Trends
in Health Insurance Coverage by Poverty Status Among Persons Under 65
Years of Age: United States, 1997-2002 by Robin A.
Cohen, Ph.D.; Hanyu Ni, Ph.D., M.P.H.; and Cathy Hao
Highlights
Preliminary data from
the early 2002 National Health Interview Survey (NHIS) showed a decline
from 1997 to 2002 in the percent of U.S. children (under 18 years of age)
who lacked health insurance coverage (table 1). This decrease is
attributable to a reduction in the percent of the uninsured among children
whose family income categorized them as being poor or near poor. During
the same time period, the percent uninsured among not poor children
remained stable (see Source of Data for poverty definitions). The decline
in the percent uninsured among children may be attributable to the State
Children’s Health Insurance Program (SCHIP), also known as Title XXI,
which was enacted in 1997 to help children without health insurance, many
of whom come from working families with incomes too high to qualify for
Medicaid, but too low to afford private health insurance. NHIS data for
January-September 2002 show that despite increasing coverage, 14.8% of
poor and 15.5% of near poor children did not have health insurance at the
time of the interview. In the first three quarters (January-September) of 2002, poor and near
poor children were more than twice as likely as not poor children to lack
health insurance coverage.
The NHIS data revealed
that the overall percent of children under 18 years of age who had a
public health plan increased from 20.0% in 1998 to 27.2% in January-September 2002
(table 2). The largest increase was seen among children in
the near poor category (22.9% in 1998 to 42.2% during the first three
quarters of 2002). A slight increase was also seen among other children.
During the same time period, private coverage among children who were in
the near poor category decreased from 56.3% in1998 to 45.1% in the first
three quarters of 2002 (table 3). A slight decrease was also observed
among children in the not poor group.
Among adults aged 18-64
years, the overall percent uninsured decreased from 18.9% in 1997 to 17.8%
in 1999, and since then has not changed significantly (table
1). Public
coverage increased among near poor adults from 15.2% in 2000 to 18.6% in
January -September 2002 (table 2). During the first three quarters of
2002, 33.4% of poor adults were covered by a
public health plan.
Private coverage
increased for poor adults aged 18-64 years from 26.8% in 1997 to 30.4% in
1999, but did not change significantly (table 3) in later years. From
January to September 2002, 31.2% of poor adults had private health
insurance coverage. Private coverage for near poor adults remained at
about 50% from 1997 to the first three quarters of 2002. Private health
insurance coverage decreased among not poor adults from 86.9 percent in
2001 to 85.9% in the first three quarters.
Source of Data
The NHIS is a
multistage probability sample survey of the civilian noninstitutionalized
population in the United States. It is conducted continuously throughout
the year by interviewers of the U.S. Census Bureau for the Centers for
Disease Control and Prevention’s National Center for Health Statistics.
For further information, see the NHIS Web site. This analysis uses
preliminary data from NHIS 2002. Final data editing and weighting have not
been done, but the data on health insurance status were edited using an
automated system based on logic checks and keyword searches. The estimates
for all years were created using these same procedures to ensure
comparability. The resulting estimates for persons not having health
insurance coverage are generally within 0.1 percentage point of those
produced from the final data files. These methods are consistent with
those used by the NHIS Early Release Program to generate estimates of
health insurance coverage at the NHIS Web site.
Poverty is categorized
based on the ratio of the family’s income in the previous calendar year
to the appropriate poverty threshold (given the family’s size and number
of children) defined by the U.S. Census Bureau for that year (1-6).
Persons who are categorized as "poor" had a ratio less than 1.0
(that is, their family income was strictly below the poverty threshold).
The "near poor" category includes persons with incomes of 100%
to less than 200% of the poverty threshold. Finally, "not poor"
persons have incomes that are 200% of the poverty threshold or greater.
The remaining group of respondents are coded as "unknown" with
respect to poverty status. The estimates for those respondents with
unknown poverty status (19.1% in 1997, 23.6% in 1998, 26.4% in 1999, 27.0%
in 2000, 27.1% in 2001, and 27.0% in the first three quarters of 2002) are
shown in the tables. Please visit our NHIS Web site
for more information on the unknown
income and poverty status categories.
References:
1.
Lamison-White, L. U.S.
Bureau of the Census. Current Population Reports, Series P60-198. Poverty
in the United States, 1996. U.S. Government Printing Office, Washington.
1997.
2.
Dalaker J, Naifeh M.
U.S. Bureau of the Census. Current Population Reports, Series P60-201,
Poverty in the United States, 1997. U.S. Government Printing Office,
Washington. 1998.
3.
Dalaker J. U.S. Census
Bureau. Current Population Reports, Series P60-207, Poverty in the United
States, 1998. U.S. Government Printing Office, Washington. 1999.
4.
Dalaker J., Proctor B.
U.S. U.S. Census Bureau. Current Population Reports, Series P60-210,
Poverty in the United States, 1999. U.S. Government Printing Office,
Washington. 2000.
5.
Dalaker J. U.S. Census
Bureau. Current Population Reports, Series P60-214, Poverty in the United
States, 2000. U.S. Government Printing Office, Washington. 2001.
6.
Proctor B., Dalaker J.
U.S. Census Bureau. Current Population Reports, Series P60-219, Poverty in
the United States, 2001. U.S. Government Printing Office, Washington.
2002.
Table
1. Percent of persons under 65 years of age without health insurance
coverage, by age group and poverty status: United States, 1997-2002
Age and poverty
status
1997
1998
1999
2000
2001
Jan.
- Sept. 2002
Percent
(standard error)
Under age 65
years
Total
17.4
(0.24)
16.5
(0.26)
16.0
(0.25)
16.6
(0.24)
15.9
(0.25)
16.1
(0.27)
Poor
32.7
(0.80)
32.7
(0.84)
32.1
(0.93)
32.2
(0.88)
30.5
(0.98)
27.8
(0.90)
Near Poor
30.4
(0.70)
30.8
(0.79)
30.7
(0.73)
30.9
(0.69)
28.1
(0.69)
27.4
(0.79)
Not Poor
8.9
(0.22)
8.0
(0.21)
7.8
(0.20)
8.7
(0.22)
8.4
(0.21)
9.3
(0.28)
Unknown poverty
status
21.6
(0.59)
20.7
(0.53)
20.1
(0.48)
19.5
(0.51)
20.0
(0.52)
20.3
(0.57)
Under age 18
years
Total
13.9
(0.36)
12.7
(0.34)
11.8
(0.32)
12.2
(0.32)
10.8
(0.34)
10.1
(0.34)
Poor
22.4
(0.99)
21.6
(1.02)
21.4
(1.13)
20.5
(1.04)
18.7
(1.26)
14.8
(1.05)
Near Poor
22.8
(0.96)
22.5
(0.97)
21.6
(0.92)
21.2
(0.93)
16.8
(0.85)
15.5
(0.94)
Not Poor
6.1
(0.33)
4.9
(0.29)
4.4
(0.29)
5.3
(0.30)
4.4
(0.26)
5.3
(0.40)
Unknown poverty
status
18.3
(0.90)
16.5
(0.75)
14.9
(0.69)
14.8
(0.71)
15.3
(0.84)
13.4
(0.78)
18-64 years
Total
18.9
(0.23)
18.2
(0.27)
17.8
(0.26)
18.4
(0.26)
18.1
(0.26)
18.7
(0.29)
Poor
40.2
(0.88)
40.8
(1.02)
39.9
(1.11)
40.4
(1.04)
38.8
(1.19)
36.8
(1.20)
Near Poor
34.9
(0.71)
36.0
(0.83)
36.3
(0.81)
37.0
(0.77)
35.1
(0.78)
35.1
(0.88)
Not Poor
9.9
(0.22)
9.2
(0.23)
9.0
(0.20)
9.9
(0.24)
9.8
(0.22)
10.8
(0.30)
Unknown poverty
status
22.9
(0.58)
22.2
(0.60)
22.2
(0.50)
21.3
(0.52)
21.7
(0.51)
23.0
(0.62)
Notes:
Poverty is categorized based on the ratio of the family’s income in the
previous calendar year to the appropriate poverty threshold (given the
family’s size and number of children) defined by the U.S. Census Bureau
for that year. Persons who are categorized as "poor" had a ratio
less than 1.0 (that is, their family income was strictly below the poverty
threshold). The "near poor" category includes persons with
incomes of 100% to less than 200% of the poverty threshold. Finally,
"not poor" persons have incomes that are 200% of the poverty
threshold or greater. The remaining group of respondents are coded as
"unknown" poverty status. The estimates for those respondents
with unknown poverty status (19.1% in 1997, 23.6% in 1998, 26.4% in 1999,
27.0% in 2000, 27.1% in 2001, and 27.0% in the first three quarters of
2002) are shown in the table. Please visit NHIS Web site for more information on the
unknown income and poverty status categories. A person was defined as
uninsured if he or she did not have any private health insurance,
Medicaid, State Children’s Health Insurance Program (SCHIP), Medicare
(disability), State-sponsored or other government-sponsored health plan or
military plan at the time of the interview. A person was also defined as
uninsured if he or she had only Indian Health Service coverage or had only
a private plan that paid for one type of service such as accidents or
dental care. The analysis excluded persons with unknown health insurance
status (about 1% of respondents). The data on health insurance status were
edited using an automated system based on logic checks and keyword
searches. The resulting estimates of health insurance coverage are
generally within 0.1 percentage point of those based on both automated and
manual editing procedures used for the final data files.
Data
Source: Family Core component of the 1997-2002 National Health Interview
Survey. The estimates for 2002 were based on data collected from January
through September.
Table 2.
Percent of persons under 65 years of age with public health plan coverage,
by age group and poverty status: United States, 1997-2002
Age and poverty
status
1997
1998
1999
2000
2001
Jan.
- Sept. 2002
Percent
(standard error)
Under age 65
years
Total
13.6
(0.25)
12.7
(0.26)
12.4
(0.24)
12.9
(0.26)
13.6
(0.26)
15.4
(0.34)
Poor
46.1
(1.01)
44.7
(1.05)
43.4
(1.04)
43.8
(1.12)
45.1
(1.15)
48.0
(1.23)
Near Poor
18.2
(0.56)
17.5
(0.57)
20.5
(0.63)
21.8
(0.63)
25.2
(0.70)
27.9
(0.79)
Not Poor
5.3
(0.19)
5.1
(0.23)
4.8
(0.18)
5.3
(0.22)
5.6
(0.22)
6.1
(0.27)
Unknown poverty
status
13.2
(0.49)
13.4
(0.45)
13.2
(0.43)
12.8
(0.42)
13.1
(0.42)
16.7
(0.53)
Under age 18
years
Total
21.4
(0.48)
20.0
(0.49)
20.4
(0.46)
21.8
(0.50)
23.3
(0.50)
27.2
(0.63)
Poor
62.1
(1.31)
61.1
(1.34)
60.7
(1.37)
61.8
(1.49)
65.2
(1.48)
69.3
(1.54)
Near Poor
24.3
(0.93)
22.9
(0.95)
28.7
(1.15)
32.4
(1.15)
36.9
(1.24)
42.2
(1.32)
Not Poor
6.3
(0.32)
6.0
(0.39)
6.0
(0.32)
7.3
(0.40)
8.1
(0.39)
9.0
(0.49)
Unknown poverty
status
21.4
(0.97)
22.1
(0.95)
22.2
(0.88)
21.9
(0.85)
22.8
(0.94)
31.0
(1.16)
18-64 years
Total
10.2
(0.20)
9.5
(0.21)
9.0
(0.19)
9.0
(0.19)
9.4
(0.21)
10.3
(0.27)
Poor
34.3
(0.93)
32.9
(1.08)
30.8
(0.98)
31.3
(1.01)
31.0
(1.11)
33.4
(1.26)
Near Poor
14.6
(0.51)
14.1
(0.53)
15.4
(0.52)
15.2
(0.54)
17.9
(0.62)
18.6
(0.76)
Not Poor
5.0
(0.18)
4.8
(0.21)
4.4
(0.17)
4.5
(0.19)
4.7
(0.20)
5.1
(0.26)
Unknown poverty
status
10.1
(0.41)
10.0
(0.34)
9.6
(0.33)
9.2
(0.33)
9.4
(0.33)
11.2
(0.40)
Notes:
Poverty is categorized based on the ratio of the family’s income in the
previous calendar year to the appropriate poverty threshold (given the
family’s size and number of children) defined by the U.S. Census Bureau
for that year. Persons who are categorized as "poor" had a ratio
less than 1.0 (that is, their family income was strictly below the poverty
threshold). The "near poor" category includes persons with
incomes of 100% to less than 200% of the poverty threshold. Finally,
"not poor" persons have incomes that are 200% of the poverty
threshold or greater. The remaining group of respondents are coded as
"unknown" poverty status. The estimates for those respondents
with unknown poverty status (19.1% in 1997, 23.6% in 1998, 26.4% in 1999,
27.0% in 2000, 27.1% in 2001, and 27.0% in the first three quarters of
2002) are shown in the table. Please visit for more information on the
unknown income and poverty status categories. The category "public
health plan coverage" includes Medicaid, SCHIP, Medicare
(disability), State-sponsored or other government-sponsored health plan
and military plans. A small number of persons who were covered by both
public and private insurance (table 3) are included in both categories.
The analysis excluded persons with unknown health insurance status (about
1% of respondents). The data on health insurance status were edited using
an automated system based on logic checks and keyword searches. The
resulting estimates of health insurance coverage are generally within 0.1
percentage point of those based on both automated and manual editing
procedures used for the final data files.
Data
Source: Family Core component of the 1997-2002 National Health Interview
Survey. The estimates for 2002 were based on data collected from January
through September.
Table 3.
Percent of persons under 65 years of age with private health insurance
coverage, by age group and poverty status: United States, 1997-2002
Age and poverty
status
1997
1998
1999
2000
2001
Jan.
- Sept. 2002
Percent
(standard error)
Under age 65
years
Total
70.8
(0.35)
72.0
(0.36)
73.1
(0.36)
72.1
(0.34)
71.9
(0.37)
70.1
(0.44)
Poor
22.9
(0.93)
23.1
(1.02)
26.1
(1.12)
25.6
(1.02)
25.9
(1.16)
26.0
(1.26)
Near Poor
53.5
(0.80)
53.0
(0.92)
50.9
(0.86)
49.3
(0.87)
48.7
(0.86)
47.1
(1.01)
Not Poor
87.6
(0.27)
88.1
(0.29)
88.9
(0.24)
87.5
(0.28)
87.3
(0.27)
86.2
(0.36)
Unknown poverty
status
66.7
(0.71)
67.1
(0.71)
68.0
(0.65)
69.1
(0.64)
68.1
(0.69)
64.0
(0.77)
Under age 18
years
Total
66.2
(0.57)
68.5
(0.55)
69.1
(0.55)
67.5
(0.53)
67.1
(0.57)
64.2
(0.68)
Poor
17.5
(1.09)
19.3
(1.17)
20.2
(1.16)
19.7
(1.23)
18.3
(1.14)
18.4
(1.29)
Near Poor
55.0
(1.15)
56.3
(1.22)
52.1
(1.23)
49.0
(1.24)
48.6
(1.24)
45.1
(1.44)
Not Poor
88.9
(0.43)
89.9
(0.48)
90.6
(0.39)
88.4
(0.47)
88.5
(0.40)
86.9
(0.58)
Unknown poverty
status
61.7
(1.18)
62.1
(1.13)
63.8
(1.02)
64.6
(0.99)
62.7
(1.16)
56.6
(1.30)
18-64 years
Total
72.8
(0.30)
73.5
(0.32)
74.7
(0.33)
74.0
(0.31)
73.9
(0.33)
72.6
(0.39)
Poor
26.8
(1.09)
25.8
(1.17)
30.4
(1.39)
29.7
(1.19)
31.3
(1.45)
31.2
(1.60)
Near Poor
52.6
(0.76)
50.9
(0.90)
50.2
(0.85)
49.5
(0.83)
48.7
(0.83)
48.5
(0.98)
Not Poor
87.1
(0.26)
87.4
(0.27)
88.2
(0.24)
87.1
(0.27)
86.9
(0.28)
85.9
(0.34)
Unknown poverty
status
68.6
(0.65)
69.1
(0.66)
69.7
(0.60)
70.9
(0.61)
70.2
(0.61)
67.0
(0.68)
Notes:
Poverty is categorized based on the ratio of the family’s income in the
previous calendar year to the appropriate poverty threshold (given the
family’s size and number of children) defined by the U.S. Census Bureau
for that year. Persons who are categorized as "poor" had a ratio
less than 1.0 (that is, their family income was strictly below the poverty
threshold). The "near poor" category includes persons with
incomes of 100% to less than 200% of the poverty threshold. Finally,
"not poor" persons have incomes that are 200% of the poverty
threshold or greater. The remaining group of respondents are coded as
"unknown" poverty status. The estimates for those respondents
with unknown poverty status (19.1% in 1997, 23.6% in 1998, 26.4% in 1999,
27.0% in 2000, 27.1% in 2001, and 27.0% in the first three quarters of
2002) are shown in the table. Please visit for more information on the
unknown income and poverty status categories. The category "private
health insurance" excludes plans that paid for only one type of
service such as accidents or dental care. A small number of persons who
were covered by both public (table 2) and private insurance are included
in both categories. The analysis excluded persons with unknown health
insurance status (about 1% of respondents). The data on health insurance
status were edited using an automated system based on logic checks and
keyword searches. The resulting estimates of health insurance coverage are
generally within 0.1 percentage point of those based on both automated and
manual editing procedures used for the final data files.
Data
Source: Family Core component of the 1997-2002 National Health Interview
Survey. The estimates for 2002 were based on data collected from
January-September.