Transcript Slide 1

Health Insurance Coverage in the U.S.,
2009
Total = 303.3 million
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.
U.S. unemployment rate
Nonelderly Uninsured by
Poverty Levels and Age, 2009
Adults
Children 8%
1%
Children
<138% FPL
139-399% FPL
10%
400%+ FPL
42%
Adults
33%
Adults
6%
Children
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.
Health Insurance Coverage of
the Nonelderly Population, 2009
Uninsured
19%
Employersponsored
Insurance
57%
Medicaid/
Other Public
19%
Private Non-group
5%
264.7 Million
SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of 2010 ASEC Supplement to the CPS.
Health Insurance Coverage of the
Nonelderly by Poverty Level, 2009
Employer/Other Private
36%
33%
Medicaid/Other Public
25%
Uninsured
5%
13%
4%
8%
21%
46%
38%
79%
91%
54%
18%
<100% FPL
30%
100-138%
FPL
139-250%
FPL
251-399%
FPL
400%+ FPL
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
Uninsured in Millions
43.0
44.4
8.4
8.7
34.6
35.6
2004
2005
46.5
50.0
45.0
45.7
8.9
8.1
37.0
36.1
37.6
41.7
2006
2007
2008
2009
9.4
8.3
Children
Adults
SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March CPS for each year.
Characteristics of the Uninsured, 2009
Family Income
Family Work Status
Part-Time
Workers
16%
400% FPL
and Above
10%
251-399% FPL
13%
No
Workers
23%
1 or More FullTime Workers
61%
Age
0-18
17%
55-64
10%
<100% FPL
40%
19-34
40%
100-250% FPL
38%
Total = 50.0 million uninsured
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.
35-54
33%
Nonelderly’s Health Insurance Coverage by
Family Poverty Level, 2009
Number
400% +
200% - 399%
88.7 M
73.5 M
100% - 199%
46.9 M
Under 100%
55.6 M
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
Number
No workers
37.1 M
Only part time
24.1 M
One full-time
worker
Two full-time
workers
135.4 M
68.2 M
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
NH
VT
WA
MT
MN
OR
WY
NV
CA
AZ
MI
PA
IA
NE
IL
CO
KS
NM
TX
OH
TN
RI
VA
MD
NC
DC
SC
AR
AL
NJ
CT
DE
WV
KY
MS
AK
IN
MO
OK
MA
NY
WI
SD
ID
UT
ME
ND
GA
LA
FL
HI
National Average = 18.1%
<14% Uninsured (13 states & DC)
14 to 18% Uninsured (20 states)
>18% Uninsured (17 states)
SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of 2009 and 2010 ASEC Supplements to the
CPS., two-year pooled data.
Children’s Health Insurance Coverage by
Family Poverty Level, 2009
Number
400% +
20.3 M
200% - 399%
21.7 M
100% - 199%
15.8 M
Under 100%
21.5 M
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
Covered by Own
or Spouse's
Employer
30%
15%
Declined offer
from Own or
Spouse's
Employer
92%
55%
4%
4%
Poor Workers
(Family Income
<100% FPL)
Higher Income Workers
Not offered
through Own or
Spouse's
Employer
(Family Income
400%+ FPL)
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
Children’s Access to Care,
by Health Insurance Status, 2009
Employer/Other Private
Medicaid/Other Public
Uninsured
34%
29%
28%
23%
14%
3%
5%
No Usual Souce
of Care
3%3%
1%2%
Postponed
Seeking Care
Due to Cost*
Went Without
Needed Care
Due to Cost*
15%
13%
2% 2%
Last MD Contact
>2 Years Ago
12%
4%
6%
Unmet Dental
Need Due to
Cost*
Last Dental Visit
>2 Years Ago
* In the past 12 months
NOTE: 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
Percent of adults (age 18 – 64) reporting:
No Usual Source
of Care
No Preventive
Care
Went Without
Needed Care Due
to Cost*
Could Not Afford
Prescription
Drug*
* In past 12 months.
55%
11%
11%
42%
6%
6%
26%
4%
9%
6%
Uninsured
Medicaid/Other Public
Employer/Other Private
13%
27%
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.
Diagnosis of Late-Stage Cancer
Uninsured vs. Privately Insured
3.0
2.5
Ratio of probability of diagnosis of late vs. early
stage cancer, Uninsured/private insurance
2.0
2.2
Colorectal
Cancer
Lung Cancer
2.3
2.0
2.9
Equal likelihood
between
Uninsured and
Insured
1.5
1.0
0.5
0.0
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.
Cumulative Change in Single and Family Health
Insurance Premiums and Federal Poverty Level,
1996-2009
*
*
*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).
Medicaid Managed Care and Traditional
Enrollment, 1999-2009
Enrollment (in millions)
31.9
33.7
36.6
40.1
42.7
44.4
45.4
45.7
46.0
47.1
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.
Financial Consequences of Medical
Bills by Insurance Status, 2009
Percent of adults (age 18-64) reporting in past 12 months:
22%
20%
Uninsured
14%
10%
9%
5%
Contacted by
Unable to Pay for
Collection Agency Basic Necessities
about Medical
Due to Medical
Bills
Bills
Insured
Used up All or
Most of Savings
NOTE: All differences between insured and uninsured are statistically significant (p<0.05).
SOURCE: Kaiser Family Foundation Health Tracking Poll: August 2009.
Figure 2: Among Adults with Employer-Sponsored
Coverage or Nongroup Coverage in January 2006, Percent
Uninsured in Each Month, January 2006 to December 2007
January
2006
January
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.
December
2007
Figure 3: Among Adults with Medicaid in January 2006,
Percent Uninsured in Each Month, January 2006 to
December 2007
January
2006
January
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.
December
2007
Figure 6: Among Adults Without Health Insurance in January
2006, Percent with Health Insurance in Each Month, January
2006 to December 2007
January
2006
January
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.
December
2007
Figure 5c: Among Children Without Health Insurance in
January 2006, Percent with Health Insurance in Each Month,
January 2006 to December 2007
January
2006
January
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.
December
2007
Impact of the Rise in Unemployment on Health
Coverage, 2008 to 2009
3.0
2.8
2.8%
=
National
Unemployment
Rate Increase
since 2008
(from 7.2% in
Dec-08 to 10.0%
in Nov-09)
Decrease in
Employer
Sponsored
Insurance
(million)
6.9
&
Medicaid Uninsured
/CHIP
Increase
(million)
Enrollment
Increase
(million)
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.
Establishment Offer Rates by Size and
Average Worker Earnings, 2000-2005
100%
90%
80%
Offer Rate
70%
60%
50%
40%
1,000 or More Workers
30%
100-999 Workers
25-99 Workers
20%
10-24 Workers
1-9 Workers
10%
0%
<15K
15K to
20K
20K to
25K
25K to
30K
30K to
35K
35K to
40K
40K to
50K
>=50K
Average Worker Earnings
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.
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
Eligibility*
Few Workers Are Lower-Wage
(Less Than 35% Earn $22,000 a Year or Less)
81%
Many Workers Are Lower-Wage (35% or
More Earn $22,000 a Year or Less)
71%
Take Up*
Few Workers Are Lower-Wage
(Less Than 35% Earn $22,000 a Year or Less)
83%
Many Workers Are Lower-Wage (35% or
More Earn $22,000 a Year or Less)
74%
Coverage*
Few Workers Are Lower-Wage
(Less Than 35% Earn $22,000 a Year or Less)
68%
Many Workers Are Lower-Wage (35% or
More Earn $22,000 a Year or Less)
52%
0%
10%
20%
30%
40%
*Estimates are statistically different from each other within category (p<.05).
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2008.
50%
60%
70%
80%
90%
100%
Nearly Two-Thirds of States Expanded
Access to Medicaid and SCHIP,
July 06 – January 08
Number of States With…
32
26
11
7
Total
Eligibility
Increases
Enrollment
Procedure
Simplifications
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.
Reduced
Children's
Premiums
HMO Enrollment, by Model Type,
1984-2006
Enrollees (in millions)
90
80.1
80
0.4
70
63.3
60
3.3
38.8
40
31.4
30
10
0
7.1
0.8
7.2
0.2 74.2
7.4
6.9
8.3
8.7
50
20
7.0
78.0
4.3
15.1
6.6
2.9
1984
2.1
3.5
3.9
5.6
16.2
1988
Mixed
70.0
71.4
66.1
7.3
0.2
7.8
7.2
8.3
0.2
7.4
0.6
11.3
0.2
11.3
31.9
29.9
2.4 27.5
23.1
72.7
8.2
25.4
21.5
26.6
18.1
9.7
8.0
13.5
33.5
0.2
32.1
31.8
28.5
29.3
28.9
2000
2001
2002
2003
2004
24.0
24.8
2005
2006
6.7
1992
1996
IPA
Network
Group
Staff
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.
Distribution of HMO Enrollment by
Ownership Status, 1981-2006
100%
90%
12.0
26.0
80%
46.2
70%
52.2
63.3
63.7
64.0
63.5
62.6
62.7
61.7
59.7
60.6
59.8
36.7
36.3
36.0
36.5
37.4
37.3
38.3
40.3
37.9
40.2
60%
50%
40%
88.0
74.0
30%
53.8
20%
47.8
10%
0%
Total
Enrollment
(in millions):
1981
1985
1989
1993
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
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
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.
Percentage For-Profit
Percentage Non-Profit
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 HealthLeadersInterStudy, The Competitive Edge, Part II: Managed Care Industry Report , March 2007, Table 10, p.25.
Growth in Workers by Type of Industry,
2000 to 2005
+5.6 million
-2.0 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
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.