Summary
This Issue Brief examines the status of health insurance coverage in the United States. The data are based primarily on the March 2004 Current Population Survey (CPS), with some analysis based on other CPS surveys. The report focuses on the nonelderly population (under age 65) because this group can receive health insurance coverage from a number of different sources. By contrast, Medicare covers nearly all of the elderly population.
The percentage of the nonelderly American population (under age 65) with health insurance coverage declined in 2003 to a post-1994 low of 82.3 percent. Declines in health insurance coverage have been recorded in all but two years since 1994, when 36.5 million nonelderly Americans were uninsured; in 2003, the uninsured nonelderly population was 44.7 million.
The main reason for the increase in the number of uninsured Americans in 2003 was the continued weak economy coupled with the rising cost of providing health benefits. Fewer workers and their families were covered by employment-based health benefits. The segment of the American population with employment-based health benefits dropped from 64.4 percent in 1994 to 63.0 percent in 2003, although in the years between 1994 and 2000 the percentage of nonelderly Americans with employment-based coverage expanded.
Enrollment in Medicaid and State Children’s Health Insurance Program increased by 2.5 million in 2003, and now covers 12.8 percent of the nonelderly population. That figure, while the same as it was in 1993 (12.7 percent), is significantly above the 10.7 percent level in 2000.
Public-sector health coverage increased to 16.8 percent of the nonelderly population in 2003.
Individually purchased health coverage was unchanged in 2003 and has basically hovered in the high 6 and low 7 percent range since 1994.
Health insurance coverage generally has not sustained unbroken trends since 1994. There were crosscurrents: Employment-based coverage expanded significantly in the 1994–2000 period to overwhelm growth in public programs. Subsequently, the dynamic reversed, as public programs expanded while employment-based coverage declined.