Congressional Budget OfficeSkip Navigation
Home Red Bullet Publications Red Bullet Cost Estimates Red Bullet About CBO Red Bullet Press Red Bullet Employment Red Bullet Contact Us Red Bullet Director's Blog Red Bullet   RSS
PDF
A
CBO
PAPER

How Many People
Lack Health Insurance
and For How Long?
May 2003


Notes

Numbers in the text and tables may not sum to 100 because of rounding.





                
Preface

More than 240 million people in the United States have health insurance today through a variety of private and public sources. At the same time, however, millions of people lack such coverage, and policymakers have proposed a range of approaches for expanding health insurance coverage. Far from being a static group, the uninsured population is constantly changing: while many people are chronically uninsured, many more are uninsured for shorter periods of time, such as between jobs. This Congressional Budget Office (CBO) paper, prepared at the request of the Chairman of the House Committee on Ways and Means, uses data from several federally sponsored national surveys to examine the size, demographic characteristics, and dynamics of the uninsured population. In keeping with CBO's mandate to provide objective, impartial analysis, the paper makes no recommendations.

Lyle Nelson of CBO's Health and Human Resources Division prepared the paper under the supervision of Steven Lieberman. Carol Frost provided assistance with data and tabulations. The paper benefited from comments from reviewers outside of CBO, including Katherine Swartz of Harvard University and Charles Nelson of the U.S. Census Bureau. Within CBO, James Baumgardner, Seth Giertz, Arlene Holen, and Bruce Vavrichek provided useful comments.

Christine Bogusz edited the manuscript, and John Skeen proofread it. Judith Cromwell produced drafts of the manuscript, Kathryn Winstead prepared the report for publication, and Annette Kalicki prepared the electronic versions for CBO's Web site.

Douglas Holtz-Eakin
Director
May 2003




CONTENTS


Summary
 
Introduction
 
Size of the Uninsured Population
      The Number of People Who Are Uninsured All Year
      The Number of People Who Are Uninsured at Any Time During the Year
      The Number of People Who Are Uninsured at a Point in Time
      The Implications of the Medicaid Undercount
      The Implications of Less-Than-Full Participation in Medicaid
 
Demographic Characteristics of the Uninsured Population
 
Dynamics of the Uninsured Population
      The Duration of Uninsured Spells
      Characteristics Associated with the Duration of Uninsured Spells
      Multiple Spells and Total Uninsured Months
 
Reasons Reported for Lacking Health Insurance
 
Policy Considerations
 
Appendix A
Strengths and Limitations of the Survey Data

Appendix B
The Consistency of Different Estimates of the Duration of Uninsured Spells



Tables
   
1.  Percentage and Number of Nonelderly People Without Health Insurance in 1998 and 1999, Estimated from Four National Surveys
2.  Nonelderly People Without Health Insurance in 1998, by Selected Characteristics
3.  Distribution of Uninsured Spells by Duration and Age
4.  Distribution of Uninsured Spells by Duration and Selected Characteristics
5.  Distribution of Uninsured Spells and Uninsured Months Among Nonelderly People Who Had a Spell That Began Between July 1996 and June 1997
6.  Reasons Reported by Nonelderly Adults for Lacking Health Insurance
B-1.  Projected Distribution of Spells in Progress in a Given Month and a Given Year, by Duration, Based on the Actual Distribution of New Spells
   
Figures
   
S-1.  Estimated Number of Nonelderly People Without Health Insurance in 1998
S-2.  Distribution of Uninsured Spells Among Nonelderly People in a Given Year and at a Given Point in Time, by Duration
A-1.  Distribution of Uninsured Spells That Began Between July 1996 and June 1997, by Duration
   
Box
   
1.  Two Approaches to Measuring Uninsured Spells
Table of Contents Next Page