or poor health status

Percent uninsured

age 18-64

All adults Agree both years Disagree both years