FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEAL 7’H STA TiiTICS 

U.S. DEPARTMENT OF HEALTH, . Public Health Service 

EDUCATION, ANI3 WELFARE Office of Health Research, Statistics, and Technology Number 44 � September 20, 1979 

Health Care Coverage: United States, 19761 

As a nationaJ issue, the type and extent of 

health insurance coverage has been a matter 

of concern for some time. The debate over the 

various national health insurance proposzds 

routinely focuses on the extent and type of 

coverage to be made availabIe under Legislation. 

In particular, the number of uninsured persons 

and their characteristics have been a matter of 

interest and investigation. Thus the population’s 

current level of coverage must be presented in 

oth a timely and relevant fashion. There is a 

eed to answer the following questions: How e many persons have no health care coverage at 

all? What are their characteristics? Among 

persons who have health care coverage, how 

many are covered under broad types of public 

and private insurance proLgrams? How many 

persons are covered exclusively under public 

programs? This report presents statistics that 

bear directly on these questions and are based 

primarily on survey respondents’ perceptions 

of their health care coverage. 

Findings in this report include estimates 

from the Health Interview Survey (HIS) of the 

number of persons covered under specific plans 

or programs, regardless of other coverage, as weIl 

as those covered exclusively under certain plans 

or programs. 

During 1976, the HIS questionnaire included 

questions designed to obtain information about 

coverage under private and public health care 

plans or progmu-ns in the civilian noninstitutionalized population of the United States. Data 

were obtained on Medicare, Medicaid, and private hospital and surgicaI insurance coverage. 

1This report was prepared bv Larrv S. Corder. Ph.D.. 

formerly w;th the Di;isi& of H<h I;terview Statistics: 

Information concerning health care coverage was 

reported by one household respondent on behalf of the efitire household. Information on 

private insurance coverage was collected in 

several areas: what services the pI an paid for 

(hospital and/or surgiczd expenses); how the plan 

was obtained (through a company, union, or 

some other method); and the type of plan (Blue 

Cross/Blue ShieId, prepaid, or other). If the 

respondent had no private hospital insurance 

coverage, no Medicare coverage (for persons 

65 years and over), and no hledicaid coverage, 

a question was asked to determine the major 

reason for lack of coverage. 

Further, HIS collected information on persons receiving Aid to Families with Dependent 

Children (AFDC) and Supplemental Security 

Income (SS1). Both groups are usually eligible 

to receive medical care paid for by the Medicaid pro<gram. 

AH of the above data items are based primarily on the survey respondents’ perceptions 

of their health care coverage. When employed in 

a way to insure the elimination of double counting, they provide a portrait of the extent of 

health care coverage in the civilian noninstitutionaJized population. However, little information is available on the proportion of health 

care costs paid for by different public or private 

plans or programs.z 

In 1976 approximately 186,583,000 persons, or 89.0 percent of the civilian noninstitu2Extensive information concerning adequacy of coverage will be available from the Natiord Medical Care 

Expenditure Survey (NMCES) in the near future. 

NMCES is a joint project of the National Center for 

Health Statistics and the National Center for Health 

Services Research. 
2 acklncedata 

* 

tionalized population of the United States, 

are estimated to have had some form of health 

care coverage. The remaining 11.0 percent, 

23,200,000 persons, who had no coverage 

under either public or private programs are defined as the uninsured population. 

An estimated 159,957,000 persons had private 

insurance coverage. Approximately 145,880,000 

of these persons had private coverage only, while 

the remaining 14,077,000 reported Medicare 

and/or Medicaid coverage as well. This fi<gureincludes an estimated 11,656,000 Medicare enrollees, 60.0 percent of all Medicare enrollees, 

whose coverage was supplemented by some form 

of private insurance plan. 

An estimated 16,392,000 persons were covered by Medicaid regardless of other coverage. 

About 12,162,000 of these had coverage under 

the Medicaid program only. These estimates 

differ from the 24.7 million recipients recorded , 

by Medicaid program statistics in 1976. 

DATA HIGHLIGHTS 

Table 1 presents information on the popuIation’ss health care coverage under private or 

public plans or programs. In this table, no per- [ 

son can be covered in more than one major 

category of coverage. Once a person appears 

under a major category of coverage, then that 

person cannot appear in another major category in the table. For example, a person covered 

by both private hospitaJ insurance and Medicare 

3The term “population” as used in this report refers 

to the civilian noninstitutionalized population. 

of the population, by heelth care coverage under types of private 

United States, 1976 

Table 1. Number, percent, cumulative number, and cumulative percent 

or public plans or programs: 

Type of private or public plan or program 

Private hospital insumnce ...... ...................... ................ .......... 

Private hospital insurance only ................................................... ...... 

Private hospital insurance and Medimre ........................... ................ 

Private hospital insurance and Medicaid ........................................... 

Medicare coverage, no private hospital insurance ... ................ 

Medicare coverage only ..................... ...... .................. ............ .. ......... 

Medicare and Medicaid coverage only .............................................. 

Medicaid coverage only . ........................................................ 

Other plans or programs onlyl ................ ........................ ..... . 

Private hospital insurance only, but don’t know what plan covers... 

No other coverage; don’t know if covered by private hospital 

insurance .......... ............................................. ........ ........................ . 

No health care mverage ......... ........................................... .... 

l,’mher ~lans or pro=ams only” breakdown as foIlows: 

CHAMPUS, CHAMPVA... 4,S07 

Private surgical insurance only .................. 236 

Professional courtesy ....... 41 

Number in 

thousands 

159,957 

145,880 

11,656 

2,421 

7,756 

5,948 

1,808 

12,162 

5,084 

1,624 

861 

23,200 

Cumulative Cumulative 

Percent number in percent thousands 

75.9 159,957 75.9 

+-+4-+


5.8 179,875 85.4 

2.4 / 184,959 I 87.8 

0.8 186,583 88.6 

0.4 187,444 89.0 

11.0 210,644 100.0 

NOTE: In this table, a person may appear only once in a major category remdless of the number of Programs, Plans, or Policies he0 

or she is covered under. 
o 

would be counted in the major category “private hospital insurance. ” Further, that person 

would be counted in the “private hospitaI 

insurance and Medicare” subcategory, one of the 

subcategories which sum to the “private hospital 

insurance” major category. While this breakdown by major categories superficially understates the number of persons covered under 

various public programs, its use makes the 

examination of a number of policy-relevant 

groups possible and eliminates muItiple counting 

of people with more than one form of coverage. 

The elimination of muItiple counting for health 

care coverage is essential to arriving at an accurate estimate of the number of uninsured 

persons. 

Highlights from tabIe 1 include an estimate 

of the uninsured group, 23,200,000 persons, 

or about 11 percent of the population; an estimate of the group covered by private hospital 

insurance and/or Medicare, 167,713,000 persons, or approximately 80 percent of the popuation; and an estimate of the number of persons 

a covered by Medicaid only, 12,162,000 persons, 

or approximately 6 percent of the population. 

Table 1 shows that 159,957,000 persons, 

or approximately 76 percent of the population, 

had private hospital insurance coverage during 

1976. Included in this group are persons having 

private hospitaJ insurance and Medicare coverage, 5.5 percent of the population, and persons 

having private hospital insurance and Medicaid 

coverage (1. 1 percent). 

Persons covered by Medicare but not by private hospital insurance comprised approximately 

4 percent of the population (7,756,000 persons). About 2.8 percent of the population had 

Medicare coverage only, and 0.9 percent had 

both Medicare and Medicaid coverage but no private hospital insurance. Persons covered only by 

Medicaid comprised approximately 6 percent of 

the population, 12,162,000 persons. 

Cumulatively, therefore, approximately 85 

percent of the population were covered under 

some combination of private hospital insurance, 

Medicare, or Medicaid. An additional 2 percent 

of the population were covered under other 

lans or pro<grams. These are the CiviIian Health 

d Medical Program for Veterans Admin­ e istration (CHAN4PVA), the Civilian HeaIth 

and MedicaI Program for Uniformed Services 

dmncdEb3 

(CHAMPUS), professional courtesy, and private surgical insurance only. These programs, 

along with Medicare, Medicaid, and private 

hospital insurance, provided approximately 

88 percent of the population with some form 

of health care coverage. Another 1 percent 

of the population, 1,624,000 persons, were 

covered by private hospital insurance but did 

not know if their pkms covered hospitaI chzu-ges 

or physicians’ fees while in the hospital. These 

persons were not covered by any other private 

or pubIic hospital insurance plan. Adding these 

to the insured population yields a total of 

186,583,000 persons, or approximately 89 

percent of the population, covered under some 

combination of Medicare, Medicaid, private 

hospital insurance, other plans or programs, or 

unidentified private hospital insurance only. 

An estimated 861,000 persons did not know 

if they had private hospital insurance but were 

not covered by any other public or private plan 

or program. Persons in this category were 

counted as neither insured nor uninsured. 

Rather, based on the respondents’ perception of 

coverage, they were categorized under “no other 

insurance, don’t know if covered by private 

hospitaI insurance.” 

The remaining population, approximately 23 

milIion persons, or 11 percent of the population, 

were not covered by any private or public health 

care coverage plans or programs in 1976. These 

persons are defined as uninsured. Twelve percent of the population under 65 years of age, 

22,763,000 persons, were uninsured. Aday and 

Anderson, using their own methods and data 

from a 1975-76 survey of the civilian noninstitutionalized population, also estimated that 

12 percent of the group under 65 years of age 

were uninsured.+ 

Major Health Care Coverage Categories 

Table 1, in which multiple counting of covered persons is eliminated, presents estimates of 

the number of uninsured persons but does not 

4Aday, L. A., and Andersen, R.: Insurance coverage 

and access: implications for health policy. Health Serv. 

Res. 13(4) :369-377, Winter 1978. 
4 acklncedata 

a 

Table 2. Number and percent of persons with health care coverage under major private or public plans or programs, by age: 

United States, 1976 

Major private All ages Under 65 years 

65 years 

and over 

or public plan 

or program Number in Percent Number in Percent Number in Percent 

thousands thousands thousands 

All plans or programs ........... ............................. 210,643 100.0 188,844 100.0 21,799 100.0 

Private hospital insurance ............................................ 159,957 75.9 146,340 77.5 13,617 62.5 

Medicare ........................ .......................................... .... 19,412 9.2 420 0.2 18,992 87.1 

Medimid ........................................... .......... ................. 16,392 7.8 13,835 7.3 2,557 11.7 

Otherplansor programsl............................................ 4,868 2.3 4,790 2.5 78 0.4 

Private surgical insurance ..... ............................. ........... 156,276 

1 ~xclud~s ~~ivateSU@Cal COVWW only. 

NOTE: Types of coverage do not sum to the population total. 

exclude double counting. 

accurately reflect the total number of persons 

covered under each private and public program. 

Table 2 presents information concerning the five 

most common types of health care coverage 

without eliminating multiple counting. A 

person covered by both private hospital insurance and Medicare appears in both categories 

in table 2. Therefore the total number of persons appearing in table 2 exceeds the total 

population. In addition, the estimates presented 

do not correspond to estimates of coverage 

provided by specific programs. The reasons 

for differences between HIS estimates and those 

reported by the groups responsible for administering the various public programs are examined 

in the following text. 

The HIS estimates that 9 percent of the 

population, 19,412,000 persons, were covered 

by Medicare in 1976. This estimate falls short of 

that prepared by the Medicare procgram. The 

Medicare program estimates, based on enrollment records, that 22,849,782 persons 65 years 

and over were covered during the year and that 

an additional 2,339,502 persons under 65 years 

of age were covered by Medicare disability and 

end-stage renal disease provisions. The difference between the HIS estimate and Medicare 

enrollment data for persons 65 years of age and 

over may be attributed to a number of factors. 

First, HIS is a survey of the civilian noninstitutionalized population and does not, therefore, 

74.2 143,450 76.0 12,826 58.8 

The table reflects extent of coverage of each type and, thus, does not 

reach those persons in institutions who receive 

Medicare benefits. Second, HIS may undercount 

the number of persons who receive Medicar 

benefits. Among persons under 65 years of age,a 

the difference between the survey estimate ‘of 

coverage and the estimate of coverage based on 

enrollment data may be substantially attributed 

to an additional factor related to the survey 

instrument design. In 1976, HIS allowed persons 

under 65 years of age to be counted as covered 

by Medicare only if they affirmed that they 

were not covered by private hospital insurance or Medicaid. 

Persons categorized by HIS as being covered 

under private hospital insurance constituted approximately 76 percent of the population, 

159,957,000 persons. Respondents included in 

that category claimed they had private hospital 

insurance coverage and were able to supply the 

name of their insurance plan. Persons covered 

under private surgical insurance comprised 

approximately 74 percent of the total population, 156,276,000 persons. 

The primary source of comparable data 

on private hospital insurance is the Health 

Insurance Association of America (HIAA). 

For 1976, their estimate of the number of 

persons protected by hospital insurance was 

176,581,000 persons of all ages–164,027,000 � 

persons under 65 years of age and 12,554,000 

persons aged 65 years and over. The differences 
� acklmwata 5 

in the magnitude of HIS and HIAA estimates percent were uninsured, whiIe among those 

might be attributed to survey undercounts (HIS) persons 65 years and over, 2.0 percent were unand to inadequate adjustment for multiple cov- insured. A lower proportion of white persons 

erage (HIAA). (about 10 percent) than of all other persons 

The HIS estimates that during 1976, (about 16 percent) were uninsured. The pro16,392,000 persons, approximately 8 percent portion of the population without health coverof the population, were covered by Medicaid. age declines as family income rises. Among perRespondents included in this category either sons in famiIies with incomes of less than 

specifically affirmed that they had been covered $3,000, Z 1.8 percent were uninsured, while 

by Lfedicaid in the previous 12 months or met among persons in families with incomes of 

other detaiIed criteria listed in the definitions. $15,000 or more, approximately 4 percent were 

The Medicaid pro<gram, however, estimated that uninsured. A smaller proportion of persons with 

24,666,252 persons received services paid for by 13 years or more of education were uninsured 

Medicaid during fiscal year 1976. The Medicaid (7.1 percent) compared with those with 11 years 

estimate of its recipient population is based on of schooling or less ( 14.3 percent). 

“unduplicated recipient counts” reported by 44 Geographic, occupational, and industrial 

States and ratio adjustment fox-remaining States variables and differences in utilization of health 

which did not provide such an estimate. How- services also are related to differences in the 

ever, little information is available concerning extent of insurance coverage. IVith respect to 

the manner in which the States counted Medic- residence, approximately 19 percent of the 

aid recipients, and it is speculated that these persons who lived outside standard metrocounts may contain subst&tiaI duplication. The politan statistical areas (SMSA’S) on farms 

difference between the Medicaid pro<gram’s esti- were uninsured, while S. 1 percent of persons 

mate of its recipient population and the estimate who lived in SMSA’S but not in the central 

based on HIS data may be further explained by city were uninsured. ReLgional differences in 

the HIS exclusion of the institutionalized the proportion of the population with no 

population. health care coverage also sho~v an interesting 

The major categolT “other plans or pro- pattern. Both the Northeast and North Central 

grams” comprises persons who had no insurance Regions had approximately 8 percent uninsured, 

but ~vho were covered by one of the follo~ving: while the South and \Vest had 14.6 and 13.7 

CHMIPUS, CHA.NIPVA, or professional cour- percent uninsured, respectively. 

tesy. Approximately 2 percent of the pop- lVide differences appear in the number and 

uation, 4,86S,000 persons, ~vere covered under percent of the uninsured in various population 

some combination of these plans. Compar- subgroups according to occupation and industry 

able program estimates of persons co~?ered in ~groupinLgs.Among professionals, approximately 

this category are not readily available. 5 percent were uninsured, while among farm 

laborers and farm foremen, approximately 41 

� 

Uninsured percent were uninsured. Among those not in 

the labor force, 11.0 percent were uninsured. 

Tables 3 and 4 show the number and percent These 12,842,000 uninsured persons not in the 

of persons by type of health insurance coverage labor force constituted approximately 55 peror Iack of coverage according to seIected charac- cent of all the uninsured. Generally, whiteteristics. The uninsured, 11.0 percent of the cok groups had a smaller percentage of unpopulation, are not under any sofi of health care insured persons than the blue-collar groups. 

coverage, pubIic or private. Differences in the Wide differences between ~groupings by 

percent of the population under no hezdth care industry are also apparent. Among those persons 

coverage between and among population sub- in the agricultural grouping, approximately 29 

�groups are readily apparent. percent were uninsured, while only 4.4 percent 

A comparison of the age <groups under 6 of persons in pubIic administration were unyears and 65 years and over is most striking. insured. The groupings of mining, manufacturAmong children under 6 years of age, 13.0 ing, transportation and public utilities, finance, 
6 dmcedaa 

o 

Table 3. Number and percent of the population, by types of health care coverage and selected characteristics: United States, 1976 

Selected characteristic 

All persons ....................... 

— 

Age

Under 6 years ............................. 

6-18 years ................................... 

19-54 years..., ............................. 

55-64 years ........... ...................... 

65 years and over . ...................... 

— 

Sex

Male ........................... ................. 

Female ............................. .......... . 

COlor 

White .. ........................................ 

All other ......................... ............ 

Family incomel 

Less than $3,000 ........................ 

$3,000-$4,999 ........................... . 

$5,000-$6,999 ..................... ....... 

$7,000-$9,999 ............ ................ 

$10,000-$1 4,999 . ....................... 

$15,000 or more ......................... 

Education of i ndividua12 

0-11 years ................................... 

12 years ...................................... 

13 years or more ....... .................. 

Residence 

SMSA . ............................ ............ 

Central city . ..................... ..... 

Not central city ..................... 

Outside SMSA ............................ 

Nonfarm .......................... ..... 

Farm ..................................... 

See footnote at end of table. 

Health care coverage 

‘rivate hospital Medicaid Other plans or tsurance, Medi. coverage only programs only care, or both 

T — — 

dumber Number Number 

in ‘e r- in Per- in ‘erthou- ent thou- cent thou- mt 

sands sands sands 

— 

167,713	 79.E 12,162 5.8 5,084 2.4 

= = 

13,237 70.0 2,373 12.5 631 3.3 

37,942 75.? 4,550 9.0 1,474 2.9 

79,283 79.5 4,177 4.2 2,365 2.4 

16,292 B2.I 815 4.1 527 2.7 

20,958 96.1 247 1.1 87 0.4 

81,367 80.1 4,923 4.8 2,381 2,3 

86,346 79.: 7,239 6.6 2,704 2.5 

150,855 82.! 6,883 3.8 4,369 2.4 

16,858 60.7 5,27g 19,0 716 2.6 

6,409 51 .( 3,06S 24.4 176 1.4 

9,097 55,L 3,43E 20.9 194 1.: 

11,534 62.[ 2,271 12.4 470 2.f 

18,327 75.E 1,097 4.5 843 3.5 

38,619 86.[ 71 ~ 1.6 1,283 24 

69,960 92.: 426 0.6 1,663 2.: 

39,129 75.( 3,821 7.4 854 1.7 

44,803 84.( 1,39( 2.6 1,252 2.: 

37,062 88.4 44C 1.0 1,026 2.L 

116,328 80.; 8,99: 3,302 2.: 

46,109 75.1 6,00[ z 1,409 2.: 

70,219 84.[ 2,98: 3.6 1,692 2.: 

51,385 77,, 3,171 4.8 1,783 2.i 

46,354 77 ,~ 3,06$ 5.1 1,676 2.[ 

5,031 76,$ 10: 1.6 107 1.( 

No other in­

,urance; don’t 

know if No health 

rivate hospital covered by xtre coverage wurance, don’t )riwte hospi­

:now covers ge tal insurance 

— 

Qumber lumber umber 

in ‘er- in ‘er- in ‘erthou- ent thou- ent thou- mt 

sands sands sands 

. — 

1,624 0.8 861 O.z 23,200 11.0 

= 

104 0.6 106 0.6 2,469 13.0 

389 0.8 228 o.! 5,825 11.6 

913 0.9 378 oat 12,550 12.6 

174 0.9 122 0.( 1,919 9.7 

43 0.2 *27 *0. I 437 2.0 

783 0.8 424 0/ 11,748 

840 0.8 436 0., 11,452 

1,398 0.8 671 0., 18,675 20.2 

225 0.8 189 0.: 4,525 16.3 

108 0.9 74 0.( 2,740 21.8 

83 0.5 99 0.( 3,500 21.3 

156 0.8 82 0., 3,857 21.0 

‘192 0.8 56 0.: 3,658 15.1 

289 0.7 128 0.: 3,437 7.7 

486 0.6 157 0.: 3,104 4.1 

358 0.7 207 0., 7,404 14.3 

483 0.9 160 0.: 5,278 9.9 

329 0.8 120 0.: 2,965 7.1 

1,129 0.8 639 0., 13,837 9.6 

425 0.7 292 ()<! 7,168 11.7 

704 0.9 347 0., 6,669 8.1 

495 0.s 222 0. 9,363 14.1 

463 0.8 213 0., 8,106 13.5 

*32 *0.5 *9 ++0.’ 1,257 19.2 
w~ 7 

Table 3. Number and percent of the population, by types of health care coverage and selected characteristics: United States, 1976–Con. 

I Health care coverage No other inurance; don’t 

know if No health 

Private hospital Medicaid Other plans or	 ~vete hospital covered by zsre coverage insurance, don’t insurance, Medi. lrivete hospi­ coverage only programs only know coverage al insurance Selected characteristic care, or both T 

Number Number Wmber Number lumber umber 

in Per- in Per- in Per- in ‘er- in Per- in Per- rrthou- cent thou- cent thou- cent thou- ent thou- cent thou- cent --Lsands sands sands

I I

sands sends sands

West 

Geographic region I I 

Northeast ... .. . .... . ... ... .. . ... .. .. .... .. .. 40,394 83.1 3,449 7.1 468 1.0 391 O.z 227 0.! 3,683 7.6 

North Central .. ... .. ... ... . .... . . .... .. .. . 47,973 85.2 2,752 4.9 464 0.8 425 O.e 161 0.: 4,458 7.9 

South ... . ... ... .. .. ..... . . ... .. .. ... . ... ... .. . 50,717 75.1 3,471 5.1 2,682 4.0 576 O.g 293 o.~ 9#833 14.6 

................................... ........ 28,629 74.s 2,490 6.5T1,470 3.8 231, 0.6 179 0.! 5,225 13.7 

Physician visit 

in last year 

No ................................... ........... 39,880 75.~ 2,454 4.e 1,032 2.0 525 1.C 300 0.[ 8,677 16.4 

es............................ ................. 127,833 81 .C 9,708 6.2 4,052 2.6 1,098 0.7 560 o.~ 14,522 9.2 

Hospitalization c in last year 

No .............................................. 149,728 79.! 10,309 5.5 4,506 2.4 1,500 0.$ 800 o.~ 21,471 11.4 

Yes . .... ... .... .. . .... .. ... ... .. . .... .. . ..... . . . 17,985 80.[ 1,852 8.< 578 2.6 124 O.E 60 0.: 1,729 7.7 

1ficludes ~erwns @th unreported income. 

2Excl”des persons under 17 years of we. 

insurance and real estate, service and miscellane- In summary, a pattern of differences in the 

OUS, and public administration were character- extent of health care coverage for different popized by a lower percent uninsured than the ulation subgroups emerges according to standard 

national average. Groupings with a higher per- social and demographic characteristics. The uncent of uninsured persons than the national insured are proportionately concentrated among 

average were agriculture, forestry and fisheries, those who have low incomes, work in certain inconstruction, and whoIesale and retaiI trade, dustries, have 10JV educational attainment, are 

which are industries characterized by seasonal very young and are other than white. 

employment, self-employment, and low levels 

of unionization. Private Hospital Insurancer 

Among persons who did not see a physician Medicare, or Both 

during the year, approximately 16 percent were 

uninsured, while among persons who saw a phy- Approximately 4 out of 5 persons were covsician, approximately 9 percent were uninsured. ered under private hospital and/or Medicare inFor persons who were not hospitalized during surance in 1976. h4any persons were covered by 

e year, approximately 11 percent did not have both, as indicated in tabIe 1–1 1,656,000 peralth care coverage, while among those persons sons, or 5.5 percent of the population. As ine ith a hospitalization, approximately 8 percent dicated in table 2, 19,412,000 persons, or 

were uninsured. approximately 9 percent of the population, were 
8 ackincedata 

Table 4. Number and percent of the population, by type of health care coverage, occupation, and industry: United States, 1976 

Health care coverage 

No other in­

;urance; don’t 

know if No health ‘rivate hospital 

murance, Medi- Medicaid 3ther 7plans or ‘rivate hospita I covered by care coverage 

care, or both coverage only )rograms only murance, don’t >rivete hospiOccupation and industry know coverage tal insurance 

All perwns ...... ................ 167,713 79.6 12,162 5.8 5,084 2.4 1,624 0.8 861 0.4 23,200 11.0 

Number Number Vumber Number tumbel lumber 

in Per- in Per- in Per- in Per- in Per- in Perthou- cent thou- cent thou- :ent thou- :ent thou- :e nt thou- cent 

sands sands sands sands sands sands 4~ — 

Occupation 

Professional, technical, and 

kindred workers . .. .. .... ... . ... . .. ... . 13,207 92.6 75 0.5 204 1.4 90 0.6, *3 I *0.2 663 4.6 

Managers and administrators, 

except farm . . .. .... .. . ..... . .. .. ... ... . .. 9,184 89.5 *32 *o .3 199 1.9 84 0.8 *22 *0.2 741 7.2 

Sales workers .. ..... .. .. ... .. . .... .. .. ... .. 4,947 84.6 84 1.4 156 2.7 47 0.8 *1 9 *0.3 591 10.1 

Clerical and kindred workers...,... 14,249 87.9 274 1.7 294 1.8 190 1.2 52 0.3 1,150 7.1 

Craftsmen and kindred workers.. 10,260 84.0 136 1,1 169 1.4 110 0.9 35 0.3 1,504 1 

Operatives, except transport .... .. 9,328 83.6 278 2.5 106 0.9 135 1.2 *25 *0.2 1,289 

Transpom equipment operatives.. 2,827 80.8 61 1.7 55 1.6 38 1.1 *22 *0.6 496 1 

kborers, except farmers .. . .. ... .. .. 3,010 72.2 103 2.5 75 1.8 55 1,3 *22 ++0.5 906 *21. 

Farm managers .. ... . ... .. . .... . ... .. .. . .. 1,164 78.4 *2 *0. I *1 6 *I .1 *9 *0.6 *4 +0.3 289 19.5 

Farm laborers and farm 

foremen ............. ...................... 591 53.9 37 3.4 *1 5 *I .3 *. *- *4 *0.3 449 41.0 

Service workers, except 

private household .. .. . ... .. . .... .. . .. 8,676 77.3 394 3.5 310 2.8 117 1.0 53 0.5 1,672 14.9 

Privatehousehold workers . .. .. .. .. 683 62.4 103 9.4 * * * * *9 *0.3 273 25.0 

Unknown .. . . .... .. .. ... ... .. ... . .. ... . . .. .. 1,078 66.4 126 7.8 41 2.6 * * *2 I *I .3 334 20.5 

Not in labor force .... .. ... .. . ... . .. ... . 88,509 76.0 10,457 9.0 3,422 2.9 123 0.6 540 0.5 12,842 11.0 

* Industry 

Agriculture ... .... . ... .. ... .. .. . .... .. . ... .. 2,125 67.8 51 1,6 38 1.2 *I 7 *0.5 *9 *0.3 895 28.6 

Forestry and fisheries..., . ... . .. ..... . 69 68.3 *4 *3.6 *. *. *1 o *9.7 *. *- *19 *8.3 

Mining ... ... .. .. .. ... ... .... ... ... .... . . .... .. 697 91.0 *6 *0.8 *6 *o .7 *6 *0.7 ++. *. 53 6.9 

Construction ... . .... . .. .. .. ... ... .. .. .. ... 4,456 76.2 77 1.3 103 1.8 64 1.1 *24 *0.4 1,119 19.2 

Manufacturing . ... ... .. ... . .. ... .. .. .... . . 19,530 89.0 298 1.4 161 0.7 218 1.0 41 0.2 1,685 7.7 

Transportation and public 

utilities . ..... .. .. ... .. .. ... . .. ... .. . .... .. .. 5,155 88.5 66 1.1 59 1.0 56 1.0 *26 *0.4 461 7.9 

Wholesale and retail trade . .. .... .. . 14,878 80.1 385 2.1 441 2.4 201 1.1 93 0.5 2,565 13.8 

Finance, insurance, and 

reel estate .. .. ..... .. .... .. ..... .. . ... .. . .. 4,578 90.3 *3O *0.6 91 1.8 44 0.9 *14 *0.2 316 6.2 

Service and miscellaneous .. ... .. . .. 21,597 84.2 585 2.3 502 2.0 218 0.9 86 0.3 2,671 10.4 

Public administration . .... .. . ... . ... .. 5,095 89.4 73 1.3 225 3.9 46 0.8 *1 o *0.2 253 4.4 

Unknown .. . .. .... .. .. ... . .. ... .. . .... .. . ... 1,023 66.0 130 8.4 37 2.4 *22 *1 .4 *I 8 1.1 320 20.6 

Not in labor force .. .. .. ... .. . .... .. . ... 88,509 76.0 10,457 9.0 3,422 2.9 723 0.6 540 0.5 12,842 11.0 

— 

covered by Medicare, and 159,957,000 persons, The Proportion of the population 

. . insured

or approximately 76 percent of the population, under prkate hospital insurance, Medicare, 

were covered by private hospital insurance. both increased directly with age. Among perso m (Figures from table 2 reflect coverage in these under 6 years of age, 70 percent had such covprograms regardless of other coverage.) erage, while for persons 65 years and over, 
ZKhElncedata 9 

@ 

a 

approximately 96 percent were covered. While 

there is very Iittle difference in the extent 

of private hospital and/or Medicare coverage 

between the sexes, the difference in coverage 

between the two major color groups is substantiaL Approximately 83 percent of white 

persons were insured under private hospital 

insurance and/or Medicare, compared with 61 

percent of persons of aIl other races. 

The proportion of persons with such coverage increased directly with increasing income. 

Among persons in f~ilies with incomes of less 

than $3,000, 51.0 percent of the population 

were so insured. Among persons who beIonged 

to families with incomes of $15,000 or more, 

approximately 92 percent were insured by private hospital insurance, Medicare, or both. The 

same pattern was found when educational leveI 

was examined. Approximately 76 percent of 

those persons who had completed 0-11 years 

of education were covered, compared with aproximately 88 percent of those-who had cornleted 13 years or more. 

The extent of coverage also varied by place 

of residence and region. Approximately 77 

percent of persons ~vho lived on farms outside 

of SMSA’S were covered, compared with approximately 85 percent of persons who lived in 

SMSA’S outside centraI cities. Further, persons 

who lived in the Northeast and North Central 

Regions were covered to a ~greater extent than 

those who Iived in the South or West. 

With respect to utilization of health services, 

approximately 75 percent of persons who did 

not use the services of a physician during the 

year were covered, while 81 percent of those 

who did use physician services during the year 

were covered. There was very little difference in 

extent of coverage, however, when those who 

were hospitalized during the year were compared with those who were not hospitalized. 

Both occupation and industry showed substantial differences between categories with 

respect to the extent of coverage under private 

hospital insurance, Medicare, or both. The extent of such coverage ranged from approximately 93 percent among professional, techical, and kindred workers to approximately 

4 percent among farm laborers and farm 

foremen. With respect to industry, coverage 

ranged from approximately 91 percent in mining 

to 68 percent in agriculture. Approximately 

76 percent of persons not in the labor force 

were covered under private hospital insurance, 

Medicare, or both. 

Medicaid Only 

Of the estimated 16.4 miIIion persons covered by Medicaid in 1976, approximately 12.2 

million persons had no other coverage. The 

remaining persons were also covered by private 

hospital insurance, Medicare, CHAM.Pl_JS or 

CHAMPVA, or professional courtesy. 

The proportion of the population covered 

only by Medicaid declined with age. Approximately 13 percent of persons under 6 years of 

age were covered ordy by Medicaid while 9 percent aged 6-18 years were so covered. Among 

persons 65 years and over, only 1.1 percent were 

covered by Medicaid only. The proportion of 

females covered by Medicaid was greater than 

that for males-approximately 7 percent for 

females and 5 percent for maIes. 

The extent of coverage under Medicaid only 

varied substantiality by color. ApproximateIy 4 

percent of white persons and 19 percent of alI 

other persons were covered by Medicaid only. 

However, there were more white persons than 

all other persons covered under hledicaid. 

As expected, the proportion of persons covered only by hfedicaid declined sharply as income leveI rose. Approximately 24 percent of 

persons in famiIies with incomes of $3,000 or 

less were covered by Medicaid only. As wouId 

be expected because of eligibility requirements, 

only about 1 percent of the persons who belonged to families with income of $15,000 or 

more were covered by Medicaid only Four 

hundred twenty-six thousand persons in this 

category, Medicaid coverage only, had family 

incomes in excess of $15,000 during the previous year. While it seems unusual that anyone 

with a family income in excess of $15,000 

would be covered by Medicaid, there are a 

number of ways in which such an event could 

legitimately occur. First, information in HIS is 

collected on the previous year’s income. Family 

dissolution or catastrophic illness could have 

intervened, causing Medicaid eligibility. Second, 

in certain States large families with incomes in 
10 ackncedata 

excess of $15,000 could qualify for Medicaid 

coverage. 

The same pattern of inverse relation was 

apparent for education. Approximately 7 percent of persons with O-11 years of education 

were covered by Medicaid, compared with 1 percent of those with 13 years or more of education. 

Substantial differences between places of 

residence and among regions of the country 

were found with respect to Medicaid coverage. 

Approximately 1 out of 10 residents of central 

cities within SMSA’S were covered by Medicaid 

only, while less than 1 out of 50 persons who 

lived on farms outside of SMSA’S were so covered. Approximately 7 percent of persons in 

the Northeast Region were covered by Medicaid only, compared with approximately 5 percent in the North Central and South ReLgions. 

Further, there were some differences in the 

proportion of persons covered by Medicaid with 

respect to utilization of services. For persons 

who saw a physician during the year, 6.2 percent 

were covered by Medicaid only, while 4.6 percent who did not see a physician were so covered. Medicaid coverage with respect to occupation and industry revealed that, as expected, 

few workers are covered by the Medicaid program only. One exception to this observation 

occurred with private household workers. Approximately 9 percent were covered by Medicaid only. Further, 9.0 percent of persons not 

in the labor force were covered by Medicaid 

only. 

Other Types of Covera9e 

Other plans or programs only .—Other 

programs are defined herein as CHAMPUS, 

CHAMPVA, professional courtesy, and private surgical insurance only. Approximately 

5 million persons, or approximately 2 percent 

of the civilian noninstitutionalized population, 

were covered by these programs only. Questionnaire design prevents an estimate of the number 

of persons covered under these programs regardless of other coverage. The extent of coverage 

under these programs alone was not large for 

any subgroup in the population. However, this 

type of coverage was most concentrated among 

persons under 6 years of age, persons in families 

with incomes of $7,000-$9,999, persons in the 

South Region, and persons employed in public 

administration. 

P~ivate hospital insurance only, but don ‘t 

know couerage.–Persons in this category did 

not constitute more than 1 percent of the population in any category of any of the standard 

social and economic variables presented in this 

report. These persons, however, are defined as 

insured. 

No other coverage; don ‘t know if covered by 

private hospital insurance. –Persons included in 

this category did not constitute more than 1 percent of the population in any category of any 

of the standard social and economic variables 

presented in this report. These persons have 

been considered neither insured nor uninsured. 

Summary 

The type and extent of the population 

health insurance coverage is Presented in thio L, . 

report according to standard social and demographic characteristics. Every effort has been 

made to insure that multipIe coverage does not 

affect the estimates of the uninsured population 

shown in tables 1, 3, and 4. For that reason, 

the size of the population enrolled in certain 

public programs as reported in tables 1, 3, and 4 

is less than the total enrollment reported by 

those programs. Estimates of the uninsured are 

presented which are not affected by the common practice of counting each enrollment in a 

public or private plan as a different insured person. Thus the figure for coverage under public 

programs, presented in table 1, may be interpreted as the extent to which these programs 

covered persons who would otherwise be completely uncovered. This interpretation is particularly appropriate for persons under 65 years 

of age. Table 2 presents estimates of coverage 

under major private or public plans or procgrams 

regardless of multiple coverage. These estimates 

reflect the total number of persons enrolled in 

each program and are discussed relative to other 

estimates of coverage. 

o 
avancedata 11 

TECHNICAL NOTES 

e 

* 

SOURCE OF DATA 

The data presented in all tables in this report 

were derived from household interviews of the 

Health Interview Survey. These interviews were 

conducted in a probability sampIe of the civilian 

noninstitutionalized population of the United 

States. During 1976 approximately 113,000 persons living in a total. of 40,000 households were 

included in the sample. A more detailed description of the sample design and a copy of the 

questionnaire used in collecting the hezdth insurance data are shown in “Current Estimates 

from the HeaIth Interview Survey, United 

States, 1976,” Vital and Health Statistics, Series 

10, No. 119. 

SAMPLE 

Since the estimates shown are based on a 

sample of the population, they are subject to 

sampling error. For example, table I shows the 

andard errors appropriate for the percent of 

=rsons Ivith hospital or surLgical insurance ccn’­

erage. 

Table 1. Standard errors, expressed in percentage points, of 

estimated percentages 

I 

Base of Estimated percentages 

percentage 

in thousands 2 or 5 or 10or 25 or 50 

98 95 90 75 h500...,, . .... .. . . 1.1 1.8 2.4 3.5 4.0 

1,000 .. ..... . .. . 0.8 1.2 1.7 2.5 2.9 

2,000 .. ..... .. . . 0,6 0.9 1.2 1.8 2.0 

5,000 .. .. ... ... . 0.4 0.6 0.8 1.1 1.3 

10,000 .. ..... . . 0.3 0.4 0.5 0.8 0.9 

20,000 .. ... ... . 0.2 0.3 0.4 0.6 0.6 

30,000 . . ... ... . 0.1 0.2 0.3 0.5 0.5 

50,000 . .. .. .... L0.1 0.2 0.2 0.4 0.4 

DEFINITIONS OF TERMS 

Persons were considered to be covered by 

private hospital insurance if they specifically 

affirmed that such coverage existed. 

Persons were considered to be covered by 

Medicare if they were 65 years of age or older 

d explicity affirmed Medicare coverage or if 

hey responded that their main reason for having no insurance was Medicare. Both older persons and persons covered under Medicare disability and end-stage renal disease provisions are 

counted. 

Persons counted as covered under the 

AIedicaid proLgram incIuded those who reported 

receipt of services paid by Medicaid during the 

past year or no receipt of such services during 

the past year but eligibility for such payment 

under Aid to Families ~vith Dependent ChiIdren 

or SuppIementaI Security Income. Further, 

persons ~vho reported Medicaid as their main 

reason for no insurance but did not report 

receipt of services under Medicaid during the 

past year or coverage under Supplemental 

Security Income or Aid to FamiIies with Dependent Children were also counted in the 

Medicaid coverage category. 

Persons counted as covered under other 

plans or programs reported that their main 

reason for no insurance was the Civilian Health 

and Medical Procgrarn for Veterans Administration (CHMIPVA), the Civilian Health 

and hledical Program for Unifozmed Services 

(CHMIPUS), professional courtesy, or private 

sur,gical insurance. 

Persons counted as co~rered under prkate 

hospital insurance on[y, but don ‘t know what 

plan covers specifically affirmed that they were 

co~~ered by prh’ate hospital insurance but did 

not lino~v tvhether the plan paid for hospital 

costs or hospital physician fees. These persons 

reported no other coverage. 

Persons included under no other cozlerage; 

don ‘t know <f covered by private hospital insurance ~vere included under no public or private 

plan or program for health care coverage. Howe~wr, they responded that they did not kno~v if 

they were co~rered by prh’ate hospital insurance. 

Because of this group’s lack of knowledge concerning its privat~ hospital insurance coverage, it 

is defined & neither insured nor uninsured but 

rather as “don’t know.” 

Health care coverage is any plan or program 

specifically designed to pay alI or part of the 

mediczd or hospital expenses of a covered individual. In the case of insurance, coverage can 

be provided through either a group or an individwd policy with the premium paid by the 

individual, his employer, a third party, or a combination of these. Benefits received under such 
---

� 12 acklncedata


plans can be in the form of payment to the individual or to the hospital or doctor. The plan, 

however, must be a formal one with defined 

membership and benefits rather than an informal 

one. For example, an employer’s simply paying 

the hospital bill for an employee would not 

constitute a health insurance plan. Plans for 

free care or highly subsidized care available to 

categorical groups such as Medicare, Medicaid, public assistance, or public welfare; care 

given free of charge to veterans; care given 

under the Uniformed Services Dependents 

Medical Care Program; and professional courtesy 

are specifically defined herein as health care 

coverage. 

For this report, utilizing information from 

HIS, health care coverage excludes the following 

kinds of plans: (1) plans limited to the “dread 

diseases” such as cancer or polio; (2) care given 

under the Crippled Children’s Program or 

similar programs and care of persons admitted 

to an institution for research purposes; (3) insurance which pays bills only for accidents, such 

as liability insurance that covers children for 

accidents at school or camp and insurance for a 

worker that covers him only for accidents, injuries, or diseases incurred on the job; and (4) 

insurance which pays only for loss of income. 

SYMBOLS 

Data not available ............................................ 

Category not applicable ................................... . . . 

Quantity zero .................................................. 

Quantity more than O but less than 0.05 . . . . . . . . . O.; 

Figure does not meet standards of reliability 

or precision ................................................... * 

Recent Issues of Advance Data From Vital and Health Statistics 

No. 43.	 Use of Intrauterine Contraceptive Devices in 

the United States (Issued: December 12, 

1978) 

No. 42.	 Office Vkits to Cardiovascular Specialists, 

National Ambulatory Medical Care Survey: 

United States, 1975-76 (Issued: October 31, 

1978) 

No. 41. Office Vkits for Respiratory Conditions, 

National Ambulatory MedlcaI Care Survey: 

A complete list of Advance Data From Vital and Health 

Information Branch. 

NCHS 

U.S. DEPARTMENT OF HEALTH, EDUCATION, ANO WELFARE


Public Health Service


Office of Health Research,Statistics,and Technology


National Center for Heslth Statistics


3700 EastWest Highway


Hyattwille, Maryland 20782


OFFICIAL BUSINESS


PENALTY FOR PRIVATE USE, $300


DHEW Publication No.


(PHS) 79.1250


United States, 1975-76 (Issued: October 30, 

1978) 

No. 40.	 Contraceptive Utilization Among Widowed, 

Divorced, and Separated Women in the United 

States: 1973 and 1976 (Issued: September 22, 

1978) 

No. 39.	 Office Visits to Urologists, National Ambulatory Me&lcal Care Survey: United States, 

1975-76 (Issued: September 7, 1978) 

Statistics is available from the Scientific and Technical 

POSTAGE AND FEES PAID 

U.S. DEPARTMENT OF H.E.W. +“ _ 

_ 

HEW 396 o 

FIRST CLASS MAIL