Health Insurance Coverage in the U.S., 2009

NOTE: Includes those over age 65. Medicaid/Other Public includes Medicaid, CHIP, other state programs, military-related coverage, and those enrolled in both Medicare and Medicaid (dual eligibles). SOURCE: Kaiser Commission on Medicaid and the Uninsured and Urban Institute estimates based on the Census Bureau's March 2010 Current Population Survey.

Total = 303.3 million

U.S. unemployment rate

Nonelderly Uninsured by Poverty Levels and Age, 2009

Total = 50.0 million uninsured

Note: Federal Poverty Level (FPL) for a family of four in 2009 is $22,050/year.SOURCE: KCMU/Urban Institute analysis of 2010 ASEC Supplement to the CPS.

<138% FPL

139-399% FPL

400%+ FPL

Children

10%

Adults42%

Children

6%

Adults 33%

Children1%

Adults8%

Employer-sponsored Insurance

57%

Medicaid/ Other Public

19%

Uninsured19%

Health Insurance Coverage ofthe Nonelderly Population, 2009

264.7 Million

SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of 2010 ASEC Supplement to the CPS.

Private Non-group 5%

Health Insurance Coverage of the Nonelderly by Poverty Level,

2009

30%

54%

38%

21%

36%25%

13%

79%

18%

91%

8%

46%

4%33%

5%

<100% FPL 100-138%FPL

139-250%FPL

251-399%FPL

400% + FPL

Employer/ Other Private Medicaid/ Other Public Uninsured

The federal poverty level (FPL) was $22,050 for a family of four in 2009. Data may not total 100% due to rounding. SOURCE: KCMU/Urban Institute analysis of 2010 ASEC Supplement to the CPS.

Number of Nonelderly Uninsured Americans,2000 – 2009

* The Census Bureau periodically revises its CPS methods, which means data before and after the revision are not comparable. Comparison across years can be made between 2000 through 2004, and 2004 though 2009.SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of 2001-2010 ASEC Supplements to the CPS.

Number of Nonelderly Uninsured Americans,2004 - 2009

37.0 36.1 37.6

8.4 8.7 9.4 8.9 8.18.3

34.6 35.641.7

2004 2005 2006 2007 2008 2009

ChildrenAdults

Uninsured in Millions

SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March CPS for each year.

43.0 44.4 46.5 45.0 45.750.0

Characteristics of the Uninsured, 2009

400% FPLand Above

10%251-399% FPL

13%

100-250% FPL38%

<100% FPL40%

Family IncomeFamily Work Status

Total = 50.0 million uninsured

1 or More Full-Time Workers

61%

No Workers

23%

Part-TimeWorkers

16%

Age

55-6410%

35-5433%

19-3440%

0-1817%

The federal poverty level was $22,050 for a family of four in 2009. Data may not total 100% due to rounding. SOURCE: KCMU/Urban Institute analysis of 2009 ASEC Supplement to the CPS.

Nonelderly’s Health Insurance Coverage by Family Poverty Level,

2009

55.6 M

46.9 M

73.5 M

88.7 M

Number

Under 100%

100% - 199%

200% - 399%

400% +

NOTES: Data may not total 100% due to rounding. The Federal Poverty Level for a family of four in 2009 was $22,050 (according to the U.S. Census Bureau’s poverty threshold). Family size and total family income are grouped by insurance eligibility. SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of 2010 ASEC Supplement to the CPS.

Nonelderly’s Health Insurance Coverage by Family Work Status,

2009

68.2 M

135.4 M

24.1 M

37.1 M

Number

Two full-time workers

One full-timeworker

Only part time

No workers

NOTES: Data may not total 100% due to rounding. SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of 2010 ASEC Supplement to the CPS.

Uninsured Rates Among Nonelderly by State, 2008-2009

<14% Uninsured (13 states & DC)

14 to 18% Uninsured (20 states)National Average = 18.1%

SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of 2009 and 2010 ASEC Supplements to the CPS., two-year pooled data.

AZ

WA

WY

ID

UT

OR

NV

CA

MT

HI

AK

AR

MS

LA

MN

ND

CO

IA

WISD

MOKS

TN

NMOK

TX

AL

MI

ILOH

IN

KYNC

PA

VAWV

SC

GA

FL

ME

NY

NH

MA

VT

NJ

DE

MD

RI

DC

CT

>18% Uninsured (17 states)

NE

Children’s Health Insurance Coverage by Family Poverty Level,

2009

21.5 M

15.8 M

21.7 M

20.3 M

Number

Under 100%

100% - 199%

200% - 399%

400% +

NOTES: The Federal Poverty Level for a family of four in 2009 was $22,050 (according to the U.S. Census Bureau’s poverty threshold). Family size and total family income are grouped by insurance eligibility. Children includes all individuals under age 19.SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of 2010 ASEC Supplement to the CPS.

Access to Employer-Based Coverage by Family Income, 2005

30%

92%

55%

4%

15%

4%

Poor Workers Higher Income Workers

Covered by Ownor Spouse'sEmployer

Declined offerfrom Own orSpouse'sEmployer

Not offeredthrough Own orSpouse'sEmployer

NOTE: The Federal Poverty Level (FPL) was $16,090 for a family of three in 2005.SOURCE: Garrett B. and L. Clemens-Cope. Changes in Employer-Sponsored Health Insurance Coverage: 2001-2005. Kaiser Commission on Medicaid and the Uninsured report #7599, Dec. 2006

(Family Income <100% FPL)

(Family Income 400%+ FPL)

3% 3%1%

4%5%3% 2% 2%

6%

29%

23%

14% 13%

28%

34%

2%

12%15%

No Usual Souceof Care

PostponedSeeking CareDue to Cost*

Went WithoutNeeded CareDue to Cost*

Last MD Contact>2 Years Ago

Unmet DentalNeed Due to

Cost*

Last Dental Visit>2 Years Ago

Employer/ Other Private Medicaid/ Other Public Uninsured

Children’s Access to Care, by Health Insurance Status, 2009

* In the past 12 monthsNOTE: Questions about dental care were analyzed for children age 2-17. MD contact includes other health professionals. Respondents who said usual source of care was the emergency room were included among those not having a usual source of care. SOURCE: Kaiser Commission on Medicaid and the Uninsured analysis of 2009 NHIS data.

Barriers to Health Care Among Nonelderly Adults, by Insurance

Status, 2009

6%

4%

6%

11%

13%

9%

6%

11%

27%

26%

42%

55%

Could Not AffordPrescription

Drug*

Went WithoutNeeded Care Due

to Cost*

No PreventiveCare

No Usual Sourceof Care

Uninsured

Medicaid/ Other Public

Employer/ Other Private

* In past 12 months.Respondents who said usual source of care was the emergency room were included among those not having a usual source of care.SOURCE: KCMU analysis of 2009 NHIS data.

Percent of adults (age 18 – 64) reporting:

Diagnosis of Late-Stage CancerUninsured vs. Privately Insured

2.9

2.32.22.0

0.0

0.5

1.0

1.5

2.0

2.5

3.0

ColorectalCancer

Lung Cancer Melanoma Breast Cancer

NOTE: Odds ratios were adjusted for age, sex, race/ethnicity, facility type, region, and income and education on basis of postal code. They represent the odds of being diagnosed with stage III or state IV cancer vs. stage I cancer.Analysis based on cases occurring between 1998-2004.SOURCE: Kaiser Family Foundation, based on Halpern MT et al, Association of insurance status and ethnicity with cancer stage at diagnosis for 12 cancer sites: a retrospective analysis." The Lancet Oncology. March 2008.

Equal likelihood between

Uninsured and Insured

Ratio of probability of diagnosis of late vs. early stage cancer, Uninsured/private insurance

*No data are available for 2007 due to MEPS transition from retrospective to current data collection.

Note: Family premium percentages were calculated based on a family of four. In 2009 and 2010, the federal poverty level for a family of four was $22,050.

Source: Premium data from Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, private sector data from Insurance Component, 1996-2009, at http://www.meps.ahrq.gov/mepsweb/. Federal Poverty Level based on HHS Federal Poverty Guidelines (1996 through 2009) at http://aspe.hhs.gov/poverty/figures-fed-reg.shtml; rate of growth based on change for one person (change for a four-person family would be 41.3% rather than 39.9% over the period).

Cumulative Change in Single and Family Health Insurance Premiums and Federal Poverty Level,

1996-2009

*

*

Medicaid Managed Care and Traditional Enrollment, 1999-2009

Note: Numbers may not produce totals because of rounding. Unduplicated count. Includes managed care enrollees receiving comprehensive and limited benefits.

SOURCE: 2009 Medicaid Managed Care Enrollment Report. CMS.

Enrollment (in millions)

31.9 33.736.6

40.142.7 44.4 45.4 45.7 46.0 47.1

Financial Consequences of Medical Bills by Insurance

Status, 2009

9%

5%

10%

22%

14%

20%

Contacted byCollection Agency

about MedicalBills

Unable to Pay forBasic NecessitiesDue to Medical

Bills

Used up All orMost of Savings

Insured

Uninsured

NOTE: All differences between insured and uninsured are statistically significant (p<0.05).SOURCE: Kaiser Family Foundation Health Tracking Poll: August 2009.

Percent of adults (age 18-64) reporting in past 12 months:

January 2007

December 2007

January 2006

Figure 2: Among Adults with Employer-Sponsored Coverage or Nongroup Coverage in January 2006, Percent Uninsured in Each Month, January 2006 to

December 2007

Source: Kaiser Family Foundation analysis using data from U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey (MEPS), 2006 and 2007.

January 2007

December 2007

January 2006

Figure 3: Among Adults with Medicaid in January 2006, Percent Uninsured in Each Month, January

2006 to December 2007

Source: Kaiser Family Foundation analysis using data from U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey (MEPS), 2006 and 2007.

January 2007

December 2007

January 2006

Figure 6: Among Adults Without Health Insurance in January 2006, Percent with Health Insurance in Each

Month, January 2006 to December 2007

Note: Family income is based on income in 2006.

Source: Kaiser Family Foundation analysis using data from U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey (MEPS), 2006 and 2007.

January 2007

December 2007

January 2006

Figure 5c: Among Children Without Health Insurance in January 2006, Percent with Health Insurance in

Each Month, January 2006 to December 2007

Note: Family income is based on income in 2006.

Source: Kaiser Family Foundation analysis using data from U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey (MEPS), 2006 and 2007.

Decrease in Employer

Sponsored Insurance

(million)2.8%

National Unemployme

nt Rate Increase

since 2008(from 7.2% in

Dec-08 to 10.0% in Nov-09)

=

2.8 3.0

Medicaid /CHIP

Enrollment Increase(million)

Uninsured Increase(million)

&

6.9

Note: Totals may not sum due to rounding and other coverage.Source: Based on John Holahan and Bowen Garrett, Rising Unemployment, Medicaid, and the Uninsured, prepared for the Kaiser Commission on Medicaid and the Uninsured, January 2009.

Impact of the Rise in Unemployment on Health Coverage, 2008 to 2009

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

<15K 15K to20K

20K to25K

25K to30K

30K to35K

35K to40K

40K to50K

>=50K

1,000 or More Workers

100-999 Workers

25-99 Workers

10-24 Workers

1-9 Workers

Establishment Offer Rates by Size and Average Worker Earnings, 2000-

2005

Notes: Wages cutoffs are adjusted for inflation to 2005 dollars.

Source: Kaiser Family Foundation calculations based on data from the National Compensation Survey, 2000-2005, conducted by the Bureau of Labor Statistics.

Off

er

Rate

Average Worker Earnings

Among Workers in Firms Offering Health Benefits, Percentage of Workers Eligible, Who Take Up, and Covered by Health Benefits Offered by Their Firm,

by Wage Level, 2008

*Estimates are statistically different from each other within category (p<.05).

Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2008.

Take Up*

Coverage*

52%

68%

74%

83%

71%

81%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Eligibility*

Many Workers Are Lower-Wage (35% or More Earn $22,000 a Year or Less)

Few Workers Are Lower-Wage(Less Than 35% Earn $22,000 a Year or Less)

Many Workers Are Lower-Wage (35% or More Earn $22,000 a Year or Less)

Few Workers Are Lower-Wage(Less Than 35% Earn $22,000 a Year or Less)

Many Workers Are Lower-Wage (35% or More Earn $22,000 a Year or Less)

Few Workers Are Lower-Wage(Less Than 35% Earn $22,000 a Year or Less)

Nearly Two-Thirds of States Expanded Access to Medicaid and

SCHIP, July 06 – January 08

SOURCE: Based on a national survey conducted by the Center on Budget and Policy Priorities for the Kaiser Commission on Medicaid and the Uninsured, 2008.

32

26

11

7

Total EligibilityIncreases

EnrollmentProcedure

Simplifications

ReducedChildren'sPremiums

Number of States With…

HMO Enrollment, by Model Type, 1984-2006

Note: HMO enrollment includes enrollees in both traditional HMOs and point-of-service (POS) plans through: group/commercial plans, Medicare, Medicaid, the Federal Employees Health Benefits Program, direct pay plans, and unidentified HMO products. Enrollment by model type may not equal total enrollment because some plans did not report these characteristics. Data are as of June 30 or July 1 of respective year.

Source: Kaiser Family Foundation, Trends and Indicators in the Changing Health Care Marketplace, 2002, May 2002, Exhibit 2.5, p.20, at http://www.kff.org/insurance/3161-index.cfm, based on July 1 data from InterStudy Publications, updated most recently with data from HealthLeaders-InterStudy, The Competitive Edge, Part II: Managed Care Industry Report, March 2007, Table 10, p.25.

6.7

23.132.1 31.8 28.5 29.3 28.9

24.0 24.8

2.913.5

16.2

27.5

33.5 31.929.9 25.4

21.526.6

18.1

5.6

3.9

3.3

7.1 6.98.3

7.88.3 11.3

11.3

6.6

8.0

9.7

8.7

7.0 7.27.4

7.37.2

7.4

8.2

3.5

0.2

0.60.2

0.20.2

0.20.4

0.8

2.4

4.3

2.1

0

10

20

30

40

50

60

70

80

90

1984 1988 1992 1996 2000 2001 2002 2003 2004 2005 2006

Mixed IPA Network Group Staff

15.1

31.4

38.8

63.3

80.1 78.074.2

70.066.1

71.4

Enrollees (in millions)

72.7

Distribution of HMO Enrollment by Ownership Status, 1981-2006

Note: Some plans failed to report profit status and are excluded from the analysis. HMO enrollment includes enrollees in both traditional HMOs and point-of-service (POS) plans through: group/commercial plans, Medicare, Medicaid, the Federal Employee Health Benefits Program, direct pay plans, and unidentified HMO products. Data are as of June 30 or July 1 of respective year.

40.237.940.338.337.337.436.536.036.336.747.8

53.8

74.0

88.0

52.246.2

26.012.0

63.3 63.7 64.0 63.5 62.6 62.7 61.7 59.7 60.6 59.8

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1981 1985 1989 1993 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Percentage For-Profit

Percentage Non-Profit

10.3 18.9 32.5 42.1

72.2 78.8 80.8

79.7

78.0 74.2 70.0 66.1 71.4 72.7

Total Enrollment (in millions):

Source: Kaiser Family Foundation, Trends and Indicators in the Changing Health Care Marketplace, 2002, May 2002, Exhibit 5.10, p. 57, at www.kff.org/insurance/3161-index.cfm, based on July 1 data from InterStudy Publications, updated most recently with data from HealthLeaders-InterStudy, The Competitive Edge, Part II: Managed Care Industry Report, March 2007, Table 10, p.25.

+5.6 million

Growth in Workers in Industries where Employer-Sponsored

Health Coverage is Less Common

Decline in Workers in Industries where Employer-Sponsored

Health Coverage is More Common

-2.0 million

Growth in Workers by Type of Industry, 2000 to 2005

Notes: Excludes those aged 65+. Uninsured rates are 23% in industries where coverage is less common, such as construction and agriculture; 10% where coverage is more common, such as education and manufacturing.Source: Urban Institute analysis of the 2001 and 2006 March CPS for KCMU, 2006.