UNINSURANCE

"Uninsurance" is the lack of any health insurance coverage, either from private sources, such as an employment-based or privately purchased health plan, or from public programs such as Medicare, Medicaid, or the Children's Health Insurance Program (CHIP). While the problem of uninsurance is not unknown in other industrialized countries, the magnitude of the problem is greatest in the United States, where the social safety net is less extensive. In the United States, nearly all persons sixty-five years old and older are covered by at least Medicare. In 1999, an estimated 42.5 million Americans of all ages had no health insurance coverage. Among children up to age eighteen, 14 percent were uninsured in 1999. The proportion of the population without any coverage has been increasing steadily over the past two decades. In 1999, however, coverage increased among most population groups, although it is unclear whether this represents a new trend or simply a fluctuation.

Because more than 80 percent of persons under age sixty-five who have any health care coverage obtain it through employment, decreases and increases in employment-based health insurance coverage are the primary determinants of the number of uninsured people. Thus, the number of uninsured had been increasing, over the long run, primarily due to declining employment-based health insurance.

In the United States, the population groups with the highest uninsured rates are low-income persons (both in working and nonworking families); people of color (particularly Latinos); young adults; workers employed in small firms; and workers employed less than full-time throughout the year. Over 80 percent of all the uninsured are workers or are in a family headed by a working adult, and about half are in families headed by a person employed full-time.

Health insurance coverage is the second strongest predictor of use of health care services, after health status. The lack of health insurance is widely regarded as the primary barrier to accessing and using health care services, particularly for preventive care and for management of chronic conditions.

E. Richard Brown

(see also: Access to Health Services; Ethnicity and Health; Health Care Financing; Medicaid; Medicare; National Health Insurance; National Health Systems; Poverty )