Health Insurance: Characteristics and Trends in the Uninsured Population
(Testimony, 03/13/2001, GAO/GAO-01-507T).

More than 1 in 6 nonelderly Americans are today uninsured. The lack of
insurance coverage does not affect all Americans equally, varying widely
among demographic groups as well as geographically. An estimated 42.1
million Americans were uninsured in 1999, which is down from 43.9
million in 1998. While the decline in the number of uninsured in 1999
following a long-term increase is welcome news, it is too early to know
whether this reflects a reversal in the trend. Recent expansions of
public programs, such as the implementation of the State Children's
Health Insurance Program, and the tight labor market likely contributed
to the improved coverage. Even with these positive factors, the number
of uninsured remains high, and any significant downturn in economic
conditions could lead to a resumption in the growth of their numbers.
The uninsured population is a diverse group, including individuals
working in different industries and firms of all sizes as well as of
different income levels, ages, races and ethnicities, and geographic
locations. This heterogeneous nature of the 42 million uninsured
Americans suggests that consideration of a combination of strategies
must be appropriate in any efforts to expand health insurance coverage.

--------------------------- Indexing Terms -----------------------------

 REPORTNUM:  GAO-01-507T
     TITLE:  Health Insurance: Characteristics and Trends in the
	     Uninsured Population
      DATE:  03/13/2001
   SUBJECT:  Health insurance
	     Employee medical benefits
	     Statistical data
	     Surveys
IDENTIFIER:  Medicaid Program
	     State Children's Health Insurance Program

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GAO-01-507T

For Release on Delivery Expected at 2: 30 p. m. Tuesday, March 13, 2001

GAO- 01- 507T

HEALTH INSURANCE Characteristics and Trends in the Uninsured Population

Statement of Kathryn G. Allen, Director Health Care- Medicaid and Private
Health Insurance Issues Testimony

Before the Committee on Finance, U. S. Senate

United States General Accounting Office

GAO

Page 1 GAO- 01- 507T

Mr. Chairman and Members of the Committee: I am pleased to be here today as
the Committee considers strategies to address the problem of Americans
lacking health insurance. Given the risk of catastrophic illness or injury,
which can devastate families financially, as well as the importance of
access to effective preventive care, health insurance is critical from an
individual and social perspective. Nevertheless, more than 1 in 6 nonelderly
Americans are today uninsured. The lack of insurance coverage does not
affect all Americans equally, varying widely among demographic subgroups as
well as geographically. To better understand the extent of the problem, my
remarks today will focus on

the number of uninsured individuals and recent trends,

? the employment and income status and other demographic characteristics of
persons who are more likely to be uninsured, and

? the variation among states in uninsured rates. My comments are based on
our ongoing analyses of the Bureau of the Census' Current Population Series,
March Supplements, 1995 to 2000; our work on the private insurance market;
and other published research.

In summary, an estimated 42.1 million Americans were uninsured in 1999,
representing 17.4 percent of the nonelderly population. Although down from a
high of 43.9 million in 1998 (18.4 percent), the number of uninsured
Americans had risen steadily for over a decade. 1 This increase has taken
place in spite of gradual but steady gains in the share of Americans with
employment- based coverage, and also was accompanied by slight decreases in
public sources of coverage such as Medicaid, the federal- state health
financing program for low- income, aged, and disabled people. More recently,
between 1998 and 1999 the number of Medicaid beneficiaries has begun to
stabilize. This stabilization, in conjunction with the continued increase in
employment- based coverage and the implementation of the new State
Children's Health Insurance Program (SCHIP), has contributed to the slight
decrease in the number of uninsured, particularly children, in 1999.

1 For information on trends in the uninsured population as well as
employment- based and Medicaid coverage from 1980 to 1995, see Private
Health Insurance: Continued Erosion of Coverage Linked to Cost Pressures
(GAO/ HEHS- 97- 122, July 24, 1997). Health Insurance: Characteristics and

Trends in the Uninsured Population

Health Insurance: Characteristics and Trends in the Uninsured Population

Page 2 GAO- 01- 507T

Although most nonelderly Americans obtain health insurance through
employment, three- fourths of all uninsured adults are in fact employed.
However, certain types of workers are less likely to have employmentbased
insurance available and thus are more likely to be uninsured. In particular,
those working part- time, for small firms, or in certain industries such as
agriculture or construction were among the most likely to be uninsured. Not
surprisingly, persons with low incomes are most likely to be uninsured, with
most uninsured individuals in families earning less than 200 percent of the
federal poverty level (which was about $34,000 for a family of four in
1999). Public programs like Medicaid and SCHIP cover many low- income
individuals, but significant numbers of low- income children and adults
eligible for these programs are not enrolled. Moreover, other low- income
individuals (particularly childless adults) are typically not eligible.
While low- income individuals are most likely to be uninsured, 8 percent of
those earning more than 4 times the federal poverty level are also
uninsured. Other populations with a disproportionately high uninsured rate
include young adults, Hispanics, and immigrants, 2 in part because of their
type of employment, relatively low incomes, or ineligibility for public
programs.

The share of people who are uninsured varies considerably across states,
ranging from less than 10 percent to nearly 27 percent of all nonelderly
residents in a state. Generally, southern and western states have higher
uninsured rates. States with high uninsured rates and those with low rates
often are distinct with regard to several demographic, employment, and
economic characteristics. Specifically, states with higher than average
uninsured rates tend to have higher unemployment, proportionally fewer
employers offering coverage to their workers, and larger than average
populations of low- income residents, Hispanics, and immigrants than states
with lower uninsured rates.

The availability of health insurance enhances access to preventive,
diagnostic, and treatment services and also provides financial security
against potential catastrophic costs associated with medical care. As a
result, lacking health insurance coverage can have important adverse health
and financial consequences. Research has demonstrated that uninsured
individuals are less likely to have a usual source of care, are more likely
to have difficulty in accessing health care, and generally have lower
utilization rates for all major health care services. For example, the
uninsured are particularly likely to forego services such as periodic check

2 For analysis purposes, we defined immigrant as any non- native- born
resident. Background

Health Insurance: Characteristics and Trends in the Uninsured Population

Page 3 GAO- 01- 507T

ups and preventive services, well- child visits, prescription drugs,
eyeglasses, and dental care. As a result, individuals not covered by health
insurance can require acute, costly medical attention for conditions that
may be preventable with early detection and/ or treatment. For example,
studies 3 have found that

? the uninsured are hospitalized at least 50 percent more often than the
insured for “avoidable hospital conditions” like pneumonia and
uncontrolled diabetes;

? uninsured people with various cancers are more likely diagnosed with
later- stage cancer than individuals with insurance; and,

? uninsured pregnant women receive prenatal care later in their pregnancy
and have fewer doctor visits than the privately insured and, as a result,
their newborn infants have a 31 percent greater risk for adverse health
outcomes such as physical disability or mental retardation.

In addition, individuals without health insurance create a public cost
because of their higher proportion of hospital emergency room visits.
Uninsured adults are 4 times and uninsured children 5 times more likely to
use the emergency room, compared with the insured. Costs for the uninsured
are often absorbed by providers, passed on to the insured through increased
fees and insurance premiums, or underwritten with public funds to support
public hospitals and finance public insurance programs.

Most nonelderly Americans obtain private health insurance coverage through
employment or by purchasing insurance on their own, and public programs
provide coverage for certain low- income and disabled individuals. Since
World War II, many employers have voluntarily sponsored health insurance as
a benefit to employees for purposes of recruitment and retention. The
federal tax code provides incentives for employers to subsidize health
benefits because their contributions can be deducted as a business expense,
and these contributions are not considered taxable income for employees.
Public programs such as Medicaid and SCHIP cover certain low- income and
disabled individuals. However, not all low- income individuals are eligible
for these public programs because eligibility is often restricted to
selected groups such as

3 For more information, see No Health Insurance? It's Enough to Make You
Sick- Scientific Research Linking the Lack of Health Coverage to Poor Health
(Philadelphia, Pa.: American College of Physicians- American Society of
Internal Medicine), and Uninsured in America- A Chart Book, 2 nd ed. (The
Kaiser Commission on Medicaid and the Uninsured, May 2000).

Health Insurance: Characteristics and Trends in the Uninsured Population

Page 4 GAO- 01- 507T

children, pregnant women, or disabled individuals. Medicare, though
primarily a source of health coverage for elderly Americans, also covers
certain disabled nonelderly individuals.

After more than a decade of steady growth, the number of uninsured declined
slightly in 1999. Between 1994 and 1998, the number of uninsured Americans
grew steadily from 39.4 million (17.1 percent of the U. S. nonelderly
population) to 43.9 million (18.4 percent), while in 1999 the uninsured
population declined to 42.1 million (17.4 percent). (See fig. 1.) More Than
42 Million

Americans Were Uninsured in 1999

Health Insurance: Characteristics and Trends in the Uninsured Population

Page 5 GAO- 01- 507T

Figure 1: Growth in the Number of Uninsured Americans, 1994- 99

Source: GAO analyses of the March 1995 to March 2000 Supplements, Current
Population Survey of nonelderly (under 65).

Trends in the uninsured population are closely related to changes in
employment- based and public programs. (See fig. 2.) Reflective of the
strong economy, the share of the nonelderly population with employmentbased
coverage grew slowly throughout the entire 1994 to 1999 period, increasing
from 64.4 to 66. 6 percent. Between 1994 and 1998, there was a decline in
the percentage of the nonelderly population covered through public programs,
from 12.9 to 10.8 percent, associated with increases in the numbers of
individuals with employment- based coverage as well as in the numbers of
uninsured. However, from 1998 to 1999, the continued increase in employment-
based coverage, coupled with a stabilization in publicly supported coverage,
largely accounts for the decrease in the number of uninsured. Notably, the
share of children who were uninsured declined from 15.4 percent to 13.9
percent, representing about 1 million fewer uninsured children in 1999 than
1998- a change likely related

39.4 40.3 41.4 43.1 43.9

42.1 20 25

30 35

40 45

50 1994 1995 1996 1997 1998 1999 Number (Millions)

Health Insurance: Characteristics and Trends in the Uninsured Population

Page 6 GAO- 01- 507T

strongly to the implementation of SCHIP. 4 The Health Care Financing
Administration reported that nearly 2 million children had enrolled in SCHIP
as of September 1999.

4 While the insurance coverage statistics from the Current Population Survey
did not separately identify SCHIP enrollment, the data do provide some
indications of the effects of SCHIP in decreasing the number of uninsured
children. Specifically, the decline in the uninsured among children reported
by the Current Population Survey was predominantly among children in
families below 200 percent of the federal poverty level- the income group
targeted by SCHIP- and was accompanied by increases in the proportion of
children with public coverage.

Health Insurance: Characteristics and Trends in the Uninsured Population

Page 7 GAO- 01- 507T

Figure 2: Changes in Sources of Health Insurance Coverage, 1994, 1998, and
1999

Note: Some people may receive coverage from several sources. To avoid double
counting, we assigned an individual reporting coverage from two or more
sources to one source, based on a hierarchy in the following order:
employment- based, Medicare, Medicaid, other public, and other private.

Source: GAO analyses of the March 1995, March 1999, and March 2000
Supplements, Current Population Survey of nonelderly (under 65).

Access to affordable employment- based coverage is the primary means for
nonelderly americans to obtain health insurance, but the availability of
this coverage varies. Most uninsured individuals are employed but working at
small businesses or in certain industries where they are less likely to be
offered coverage and are therefore more likely to be uninsured. Although
public programs cover many low- income individuals, this group is still the
most likely to be uninsured since many either are not eligible for these
programs or are not enrolled even if they are eligible. Furthermore,
disproportionately large shares of young adults, hispanics, and immigrants
are uninsured. Despite Widespread

Private EmploymentBased and Public Program Coverage, Many Workers and Low-
Income Individuals Remain Uninsured

64.4 5.6

17.1 12.9 65

.8 18. 4 5.0 10. 8

5.2 10.8

17.4 66.6

Employment- Based Insurance

Public Insurance Other Private Insurance

Uninsured Percentage of Nonelderly

1994 1998 1999

80 70 60 50 40 30 20 10

0

Health Insurance: Characteristics and Trends in the Uninsured Population

Page 8 GAO- 01- 507T

Although employment- based health insurance is the major source of coverage
and insures two- thirds of nonelderly Americans, a significant number of
workers do not have health insurance because either their employers do not
offer it or they choose not to purchase it. In fact, about three- quarters
of the uninsured population in 1999 worked either full- or part- time. (See
fig. 3.)

Figure 3: Most Uninsured Adults Are Employed (1999)

Source: GAO analysis of the March 2000 Supplement, Current Population Survey
of nonelderly adults (18- to 64- year- olds).

Lack of insurance coverage is more common among certain types of workers,
employers, and industries. Employers often do not offer health benefits to
part- time workers. As a result, part- time workers are almost as likely to
be uninsured as nonworkers, and nearly twice as likely to be uninsured as
full- time workers. Employees of small firms are more likely to be uninsured
than those working for larger firms, with the likelihood of being uninsured
decreasing as the size of the firm increases. Of those working for firms
with fewer than 10 employees, 30 percent were uninsured in 1999, compared
with only about 11 percent of those working for firms with more than 1,000
employees. (See fig. 4.) In large part this is because small employers are
much less likely to offer health insurance to their employees than larger
employers: only 36 percent of private establishments with fewer than 10
employees offered health insurance in Employer Coverage, the

Principal Source of Health Insurance, Is Not Universally Available

Full- Time 41.7%

Nonworker

24.7%

Part- Time 33.6%

Health Insurance: Characteristics and Trends in the Uninsured Population

Page 9 GAO- 01- 507T

1998, compared with nearly all private establishments with 50 or more
workers. 5

Figure 4: Employees of Small Firms More Likely to Be Uninsured (1999)

Source: GAO analysis of the March 2000 Supplement, Current Population Survey
of nonelderly adults (18- to 64- year- olds).

Those working in certain industries are less likely to be offered health
insurance and face a greater risk of being uninsured. In 1999, more than 30
percent of workers in the construction, agriculture, and natural resources
(for example, mining, forestry, and fisheries) industries were uninsured. In
contrast, 10 percent or less of workers in the finance, insurance, real
estate, and public employment sectors were uninsured. (See fig. 5.)

5 Agency for Healthcare Research and Quality, Center for Cost and Financing
Studies, 1998 Medical Expenditure Panel Survey, Insurance Component.

Under 10 10 to 24 25 to99 100 to 499 500 to 999 1,000 or More Percentage
Uninsured Number of Employees

35 30 25 20 15 10

5 0

Health Insurance: Characteristics and Trends in the Uninsured Population

Page 10 GAO- 01- 507T

Figure 5: Likelihood of Being Uninsured Varies by Industry (1999)

Source: GAO analysis of the March 2000 Supplement, Current Population Survey
of nonelderly adults (18- to 64- year- olds).

Despite the presence of Medicaid and other public programs that enroll
millions of low- income Americans, many remain uninsured because either they
are ineligible for public coverage (such as most childless adults, under
Medicaid), or they are eligible but do not enroll. In 1999, 35 percent of
individuals in families with incomes below the federal poverty level had
Medicaid as their only source of health coverage, but a similar share were
uninsured. More than half of the uninsured (54 percent) had family incomes
less than 200 percent of the federal poverty level. Lower- income
individuals are less likely to believe purchasing health insurance is
affordable. Nearly three- quarters of uninsured adults surveyed for one
study in 2000 cited the high cost of coverage as a major reason for their
lack of coverage, nearly half of whom cited high costs as the most Despite
the Availability of

Public Programs, the Likelihood of Being Uninsured Is Strongly Related to
Income

Percentage Uninsured 35 30 25 20 15 10

5 0

Transportation/ Communication/ Utilities Construction

Agriculture/ Natural Resources Wholesale/ Retail Trade

Services Manufacturing

Finance/ Insurance/ Real Estate Public Employment

Health Insurance: Characteristics and Trends in the Uninsured Population

Page 11 GAO- 01- 507T

important reason. 6 While low- income individuals were most likely to be
uninsured, about 8 percent of those earning 4 times the federal poverty
level or more (over $68,000 for a family of four) were also uninsured. (See
fig. 6.)

Figure 6: Low- Income Persons Are More Likely to Be Uninsured (1999)

Source: GAO analysis of the March 2000 Supplement, Current Population Survey
of nonelderly (under 65).

6 Uninsured in America- A Chart Book, The Kaiser Commission on Medicaid and
the Uninsured.

<100% 100- 149% 150- 199% 200- 299% 300- 399% >400% Income as Percentage of
Federal Poverty Level ($ 17,029 for a Family of Four, 1999) Percentage
Uninsured 40

35 30 25 20 15 10

5 0

Health Insurance: Characteristics and Trends in the Uninsured Population

Page 12 GAO- 01- 507T

Certain groups- such as young adults, Hispanics, and immigrants- were
disproportionately likely to be uninsured. Young adults, aged 18 to 24, were
more likely than any other age group to be uninsured. (See fig. 7.) Young
adults' transition to the workforce- often working part- time or for low
wages, changing jobs frequently, and working for small employers- makes them
less likely to be eligible for employment- based coverage. Moreover, if they
are childless they generally are ineligible for public programs. In addition
to being more likely to find insurance less affordable, young adults may
value it less if they are healthy.

Figure 7: Young Adults Most Likely to Be Uninsured (1999)

Source: GAO analysis of the March 2000 Supplement, Current Population Survey
of nonelderly (under 65).

While about half of the 42 million uninsured people in 1999 were white and
non- Hispanic, racial and ethnic minorities faced a significantly greater
risk of being uninsured. About one- third of Hispanics, Native Americans,
and Eskimos were uninsured, compared with just over one- fifth of blacks,
Asians, and Pacific Islanders and one- eighth of whites. (See fig. 8.) Some
Groups

Disproportionately Uninsured for a Variety of Reasons

0- 17 18- 24 25- 34 35- 44 45- 54 55- 64 Percentage Uninsured 35

30 25 20 15 10

5 0

Age

Health Insurance: Characteristics and Trends in the Uninsured Population

Page 13 GAO- 01- 507T

Figure 8: Minorities More Likely to Be Uninsured (1999)

Source: GAO analysis of the March 2000 Supplement, Current Population Survey
of nonelderly (under 65).

Disparities in uninsured rates among racial and ethnic groups are partially,
but not fully, related to income. For example, among individuals with
incomes below the federal poverty level, uninsured rates are similar for
black and white non- Hispanics, but blacks are more likely to be uninsured
than whites within higher income categories. Within all income categories,
Hispanics and other non- black minorities are more likely to be uninsured
than whites. (See table 1.)

Asian/ Pacific Islander Native American

/Eskimo Hispanic Black White Percentage Uninsured 40

35 30 25 20 15 10

5 0

Health Insurance: Characteristics and Trends in the Uninsured Population

Page 14 GAO- 01- 507T

Table 1: Uninsured Rates by Race/ Ethnicity and Income, 1999 Percentage
uninsured Income category (percentage of federal poverty level) White a
Black a Hispanic

Asian, Eskimo, Native American,

and Pacific Islander a

Less than 100 percent 32.1 30.5 45.4 43.6 100 to 199 percent 23.0 28.6 42.0
36.3 200 to 299 percent 14.7 22.2 32.8 24.9 300 to 399 percent 9.8 16.0 24.0
20.6 400 percent or more 6.7 12.7 15.8 11.8 a Only non- Hispanics were
included in the white; black; and Asian, Eskimo, Native

American, and Pacific Islander groups. Source: GAO analysis of the March
2000 Supplement, Current Population Survey of nonelderly (under 65).

In addition, immigrants are more than twice as likely to be uninsured- about
37 percent compared with about 15 percent of nonimmigrants. Their higher
uninsured rates are in part because they are more likely to be lowincome and
potentially facing legal and other difficulties in obtaining coverage under
public programs such as Medicaid. In 1999, about 20 percent of immigrants
from families earning less than the federal poverty level were covered by
Medicaid, compared with nearly 38 percent of nonimmigrants. Lower Medicaid
coverage rates may be related in part to recent changes in federal law that
preclude certain immigrants from Medicaid and SCHIP eligibility for 5 years
after immigrating to this country. 7 Individuals who are undocumented
(illegal) aliens are ineligible for Medicaid and SCHIP coverage regardless
of how long they have been in the country, with the exception of emergency
treatment, for which they are covered under Medicaid. Moreover, undocumented
individuals may be reluctant to seek Medicaid or SCHIP coverage for their
citizen children for fear that program participation by any family members
may impact their ability to remain in the country or sponsor other family
members coming to the United States.

7 Under the Personal Responsibility and Work Opportunity Reconciliation Act
of 1996, states may not use federal funds for Medicaid or SCHIP coverage for
5 years for certain immigrants arriving on or after August 22, 1996. States
have the option of providing coverage to such immigrants entirely out of
state funds; however, only about 13 states had done so as of October 2000.

Health Insurance: Characteristics and Trends in the Uninsured Population

Page 15 GAO- 01- 507T

Health insurance coverage rates vary considerably across the nation.
Generally, uninsured rates are highest in the South and West and lowest in
the Midwest and Northeast. (See fig. 9.) In addition, more populous states
such as Florida and New York tend to have higher rates of uninsured. New
Mexico has the highest uninsured rate at 26.6 percent, while Minnesota has
the lowest at 9. 6 percent.

Figure 9: States With High Uninsured Rates Concentrated in South and West
(1998- 99)

Source: GAO analyses of the March 1999 and March 2000 Supplements, Current
Population Survey of nonelderly (under 65). Estimates for 1999 and 2000 were
combined to improve the precision of the state- level estimates.

States with high uninsured rates share many employment, economic, and
demographic characteristics, which differ from the characteristics of
Uninsured Rates Vary

Widely Among States

Uninsurance Rate

Higher Than U. S. Average (13) Same as U. S. Average (9) Lower Than U. S.
Average (29)

Health Insurance: Characteristics and Trends in the Uninsured Population

Page 16 GAO- 01- 507T

states with low uninsured rates. 8 We found that states with higher
uninsured rates tend to have a disproportionate share of low- income,
unemployed, Hispanic, and immigrant residents as well as fewer firms
offering coverage. 9 (See table 2.) (See app. I for uninsured rates by
state.)

Table 2: States With High Uninsured Rates Share Some Economic and
Demographic Characteristics Economic characteristics Demographic
characteristics

State group Percentage of

nonelderly below poverty level,

1998- 99 a Unemployment rate, 1999 b

Percentage of private firms

offering coverage,

1998 c Percentage of

nonelderly Hispanic 1998- 99 a

Percentage of nonelderly nonnative- born, 1998- 99 a

13 states with significantly higher uninsured rates 15.6 4.9 50.5 24.5 16.8
9 states with uninsured rates not significantly different from the U. S.
average 13.4 4.6 51.6 4.6 4.2 29 states with significantly lower uninsured
rates 10.3 3.7 55.2 4.8 6.0

a Source: GAO analyses of pooled Current Population Survey March Supplements
for 1999 and 2000. Estimates for 1999 and 2000 were combined to improve
precision of the statelevel estimates.

b Source: Bureau of Labor Statistics' Local Area Unemployment Statistics'
annual averages for the civilian noninstitutional population 16 years and
older. c Source: Agency for Healthcare Research and Quality. Estimates from
the 1998 Medical Expenditure Panel Survey- Insurance Component. Offer rates
were not reported separately for the following 10 states and the District of
Columbia: Alaska, Hawaii, Maine, Mississippi, Montana, Nevada, North Dakota,
Rhode Island, South Dakota, and Vermont.

For example, the demographic profiles of both Florida and California- two
large states with higher than average uninsured rates- are strikingly
different from the nation as a whole. These two states have among the
highest percentage of Hispanic and immigrant residents in the nation. The

8 To compare these characteristics across states with high or low uninsured
rates, we placed states into three groups: (1) the 13 states with
uninsurance rates significantly higher than the U. S. average (as a group,
averaging 22. 9 percent of nonelderly residents uninsured), (2) the 8 states
and the District of Columbia with uninsured rates not significantly
different from the U. S. average (as a group, averaging 18. 1 percent of
nonelderly residents uninsured), and (3) the 29 states with uninsured rates
significantly lower than the U. S. average (as a group, averaging 13. 6
percent of nonelderly residents uninsured).

9 Other demographic characteristics reviewed but found to be similar for
higher and lower uninsured states include the proportion of black residents
and median age for the nonelderly population.

Health Insurance: Characteristics and Trends in the Uninsured Population

Page 17 GAO- 01- 507T

proportion of the Hispanic population in 1998- 99 was more than two times
greater in California (33 percent) than for the United States as a whole (13
percent). In Florida, immigrants composed more than 17 percent of the
population, higher than the U. S. average of about 10 percent and lower only
than California and New York. Some states with high uninsured rates,
including Florida, Idaho, and Montana, have more of their workers in
industries less likely to offer health insurance and fewer in industries
more likely to offer it. For example, nearly 40 percent of Montana's workers
are employed by the three industries with the highest uninsured rates
(agriculture, construction, and trade), one- third more than the national
average. Conversely, less than 20 percent of Montana's workers are in the
three industries with the lowest uninsured rates (manufacturing, finance,
and the public sector), about one- fourth less than the national average.

While the decline in the number of uninsured in 1999 following a long- term
increase in this population is welcome news, it is too early to know whether
this reflects a reversal in the trend. Recent expansions of public programs,
such as the implementation of SCHIP, and the tight labor market likely
contributed to the improved coverage. Even with these positive factors, the
number of uninsured remains high, and any significant downturn in economic
conditions could lead to a resumption in the growth of their numbers. The
uninsured population is a diverse group, including individuals working in
different industries and firms of all sizes as well as of different income
levels, ages, races and ethnicities, and geographic locations. This
heterogeneous nature of the 42 million uninsured Americans suggests that
consideration of a combination of strategies might be appropriate in any
efforts to expand health insurance coverage.

Mr. Chairman, this concludes my statement. I would be happy to answer any
questions that you or Members of the Committee may have.

For more information regarding this testimony, please contact me at (202)
512- 7118 or John Dicken at (202) 512- 7043. JoAnne R. Bailey, Paula Bonin,
Randy DiRosa, Betty Kirksey, and Elizabeth T. Morrison also made key
contributions to this statement. Concluding

Observations GAO Contacts and Staff Acknowledgments

Page 18 GAO- 01- 507T

1998- 99 a 1994- 95 a Difference: 1994- 95 to 1998- 99

States with uninsured rates significantly above U. S. average, 1998- 99

New Mexico 26.6 27.3 -0.7 Texas 26.3 26.7 -0.4 Arizona 25.5 23.1 2. 4
California 23.4 23.0 0. 4 Louisiana 23.2 22.0 1. 2 Nevada 23.2 19.4 3. 8
Florida 22.0 21.1 0. 9 Montana 21.5 15.3 6. 2 Mississippi 20.9 21.3 -0.4
Oklahoma 20.8 21.2 -0.4 West Virginia 20.7 18.7 2. 0 Idaho 20.6 15.7 4. 9
New York a 19.1 17.7 1. 4

States with rates not significantly different from U. S. average, 1998- 99

Arkansas a 19.3 20.2 -0.9 Alaska 18.9 13.4 5. 5 South Carolina 18.7 16.0 2.
7 Georgia 18.6 19.0 -0.4 District of Columbia 18.4 18.8 -0.4 Wyoming 18.3
17.1 1. 2

U. S. average 17.9 17.2 0. 7

Alabama 17.8 18.8 -1.0 Colorado 17.4 14.8 2. 6 North Carolina 17.2 15.8 1. 4

States with rates significantly below U. S. average, 1998- 99

New Jersey 16.5 15.4 1. 1 Illinois 16.2 12.6 3. 6 Kentucky 16.2 17.0 -0.8
Maryland 16.2 15.7 0. 5 Oregon 16.2 14.4 1. 8 Virginia 15.8 14.2 1. 6
Washington 15.4 14.0 1. 4 North Dakota 15.2 9. 5 5.7 Utah 15.2 12.9 2. 3
South Dakota 15.0 11.1 3. 9 Delaware 14.9 16.3 -1.4 Indiana 14.2 13.1 1. 1
Maine 13.9 15.3 -1.4 Michigan 13.6 11.6 2. 0 Tennessee 13.5 13.9 -0.4

Appendix I: Percentage of Nonelderly That Were Uninsured, by State

Appendix I: Percentage of Nonelderly That Were Uninsured, by State

Page 19 GAO- 01- 507T

1998- 99 a 1994- 95 a Difference: 1994- 95 to 1998- 99

Kansas 13.0 14.4 -1.4 Connecticut 12.8 11.1 1. 7 Wisconsin 12.7 8. 9 3.8
Vermont 12.3 12.1 0. 2 Ohio 12.1 13.0 -0.9 New Hampshire 11.9 12.4 -0.5
Hawaii 11.8 10.2 1. 6 Massachusetts 11.7 13.4 -1.7 Pennsylvania 11.5 11.9
-0.4 Nebraska 11.2 11.1 0. 1 Missouri 10.8 15.5 -4.7 Iowa 10.2 12.1 -1.9
Rhode Island 9.8 14.4 -4.6 Minnesota 9. 6 9.8 -0.2

a March 1999 and 2000 Supplements were combined, as were the March 1995 and
1996 Supplements, to improve the precision of the state estimates. b States
are categorized as higher than, similar to, or lower than the U. S. average
based on whether the state- level estimate statistically is significantly
different from the U. S. average. Because smaller states have smaller sample
sizes in the Current Population Survey, the potential sampling error is
larger in these states than in larger states. Thus, a specific uninsured
rate may be significantly different from the U. S. average for one state but
not for another with a smaller population and sample size. For this reason,
New York's uninsured rate of 19.1 percent is significantly higher than the
U. S. average, even though it is slightly lower than Arkansas' estimated
rate of 19.3 percent, which is not significantly different from the U. S.
average.

Source: GAO analyses of pooled Current Population Survey March Supplements
for 1999 and 2000 and for 1995 and 1996 for the nonelderly population (under
65).

(201099)

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