U.S. Department of Commerce Economics and Statistics Administration

Current

Population

Household Economic Studies

 Reports

 P70-54

Dynamics of Economic Well-Being: 

Health Insurance, 1992 to 1993

Who Loses Coverage and

for How Long?

By Robert L. Bennefield

C E N S U S B U R E A U May 1996

Introduction  Nearly 4 out of 5 people—78.8 (±1.4) percent of those with an inMany people are concerned (±0.6) percent of all people—had come-to-poverty ratio below 2.0.

about the growing number of continuous health insurance cov-  Twenty-seven (±0.8) percent of

Americans who lack health insur- erage all months of 1993. Thus, all people experienced at least

ance. This report uses data from 21.2 (±0.6) percent, or 53.6 (±1.6) one period of time without health

the Survey of Income and Pro- million people, lacked insurance insurance coverage during the

gram Participation (SIPP) to for at least 1 month. This percent- 28-month survey period. Of all obexamine this issue. It focuses pri- age was not significantly different served spells without health

marily on the extent to which from the 21.6 (±0.6) percent who insurance, half lasted for 5.7

people are covered by health in- experienced a lapse in coverage months or longer. This estimate

surance over a 28-month period during calendar year 1992. was significantly shorter than the

beginning in early 1992. The  Over a 28-month period during 7.1 months of noncoverage for the

source of this information is the 1992 to 1994, 73.0 (±0.8) percent 1991-1993 period.

first seven waves of the 1992 of all people had continuous Estimates of Health panel of the SIPP. health insurance coverage; there- Insurance Coverage

During each SIPP interview, fore, 27.0 (±0.8) percent, or 66.6 Health insurance coverage is

information is collected on health (±1.7) million people, lacked insur- commonly associated with other

insurance coverage (along with ance for at least 1 of those 28 life circumstances, such as emother information on income and months— 4.8 percent (±0.4) or ployment, retirement, and

labor force and program participa- 11.9 (±0.8) million were uninsured government program participation.

tion) for each month in the for the full 28-month period from As a result, there exists a strong

4-month reference period. It is early 1992 to mid-1994. likelihood that, for some segments

therefore possible to classify  of the population, health insurance Young adults (those between people by the number of months status will change over time. the ages of 18 and 24 years over the 28-month period that the Through the use of longitudinal old) were the most likely of any person was covered by one or estimates, it is possible to ex- age group to lack insurance for at

more types of health insurance. It amine the dynamics of health least 1 month—over one-half, or is also possible to measure the ± insurance coverage, and the ex- 51.5 percent ( 2.5) were not number of months continuously tent to which people experience a continuously insured during the

spent without insurance coverage; lapse in coverage during a given 28-month period. that is, spells of noncoverage. time period.  Work experience has a Health insurance in this report The first seven waves of the significant effect on health insur- refers to the following types of 1992 SIPP panel file were used to ance coverage: 86.5 (±1.1) coverage: 1) employer- or union- examine the number of months percent of people who worked full provided insurance, 2) other people were covered by health in- time for the entire period were privately purchased health insur- surance during a 28-month period. covered continuously by health inance, 3) medicare, 4) military Interviews from this panel were surance, compared with 73.5 health care, and 5) medicaid. conducted between February (±4.7) percent for full-period, part- 1992 and May 1994, allowing ex- Highlights time workers, and 58.1 (±1.4) amination of health insurance (The figures in parentheses denote percent for workers with one or

coverage for 2 calendar years, the 90-percent confidence intervals.) more job interruptions. 1992 and 1993. During the 1993

 Estimates for 1993 show that  Those who were poor or near calendar year, 79 percent of all

19.4 (±1.1) million people were poor were less likely to have con- people had health insurance covuninsured over that 12-month peri- tinuous health insurance coverage erage for the entire year; 21

od. That estimate was not than others: 82.5 (±0.7) percent of percent, or 54 million people,

significantly higher than the 1992 those with an income-to-poverty lacked coverage for at least 1

estimate of 19.0 (±1.0) million ratio of 2.0 or greater had continu- month. Eight percent, or 19 million

uninsured people. ous coverage, compared with 52.8 people, were never covered in
2 P70-54

1993. The 1992 calendar year estimates were similar, showing 78

percent, 22 percent, and 8 percent, respectively.

Between 1992 and early 1994,

73 percent of all people had continuous health insurance coverage

over the entire 28-month survey

period; 27 percent lacked health

insurance for at least 1 month.

Eight percent of all people were

covered by insurance for 6

months or less (5 percent lacked

coverage for the entire period, and

another 3 percent were covered

for 1 to 6 months) (see figure 1).

Comparisons Over Different

Time Periods

The proportion of people with

lapses in coverage is greater

when measured over a longer

time period, as different people

may lose coverage in different

years. For example, proportions of

those with lapses in coverage

were similar for calendar years

1992 and 1993; 22 and 21 percent, respectively. However, over

the full 28-month period, the proportion of those with a lapse in

coverage increased to 27 percent.

Comparisons of estimates over

a 28-month period from the 1992

panel with those from the 1991

panel show almost similar patterns

of health insurance coverage between the 1991-1993 period and

the 1992-1994 period. A slightly

lower proportion of people had

continuous coverage in the later

period—the percent covered for

the entire 28-month period

dropped from 75 percent in the

1991-1993 period to 73 percent

from 1992 to1994. The remainder

of this report will focus only on information collected for the 28

months between February 1992

and May 1994.

Sex, Race, and Hispanic Origin1

As shown in figure 2, over

the 28-month interview period

1 Persons of Hispanic origin may be of

any race. The information on the Hispanic

population shown in this report was collected in the 50 States and the District of

Columbia, and therefore, does not include

residents of Puerto Rico.

with incomes below poverty,2 and beginning in February 1992,

wome are more likely to participate in n were more likely than men

means-tested government to have continuous health insurance coverage—75 percent of

women compared with 71 percent 2 In 1994 the official poverty rate was

of men. This difference is partially 12.8 percent for men and 16.3 percent

attributable to differences in eco- for women. See Current Population

Reports, Series P60-189, “Income, nomic status. Women are more Poverty, and Valuation of Noncash

likely than men to live in families Benefits: 1994.”

1 to 11 months

14%

Figure 1.

Percent Covered by Health Insurance: 1992 to 1994

No months

8%

12 months

78%

1 to 11 months

14%

No months

8%

12 months

79%

7 to 27 months

19%

1 to 6 months

3%

28 months

73%

No months

5%

1992

1993

1992 to 1994

Source: U.S. Bureau of the Census, Survey of Income and Program Participation.
P70-54 3

assistance programs.3 Thus,

women were more likely than men

to take part in medicaid.

A second factor contributing to

the difference in health insurance

coverage between men and

women is age. More women than

men are 65 years old and over,

and virtually everyone in that age

group is covered by medicare.

The relationship between race

or Hispanic origin and health insurance was a strong one. The

percentages of people who spent

at least 1 month without health insurance were 23 percent for

Whites (not of Hispanic origin), 36

percent for Blacks, and 49 percent

for Hispanics.

Age

Young adults (those between

the ages of 18 and 24) were the

most likely of any age group to

spend at least 1 month without

health insurance coverage—about

one-half (52 percent) lacked insurance for at least 1 month during

the 28-month period, while 13 percent were covered for less than 7

months. Moreover, as age increased among adults, continuous

health insurance coverage became more common.4

Years of School Completed

People completing at least 1

year of college were less likely to

spend at least 1 month without

health insurance coverage than

those with lower levels of educational attainment. For example,

about 20 percent of those (18

years old and over) completing at

least 1 year of college were without health insurance coverage for

at least 1 month, compared with

29 percent for those who only

completed high school and 32

percent for those with less than a

high school diploma.

3 For an average month in 1993, 16.0

percent of all women participated in

means-tested assistance programs,

compared with 11.8 percent of all men.

(The source of these estimates is the

1992 SIPP panel file.)

4 The difference between the two age

groups 35 to 44 and 45 to 64 was not

statistically different.

Figure 2.

Percent Without Health Insurance

for at Least 1 Month: 1992 to 1994

All persons

Suburb

Nonmetropolitan area

Northeast

Midwest

South

West

High school diploma, no college

One or more years of college

Below poverty

Above poverty

Metropolitan area

Central city

25–34

35–44

45–64

65 and over

Under 18

18–24

No high school diploma

Hispanic origin1

White, non-Hispanic

Black

Male

Female

Sex

Race and HIspanic Origin1

Age2

Education2 (adults age 18 and over)

Poverty

Type of Residence

Region

1 Persons of Hispanic origin may be of any race.

2 Age and education refer to February 1992.

27

29

25

23

36

49

30

52

34

24

21

1

32

29

20

49

24

26

30

24

30

22

23

31

31

Source: U.S. Bureau of the Census, Survey of Income

and Program Participation.

Figure 3.

Percent Covered for 28 Months by

Income-to-Poverty Ratios: 1992 to 1994

Percent

40

50

60

70

80

90

100

Less than

1.0

1.0 to

1.99

2.0 to

2.99

3.0 to

3.99

4.0 to

4.99

5.0 to

5.99

6.0 and

over

Source: U.S. Bureau of the Census, Survey of Income and Program Participation.
4 P70-54

Type of Residence and Region

People living in suburban

areas5 were more likely to have

continuous health insurance coverage over the 28-month period

than people living in central cities

or outside of metropolitan

areas—76 percent of those in the

suburbs compared with 70 percent in other areas.

People residing in the South

and West were more likely to

experience 1 or more months

without health insurance coverage

than those living in the Northeast

or Midwest—31 percent in both

the South and West compared

with 23 percent in the Midwest

and 22 percent in the Northeast.6

Perhaps the higher noncoverage

rates in the South and West can

be partially attributed to higher

concentrations of Blacks in the

South and Hispanics in the West.

These groups had higher noncoverage rates than Whites who

were non-Hispanic.

Income-to-Poverty Ratios

Income-to-poverty ratios represent one way of characterizing

individuals by their relative economic status. These ratios are

computed by summing the person

or family income over the entire

28-month period, and dividing this

total by the summed monthly poverty thresholds. Thus, a ratio of

under 1.0 indicates that, on average, an individual’s family income

was less than the sum of that

family’s poverty threshold. In the

28-month period covered here, 11

percent of all people had an income-to-poverty ratio less than

1.0. About one-half (49 percent) of

them lacked continuous health insurance, and 12 percent were not

covered at all, compared with

24 and 4 percent, respectively,

for all others.

5 The term “suburban areas” refers to

portions of metropolitan areas outside of

central cities.

6 There was no significant difference

between the noncoverage rate in the

Northeast (22 percent) and in the Midwest (23 percent).

As would be expected, there is employment status, wage and

a strong correlation between in- salary workers 18 to 64 years old

come-to-poverty ratios and the were separated into three groups:

likelihood of continuous health in- 1. Those who worked full time for

surance. The percentage of the entire period

people with health insurance for

2. Those who worked for the the entire 28 months rose from 53

entire period but not always percent for those with ratios under

full time 2.0 to 92 percent for those with ratios of 6.0 and over (see figure 3). 3. Those with one or more job

interruptions. Employment Status

The relationship between Eighty-seven percent of all fullhealth insurance coverage and time, full-period workers were

employment is an important one, covered by health insurance for

given that firms provide such a the entire period, but there were

large proportion of total health in- significant differences for Whites

surance coverage for employees (non-Hispanic), Blacks, and Hisand their dependents. In order to panics. The continuous coverage

examine the relationship between rates for these groups were 89,

health insurance coverage and 81, and 69 percent, respectively.

Figure 4.

Duration of Spells Without Health Insurance

Coverage: 1992 to 1994

Median number of months without health insurance coverage

All persons

Suburb

Nonmetropolitan area

Northeast

Midwest

South

West

High school diploma, no college

One or more years of college

Below poverty

Above poverty

Metropolitan area

Central city

25–34

35–44

45–64

65 and over

Under 18

18–24

No high school diploma

Hispanic origin1

White, non-Hispanic

Black

Male

Female

Sex

Race and HIspanic Origin1

Age2

Education2 (adults age 18 and over)

Poverty

Type of Residence

Region

1 Persons of Hispanic origin may be of any race.

2 Age and education refer to February 1992.

5.7

6.2

5.2

5.5

5.9

6.9

4.0

5.8

7.2

6.9

5.8

7.1

7.7

6.9

4.5

5.7

5.6

5.2

5.3

4.9

7.2

5.6

4.8

6.0

5.7

Source: U.S. Bureau of the Census, Survey of Income and Program Participation.
P70-54 5

Part-time, full-period workers people), half of them lasted for Accuracy Statement

were more likely than their 5.7 months or longer. This esti- All statistics are subject to

full-time counterparts to lack mate is significantly shorter than sampling error, as well as noncontinuous health insurance the 7.1-month median duration sampling error such as survey

coverage—27 percent, compared of noncoverage for the design flaws, respondent classifiwith 14 percent. 1991-1993 period. cation and reporting errors, data

processing mistakes, and under- About 42 percent of workers Attaining a high level of

wit coverage. The Census Bureau h one or more job interruptions education appears to shorten

has taken steps to minimize errors experienced 1 or more months the time someone goes without

withou in the form of quality control and t health insurance cover- health insurance (see figure 4). edit procedures to reduce errors age. Men in this category were The median spell of 7.7 months

mor made by respondents, coders, e likely than women to lack without health insurance coverage

and interviewers. Ratio estimation health coverage for at least 1 for those without a high school

month (5 to independent age-race-sex pop- 1 to 35 percent). diploma was significantly different

ulation controls partially corrects from 4.5 months of noncoverage Younger full-time, full-period for bias attributable to survey un- for those with at least 1 year workers were less likely than their dercoverage. However, biases of college.8

older counterparts to have been exist in the estimates when

covered by health insurance con- Among the age groups ex- missed persons have characteristinuously—38 percent of those amined, the median spell of tics different from those of

age 18 to 24 years old spent 1 or 4.0 months without coverage for interviewed persons in the same

more months without health insur- children less than 18 years of age-race-sex group.

ance, compared with 17 percent age was significantly shorter

Analytical statements in of those age 25 to 34 and 10 per- than spells for other age groups,

7 this report have been tested cent of those age 35 to 44. except for those 45-64.

and meet statistical standards.

Spells of Noncoverage As expected, full-time workers However, because of methodologOne of the major concerns had a significantly shorter median ical differences, use caution when

regarding health insurance is how spell without health insurance than comparing these data with

long Americans go without those employed part time, those data from other sources. Contact

coverage. Using a technique unemployed, or those not in the Tracy James, Demographic

known as survival analysis, it is labor force—5.0 months for Statistical Methods Division, at

possible to estimate the duration full-time workers, compared 301-457-4182 or on the Internet

of spells without health insurance. with 7.2 months, 7.6 months, at tjames@census.gov for inforA median spell of 5.7 months and 7.1 months, respectively, mation on (1) the source of the

without health insurance was ob- for the others.9 data, (2) the accuracy of the

served for people who lost their estimates, (3) the use of standard

health insurance after the begin- errors, and (4) the computation

ning of the 28-month period of the of standard errors.

1992 panel. In other words, of all Contacts: spells without health insurance

(experienced by 27 percent of the Health insurance coverage— 8 No statistical difference was observed Robert Bennefield

between other comparisons by educationa 301-763-8576 l level.

7 The difference between the two age 9 Estimates of 7.2 months, 7.6 months, Statistical Methods—

groups 35 to 44 and 45 to 64 was not and 7.1 months are not significantly Tracy James

statistically different. different. 301-457-4182