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State-Specific Prevalence Estimates of Uninsured and Underinsured Persons -- Behavioral Risk Factor Surveillance System, 1995In the United States, cost of health-care services is a barrier to accessibility of health care, and persons often do not seek medical care because of concerns about cost, regardless of whether they have health insurance (1,2). In addition, three fourths of persons in the United States who have difficulties paying their medical bills have some type of health insurance (1). Although the affordability of health care among persons without health insurance has been described, characterization of affordability among persons who are underinsured is limited (3). To determine state-specific estimates of the prevalence of persons aged 18-64 years who are either uninsured or underinsured using an experiential definition of underinsurance, CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of that analysis, which document variations in state-specific rates for adequate insurance coverage. The BRFSS is a state-based, random-digit-dialed telephone survey of the U.S. noninstitutionalized population aged greater than or equal to 18 years. Data were obtained from all 50 states participating in the 1995 BRFSS. A total of 90,691 persons responded (range across states: 944-3398). Analyses were restricted to persons aged 18-64 years. Sample estimates were statistically weighted on the basis of sex, age, and race to reflect the noninstitutionalized civilian population of each state. The presence of health insurance was based on responses to the question "Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare?" Failure to seek medical care because of cost was based on responses to the question "Was there a time during the last 12 months when you needed to see a doctor, but could not because of the cost?" Adequate insurance was defined as being insured and reporting no problems because of cost, and underinsurance was defined as being insured but failing to see a doctor because of cost. Additional state-specific analyses examined the prevalence of adequate insurance, underinsurance, and lack of insurance among persons by employment status (i.e., employed for wages, self-employed, or unemployed). During 1995, 67.8%-87.9% of persons aged 18-64 years were adequately insured (Table_1); however, approximately one fifth were either underinsured (range: 4.3%-9.0%) or uninsured (range: 6.8%-24.6%). The prevalence of adequate coverage was highest in Hawaii (87.9%), the only state to have nearly universal health-care coverage (4). The prevalence of adequate insurance was higher in states in the northern plains and the upper Midwest and lower in states in the South, Southwest, and West (Figure_1). Underinsurance and lack of insurance were most common among the unemployed (ranges: 1.2%-21.0% and 24.0%-60.0%, respectively). Persons who were self-employed were more frequently uninsured (range: 4.7%-36.8%) than those employed for wages (range: 3.6%-21.0%) but reported similar estimates of underinsurance (range: 1.7%-11.7%). Among persons employed for wages, estimates of either underinsured or uninsured persons ranged from 7.9% (Hawaii) to 28.0% (Louisiana) Table_2. Reported by the following BRFSS coordinators: J Cook, MPA, Alabama; P Owen, Alaska; B Bender, Arizona; J Senner, PhD, Arkansas; B Davis, PhD, California; M Leff, MSPH, Colorado; M Adams, MPH, Connecticut; F Breukelman, Delaware; D McTague, MS, Florida; E Pledger, MPA, Georgia; J Cooper, MA, Hawaii; C Johnson, MPH, Idaho; B Steiner, MS, Illinois; N Costello, MPA, Indiana; A Wineski, Iowa; M Perry, Kansas; K Asher, Kentucky; R Meriwether, MD, Louisiana; D Maines, Maine; A Weinstein, MA, Maryland; D Brooks, MPH, Massachusetts; H McGee, MPH, Michigan; N Salem, PhD, Minnesota; P Arbuthnot, Mississippi; T Murayi, PhD, Missouri; P Smith, Montana; S Huffman, Nebraska; E DeJan, MPH, Nevada; K Zaso, MPH, New Hampshire; G Boeselager, MS, New Jersey; W Honey, MPH, New Mexico; T Melnik, DrPH, New York; K Passaro, PhD, North Carolina; J Kaske, MPH, North Dakota; R Indian, MS, Ohio; N Hann, MPH, Oklahoma; J Grant-Worley, MS, Oregon; L Mann, Pennsylvania; J Hesser, PhD, Rhode Island; Y Gladman, South Carolina; M Gildemaster, South Dakota; D Ridings, Tennessee; K Condon, Texas; R Giles, Utah; R McIntyre, PhD, Vermont; L Redman, Virginia; K Wynkoop-Simmons, PhD, Washington; F King, West Virginia; E Cautley, MS, Wisconsin; M Futa, MA, Wyoming. DL Warner, MPH, Epidemiology and Prevention Br, Georgia Div of Public Health. Health Care and Aging Studies Br and Behavioral Surveillance Br, Div of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. Editorial NoteEditorial Note: The finding in this report that 6.8%-24.6% of persons aged 18-64 years in the United States during 1995 were uninsured is consistent with previous national estimates (3,5). Previous reports have indicated a decline in the proportion of persons in the United States with health insurance, including a decline among employed persons (3,5). The BRFSS analysis also indicates that most persons who were uninsured or underinsured were employed, and approximately one fifth of employed adults were either uninsured or underinsured, possibly reflecting the inadequacy of employer-based health-care coverage (3). The findings in this report are subject to at least two limitations. First, only residences with telephones were surveyed. Because households without telephones generally have lower incomes than those with telephones, the percentages of uninsured and underinsured persons may have been underestimated (6). Second, estimates of underinsurance were based on a relatively simple definition of underinsurance that differs from the econometric and perceptual terms used previously (7); this definition requires further evaluation to determine its accuracy. Many studies examining trends in health-care coverage or the impact of health-care coverage on health-care status, receipt of services, or health outcomes have characterized persons as either "insured" or "uninsured." Developing a standardized working definition for monitoring underinsurance is a priority. Because the question used to define "underinsured" in the state-based BRFSS has been used frequently in national surveys, this definition enables states to compare their rates of underinsurance with national estimates and to better characterize the population segments that lack adequate health insurance. References
TABLE 1. Percentage of persons aged 18-64 years who were adequately insured,
underinsured, or uninsured, by state -- United States, Behavioral Risk Factor
Surveillance System, 1995
=========================================================================================
Adequately insured Underinsured Uninsured
------------------ ---------------- ----------------
State % (95% CI*) % (95% CI) % (95% CI)
---------------------------------------------------------------------------------------
Alabama 76.6 (+/-2.5%) 6.9 (+/-1.4%) 16.5 (+/-2.2%)
Alaska 75.7 (+/-3.2%) 8.0 (+/-1.9%) 16.3 (+/-2.9%)
Arizona 76.0 (+/-2.8%) 5.5 (+/-1.4%) 18.5 (+/-2.7%)
Arkansas 73.9 (+/-2.5%) 7.5 (+/-1.4%) 18.6 (+/-2.3%)
California 70.2 (+/-2.5%) 7.2 (+/-1.4%) 22.6 (+/-2.3%)
Colorado 79.0 (+/-2.3%) 4.5 (+/-1.1%) 16.5 (+/-2.2%)
Connecticut 82.3 (+/-2.3%) 6.2 (+/-1.5%) 11.4 (+/-2.0%)
Delaware 81.0 (+/-2.2%) 5.6 (+/-1.2%) 13.4 (+/-1.9%)
Florida 72.6 (+/-2.0%) 8.2 (+/-1.2%) 19.2 (+/-1.8%)
Georgia 79.9 (+/-2.1%) 8.8 (+/-1.4%) 11.3 (+/-1.7%)
Hawaii 87.9 (+/-1.9%) 5.3 (+/-1.4%) 6.8 (+/-1.5%)
Idaho 74.9 (+/-1.9%) 8.1 (+/-1.2%) 17.0 (+/-1.7%)
Illinois 80.1 (+/-2.0%) 6.5 (+/-1.2%) 13.4 (+/-1.7%)
Indiana 81.4 (+/-2.0%) 6.5 (+/-1.2%) 12.1 (+/-1.6%)
Iowa 83.9 (+/-1.5%) 4.5 (+/-0.8%) 11.6 (+/-1.4%)
Kansas 80.4 (+/-2.1%) 6.2 (+/-1.3%) 13.4 (+/-1.9%)
Kentucky 74.0 (+/-2.3%) 9.0 (+/-1.4%) 17.0 (+/-2.0%)
Louisiana 67.8 (+/-2.8%) 7.6 (+/-1.6%) 24.6 (+/-2.6%)
Maine 76.0 (+/-3.0%) 4.5 (+/-1.3%) 19.6 (+/-2.8%)
Maryland 84.1 (+/-1.3%) 5.2 (+/-0.7%) 10.7 (+/-1.1%)
Massachusetts 81.9 (+/-2.3%) 5.8 (+/-1.4%) 12.3 (+/-2.0%)
Michigan 83.2 (+/-1.8%) 6.8 (+/-1.2%) 10.0 (+/-1.4%)
Minnesota 84.7 (+/-1.4%) 5.8 (+/-0.9%) 9.5 (+/-1.1%)
Mississippi 74.3 (+/-2.9%) 9.0 (+/-1.7%) 16.8 (+/-2.5%)
Missouri 75.3 (+/-2.9%) 6.6 (+/-1.4%) 18.1 (+/-2.7%)
Montana 72.7 (+/-3.1%) 7.8 (+/-1.8%) 19.5 (+/-2.7%)
Nebraska 84.1 (+/-2.2%) 6.3 (+/-1.4%) 9.7 (+/-1.8%)
Nevada 78.3 (+/-2.5%) 6.4 (+/-1.4%) 15.3 (+/-2.2%)
New Hampshire 79.5 (+/-2.8%) 6.0 (+/-1.5%) 14.5 (+/-2.5%)
New Jersey 81.3 (+/-2.9%) 8.9 (+/-2.0%) 9.9 (+/-2.3%)
New Mexico 71.3 (+/-3.2%) 7.1 (+/-1.6%) 21.7 (+/-3.0%)
New York 79.6 (+/-2.2%) 6.1 (+/-1.1%) 14.3 (+/-2.0%)
North Carolina 76.7 (+/-1.9%) 8.6 (+/-1.2%) 14.6 (+/-1.6%)
North Dakota 82.9 (+/-2.1%) 4.4 (+/-1.1%) 12.8 (+/-2.0%)
Ohio 80.3 (+/-2.9%) 6.6 (+/-1.6%) 13.1 (+/-2.5%)
Oklahoma 76.4 (+/-2.7%) 5.6 (+/-1.4%) 18.0 (+/-2.5%)
Oregon 76.2 (+/-2.0%) 8.1 (+/-1.2%) 15.7 (+/-1.7%)
Pennsylvania 82.5 (+/-1.9%) 6.0 (+/-1.4%) 11.5 (+/-1.5%)
Rhode Island 81.5 (+/-2.3%) 5.6 (+/-1.3%) 13.0 (+/-2.0%)
South Carolina 77.6 (+/-2.3%) 8.3 (+/-1.5%) 14.2 (+/-1.9%)
South Dakota 83.0 (+/-2.2%) 6.1 (+/-1.4%) 10.9 (+/-1.8%)
Tennessee 78.5 (+/-2.2%) 8.3 (+/-1.4%) 13.2 (+/-1.9%)
Texas 73.2 (+/-2.8%) 6.9 (+/-1.5%) 19.9 (+/-2.5%)
Utah 80.6 (+/-2.2%) 6.8 (+/-1.4%) 12.6 (+/-1.8%)
Vermont 78.8 (+/-2.1%) 7.3 (+/-1.4%) 13.9 (+/-1.8%)
Virginia 80.1 (+/-2.4%) 6.8 (+/-1.4%) 13.1 (+/-2.0%)
Washington 79.9 (+/-1.7%) 6.6 (+/-1.0%) 13.5 (+/-1.4%)
West Virginia 71.3 (+/-2.4%) 8.8 (+/-1.3%) 19.9 (+/-2.1%)
Wisconsin 86.4 (+/-2.1%) 4.3 (+/-1.2%) 9.3 (+/-1.8%)
Wyoming 73.7 (+/-2.2%) 7.3 (+/-1.2%) 19.0 (+/-2.0%)
Median 79.2 6.6 14.0
Range 67.8-87.9 4.3-9.0 6.8-24.6
---------------------------------------------------------------------------------------
* Confidence interval.
=========================================================================================
Return to top. Figure_1  Return to top. Table_2 Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.
TABLE 2. Percentage of persons aged 18-64 years employed for wages who were
adequately insured, underinsured, or uninsured, by state -- United States, Behavioral
Risk Factor Surveillance System, 1995
=========================================================================================
Adequately insured Underinsured Uninsured
------------------ ---------------- ----------------
State % (95% CI*) % (95% CI) % (95% CI)
---------------------------------------------------------------------------------------
Alabama 81.5 (+/-2.8%) 6.8 (+/-1.7%) 11.7 (+/-2.4%)
Alaska 79.4 (+/-3.9%) 8.1 (+/-2.5%) 12.6 (+/-3.3%)
Arizona 80.1 (+/-3.4%) 5.4 (+/-2.0%) 14.5 (+/-3.1%)
Arkansas 78.5 (+/-3.0%) 7.7 (+/-1.9%) 13.7 (+/-2.5%)
California 74.7 (+/-3.0%) 6.5 (+/-1.5%) 18.8 (+/-2.8%)
Colorado 82.0 (+/-2.8%) 4.4 (+/-1.3%) 13.7 (+/-2.5%)
Connecticut 87.2 (+/-2.5%) 5.3 (+/-1.7%) 7.5 (+/-2.0%)
Delaware 83.7 (+/-2.5%) 5.3 (+/-1.5%) 10.9 (+/-2.2%)
Florida 76.2 (+/-2.6%) 7.5 (+/-1.4%) 16.3 (+/-2.3%)
Georgia 83.4 (+/-2.2%) 8.4 (+/-1.6%) 8.2 (+/-1.7%)
Hawaii 92.1 (+/-2.0%) 4.3 (+/-1.6%) 3.5 (+/-1.3%)
Idaho 79.1 (+/-2.4%) 7.2 (+/-1.5%) 13.6 (+/-2.0%)
Illinois 83.8 (+/-2.2%) 5.4 (+/-1.2%) 10.8 (+/-1.9%)
Indiana 85.1 (+/-2.1%) 5.8 (+/-1.3%) 9.1 (+/-1.8%)
Iowa 86.0 (+/-1.8%) 4.4 (+/-1.0%) 9.6 (+/-1.5%)
Kansas 82.7 (+/-2.4%) 6.1 (+/-1.5%) 11.2 (+/-2.1%)
Kentucky 81.9 (+/-2.6%) 7.5 (+/-1.7%) 10.7 (+/-2.1%)
Louisiana 72.0 (+/-3.6%) 7.1 (+/-2.0%) 21.0 (+/-3.2%)
Maine 83.1 (+/-3.3%) 3.2 (+/-1.4%) 13.7 (+/-3.1%)
Maryland 87.1 (+/-1.4%) 5.1 (+/-0.9%) 7.8 (+/-1.2%)
Massachusett 85.0 (+/-2.6%) 4.8 (+/-1.6%) 10.3 (+/-2.2%)
Michigan 86.5 (+/-2.0%) 5.4 (+/-1.3%) 8.1 (+/-1.7%)
Minnesota 86.8 (+/-1.6%) 5.4 (+/-1.0%) 7.8 (+/-1.3%)
Mississippi 81.3 (+/-3.0%) 7.7 (+/-2.0%) 11.0 (+/-2.5%)
Missouri 77.4 (+/-3.4%) 6.4 (+/-1.8%) 16.1 (+/-3.1%)
Montana 76.9 (+/-3.9%) 7.1 (+/-2.2%) 16.0 (+/-3.5%)
Nebraska 85.8 (+/-2.6%) 5.6 (+/-1.6%) 8.7 (+/-2.1%)
Nevada 85.0 (+/-2.6%) 6.0 (+/-1.7%) 9.0 (+/-2.1%)
New Hampshire 83.4 (+/-3.0%) 6.0 (+/-1.8%) 10.6 (+/-2.5%)
New Jersey 87.0 (+/-3.2%) 6.7 (+/-2.2%) 6.4 (+/-2.5%)
New Mexico 76.1 (+/-3.8%) 7.0 (+/-2.0%) 17.0 (+/-3.6%)
New York 85.4 (+/-2.2%) 5.5 (+/-1.4%) 9.1 (+/-1.8%)
North Carolina 80.2 (+/-2.2%) 7.7 (+/-1.4%) 12.0 (+/-1.8%)
North Dakota 85.1 (+/-2.5%) 3.5 (+/-1.2%) 11.4 (+/-2.3%)
Ohio 81.9 (+/-3.4%) 5.8 (+/-2.0%) 12.3 (+/-3.1%)
Oklahoma 79.7 (+/-3.2%) 4.7 (+/-1.6%) 15.6 (+/-3.0%)
Oregon 80.0 (+/-2.4%) 7.8 (+/-1.6%) 12.3 (+/-1.9%)
Pennsylvania 86.5 (+/-1.9%) 4.7 (+/-1.1%) 8.8 (+/-1.6%)
Rhode Island 84.3 (+/-2.8%) 5.9 (+/-1.7%) 9.7 (+/-2.4%)
South Carolina 80.1 (+/-2.8%) 8.5 (+/-1.8%) 11.5 (+/-2.3%)
South Dakota 84.3 (+/-2.6%) 6.1 (+/-1.6%) 9.6 (+/-2.1%)
Tennessee 83.2 (+/-2.6%) 6.4 (+/-1.6%) 10.5 (+/-2.2%)
Texas 78.5 (+/-3.2%) 7.5 (+/-2.0%) 14.0 (+/-2.7%)
Utah 83.4 (+/-2.5%) 6.2 (+/-1.6%) 10.4 (+/-2.1%)
Vermont 81.2 (+/-2.5%) 5.6 (+/-1.4%) 13.2 (+/-2.2%)
Virginia 81.8 (+/-2.8%) 6.6 (+/-1.7%) 11.5 (+/-2.3%)
Washington 84.4 (+/-1.9%) 5.9 (+/-1.2%) 9.7 (+/-1.6%)
West Virginia 75.2 (+/-2.9%) 8.8 (+/-1.8%) 16.1 (+/-2.5%)
Wisconsin 88.4 (+/-2.4%) 3.8 (+/-1.3%) 7.8 (+/-2.1%)
Wyoming 77.9 (+/-2.7%) 7.0 (+/-1.5%) 15.1 (+/-1.2%)
Median 81.2 6.1 11.2
Range 72.0-92.1 3.2-8.5 3.6-21.0
---------------------------------------------------------------------------------------
* Confidence interval.
=========================================================================================
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