Chartbook on Children's Health Insurance, 1998

12/01/1998

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Table of Contents

Preface Page 1Health Insurance Coverage by Coverage Category Page 2Health Insurance Coverage - Percent of All Persons Page 3Health Insurance Coverage - Millions of Persons Page 4Uninsured Children by Adult's Work Last Year Page 5Distribution of Uninsured and Insured Children by Family Adult's Work History Page 6Distribution of Uninsured and Insured Children by Family Adult's Work History Page 7Percentage of Children Uninsured by Adult Workers in the Family Page 8Uninsured Children by Income Class Page 9Distribution of Uninsured and Insured Children by Family Income Class Page 10Percentage of Children Uninsured by Family Income Class Page 11Uninsured Children by Race/National Origin Page 12Distribution of Uninsured and Insured Children by Race/National Origin Page 13Percentage of Children Uninsured by Race/National Origin Page 14Family Structure Page 15

Distribution of Uninsured and Insured Children by Relationship to Family Head Page 16Percentage of Children Uninsured by Relationship to Family Head Page 17Presence of Private Insurance in the Family Page 18Distribution of Uninsured Children by Presence of Private Insurance in the Family Page 19Insurance Status by Country of Citizenship Page 20Distribution of Uninsured and Insured Children by Country of Citizenship Page 21Percentage of Children Uninsured by Country of Citizenship Page 22Insurance Status by Census Region Page 23Distribution of Uninsured and Insured Children by Census Region Page 24Percentage of Children Uninsured by Census Region Page 25Insurance Status by Age Class Page 26Distribution of Uninsured and Insured Children by Age Class Page 27Percentage of Children Uninsured by Age Class Page 28Insurance Status by Family Adult's Firm Size Page 29Distribution of Uninsured and Insured Children by Family Adult's Firm Size Page 30Percentage of Children Uninsured by Family Adult's Firm Size Page 31

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Preface

This chartbook examines demographic and other characteristics of insured and uninsured children in the U.S. It is based on data from the March 1998 Current Population Survey CPS and reflects childrens insurance status during calendar year 1997. For the purposes of this chartbook, the term children applies to all U.S. citizens and non-citizen residents under age 18. This definition is consistent with that used by other data sources. This chartbook was prepared by Gene Moyer from the Office of the Assistant Secretary for Planning and Evaluation ASPE, Office of Health Policy. For further information, contact Gene Moyer at 202/690-7861. The author thanks Adele Kirk, Ellie Dehoney, and Laura Brice for earlier versions used as a model for this one.

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Health Insurance Coverage by Coverage Category

Each March the Current Population Survey asks about the health insurance status of each person in the household during the previous year. The March 1998 results are presented in the following two charts, each contrasting uninsured children under age 18 with the U.S. population as a whole. The first chart indicates the percentage of children and the percentage of the U.S. population having a particular source of health insurance; the second indicates the number of people having a particular source of health insurance in millions. Note that persons with more than one insurance type are represented more than once. Results are summarized in the table below:

Type of Coverage Children Population
Employer-Sponsored Insurance ESI 44.9 63% 165.1 61%
Other Private Insurance 3.1 4% 23.4 9%
Medicaid 14.7 21% 29.0 11%
Medicare 0.4 1% 35.6 13%
VA, Military, Other 2.2 3% 8.5 3%
Uninsured 10.7 15% 43.4 16%

Key findings include:

10.7 million children, 15% of the population under age 18, are uninsured. In the March 1997 survey 10.6 million children 15% were uninsured.

45 million children 63% are covered under employer-sponsored insurance. This is consistent with the proportion of individuals in the overall population who are insured through an employer.

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Uninsured Children by Adult's Work Last Year

The following three charts show the relationship between uninsured children and adult work history in a child's household. The first two charts show the number and percentage distribution of uninsured children by the family adult's work status the previous year. The "Family Adult" is the adult of the household with the most complete work history during the previous year. This person is not necessarily the parent of the child. About 13% of uninsured children have no parent in the household. The third chart shows coverage status by the number of working adults in the family none, one, or two working adults.

6.5 million children 61% of the 10.7 million uninsured children, but 46.3 million 76% of insured children, lived with at least one adult who worked full-time throughout the previous year.

1.5 million 14% of uninsured children, but 5.1 million 8% of insured children, lived with a family adult who worked full-time for a portion of the year.

1.1 million 10% of uninsured children, but 3.9 million 6% of insured children, lived with a family adult who worked part-time either for a portion or throughout the previous year.

1.6 million 15% of uninsured children, but 5.6 million 9% of insured children lived with a family adult who had no employment or did not live with an adult during the previous year.

85% of uninsured children and 90% of insured children lived with at least one adult with some full or part-time work in the past year.

Children with one adult worker in the household were somewhat less likely to be uninsured than those with no adult workers 19% vs 22%; only 10% of children with two working adults in the household were uninsured.

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Uninsured Children by Income Class

The following charts examine the relationship between children's insurance status and family income in the previous year. Family income is shown as a percentage of the federal poverty level FPL. For example, "<100%" means less than 100% of the FPL, while "500%+" means five or more times the FPL. For a family of four in 1997, 100% of FPL is approximately $16,400. The first chart compares the distribution of uninsured children to that of insured children in terms of family income status. The second chart shows the percentage of children in each income group who are uninsured.

34% of uninsured children below age 18 are in families with income below the federal poverty level, compared to 18% of insured children.

Similarly, 34% of uninsured children below age 18 are in families with income between 100 and 199% of poverty, compared to 19% of insured children.

Above 199% of poverty, the distributions switch: uninsured children are under-represented in the higher incomes. For example, 17% of insured children live in families with income over 500% of poverty, but only 6% of uninsured children come from families with income above 500% of poverty.

Lower income children are considerably more likely to be uninsured than those from higher-income families: 25% of children from families with incomes less than 100% of poverty are uninsured, while only 6% of children with family incomes greater than 500% of poverty are uninsured.

However, uninsurance is not just a problem among poor children: almost a third of uninsured children 32% live in families with incomes at or above 200% of poverty about $32,800 for a family of four.

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Uninsured Children by Race/National Origin

The following two charts show the relationship between coverage status and race or national origin Hispanics of any race are counted as Hispanics. The first chart compares a given race's representation in the insured and uninsured populations. The second chart shows the percentages of children in each race/national origin who are uninsured.

Although white children comprise 67% of the insured population under 18 years, they are less than half 46% of the uninsured population under 18.

Hispanics, on the other hand, comprise a disproportionate share of uninsured children: Hispanic children comprise 13% of insured children, but 29% of the uninsured.

African-American children are also over-represented among uninsured children, although not to as great a degree as Hispanics: they represent 15% of insured children, but 19% of the uninsured.

Over 1/4 29% of all Hispanic children are uninsured, compared with 19% of all African-American non-Hispanic children and 11% of all white non-Hispanic children.

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Family Structure

The next two charts illuminate differences in family structure among families with uninsured children and those with insured children. Both charts focus on the relationship between children and the head of household; i.e., is the household head the child's parent, another relative, or unrelated to the child? The first chart shows the prevalence of each type of family structure among uninsured children relative to insured children. The second chart shows the percentage of children with a given relationship to the head of household who are uninsured; it demonstrates the dramatic differences among different family structures in rates of uninsurance.

Compared to insured children, uninsured children are less likely to be part of families in which one of their parents is the household head. 21% of uninsured children live in households run by a non-parent relative or an unrelated adult, compared to 7% of insured children.

Children living with a parent who is the household head are at lowest risk of being uninsured: 13% of such children are uninsured.

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Presence of Private Insurance in the Family

The following chart shows the distribution of uninsured children by the presence of private insurance in the family. The vast majority of uninsured children 75% live with a parent or spouse who has no private insurance, while 25% have a privately insured parent or spouse.

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Insurance Status by Country of Citizenship

These charts compare the coverage status of children who are U.S. citizens and those who are non-citizen residents.

The first chart indicates that non-U.S. citizens are over-represented in the uninsured population relative to their numbers in the insured population. Non-citizens comprise 2% of insured children, but they account for 9% of the uninsured population.

The second chart compares the coverage rates of citizen and non-citizen children. Although they comprise a small proportion of the uninsured population, non-citizen children are at a higher risk of being uninsured: 14% of U.S. citizen children are uninsured, while 43% of non-citizen children are uninsured.

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Insurance Status by Census Region

As the following two charts show, uninsured children are not evenly distributed among geographic census regions. The first chart compares the relative proportions of uninsured children and insured children in each census region: the first bar shows the proportion of uninsured children living in a given region, while the second bar shows the proportion of insured children living in that same region. The second chart shows the percentages of children within each region who are uninsured.

The South and West regions are home to a disproportionate percentage of uninsured children under 18: 56% of insured children reside in the South or West, but 70% of uninsured children live in these regions.

43% of all uninsured children reside in the South, while only a third 33% of insured children live there.

Although 15% of children nationwide are uninsured, only 10% of those in the Midwest are uninsured, while 19% of those in the South and 17% of those in the West lack insurance.

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Insurance Status by Age Class

The following two charts show the differences in coverage status among children of different age groups. The first chart compares the distribution of uninsured children among different age groups with the distribution of insured children. The second chart shows the percentages of children in each age group who are uninsured.

The distribution of uninsured children among age groups is close to that of the distribution of insured children, and levels of uninsurance remain fairly constant among different ages through age 17.

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Insurance Status by Family Adult's Firm Size

The following two charts show the insurance status of children by size of firm at which the family adult is employed. The first chart compares the distribution of the uninsured children across firm sizes, while the second chart shows the percentage of children who are uninsured among each firm size at which the family adults are employed.

54% of uninsured children have no family adult or have family adults employed by firms of less than 25 employees, in contrast to only 31% of insured children. For firms employing greater than 1,000 people, the opposite is seen: 20% of uninsured children have family adults employed by firms of this size, while 39% of insured children do.

The chance of a child being uninsured is inversely related to the size of the firm in which his or her family adult is employed. 24% of children whose family adults work for firms with less than 10 employees are uninsured, compared to only 8% of children whose family adults work for firms with greater than 1,000 employees.

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