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 1997 Current Population Survey (CPS) and reflects children’s insurance status during calendar year 1996. 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 and Laura Brice 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 authors thank Adele Kirk and Ellie Dehoney for an earlier version used as a model for this one.
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 1997 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:
Key findings include:
- 10.6 million children, 15% of the population under age 18, are uninsured. In the March 1996 survey only 9.8 million children (14%) were uninsured.
- 44 million children (62%) are covered under employer-sponsored insurance. This is consistent with the proportion of individuals in the overall population who are insured through an employer.
Percent of All Persons
Persons with more than one insurance type are represented more than once.
Source: ASPE tabulations of the March 1997 Current Population Survey
Millions of Persons
Persons with more than one insurance type are represented more than once.
Source: ASPE tabulations of the March 1997 Current Population Survey
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 (62%) of the 10.6 million uninsured children, but 45.4 million (75%) of insured children, lived with at least one adult who worked full-time throughout the previous year.
- 1.6 million (15%) of uninsured children, but 1.9 million (3%) 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 3.8 million (6%) of insured children, lived with a family adult who worked part-time either for a portion or throughout the previous year.
- 1.4 million (13%) of uninsured children, but 6 million (10%) of insured children lived with a family adult who had no employment or did not live with an adult during the previous year.
- 87% 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 considerably less likely to be uninsured than those with no adult workers (17% vs 45%); only 12% of children with two working adults in the household were uninsured.
Distribution of Uninsured and Insured Children by Family Adult's Work History
The family adult is the family head or spouse with the most complete work history.
Source: ASPE tabulations of the March 1997 Current Population Survey
Uninsured Children by Family Adult's Work History in 1996
The family adult is the family head or spouse with the most complete work history.
Source: ASPE tabulations of the March 1997 Current Population Survey
Percentage of Children Uninsured by Adult Workers in the Family
Source: ASPE tabulations of the March 1997 Current Population Survey
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 1996, 100% of FPL is approximately $16,000. 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 19% of insured children.
- Similarly, 36% of uninsured children below age 18 are in families with income between 100 and 199% of poverty, compared to 20% of insured children.
- Above 199% of poverty, the distributions switch: uninsured children are under-represented in the higher incomes. For example, 16% of insured children live in families with income over 500% of poverty, but only 4% 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: 24% of children from families with incomes less than 100% of poverty are uninsured, while only 4% of children with family incomes greater than 500% of poverty are uninsured.
- However, uninsurance is not just a problem among poor children: more than one-fourth of uninsured children (30%) live in families with incomes at or above 200% of poverty (about $32,000 for a family of four).
Distribution of Uninsured and Insured Children by Family Income Class
Source: ASPE tabulations of the March 1997 Current Population Survey
Percentage of Children Uninsured by Family Income Class
Source: ASPE tabulations of the March 1997 Current Population Survey
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 68% 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 12% 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 20% 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.
Distribution of Uninsured and Insured Children by Race/National Origin
Hispanics of any race are counted as Hispanic.
Source: ASPE tabulations of the March 1997 Current Population Survey
Percentage of Children Uninsured by Race/National Origin
Hispanics of any race are counted as Hispanic.
Source: ASPE tabulations of the March 1997 Current Population Survey
Lack of Insurance and Self-Reported Health Status
As the following two charts show, uninsured children differ from insured children in their self-reported health status:
- Uninsured children are less likely than insured children to report excellent or very good health status: 80% of insured children report excellent or very good health status, compared to 72% of the uninsured children under 18.
- More than half of insured children under 18 report their health as excellent, while only 41% of uninsured children under 18 do so.
Distribution of Uninsured and Insured Children by Self-Reported Health Status
Source: ASPE tabulations of the March 1997 Current Population Survey
Percentage of Children Uninsured by Self-Reported Health Status
Source: ASPE tabulations of the March 1997 Current Population Survey
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. 12% of uninsured children live in households run by a non-parent relative or an unrelated adult, compared to 3% 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.
Distribution of Uninsured and Insured Children by Relationship to Family Head
Source: ASPE tabulations of the March 1997 Current Population Survey
Percentage of Children Uninsured by Relationship to Family Head
Source: ASPE tabulations of the March 1997 Current Population Survey
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.
Distribution of Uninsured Children by Presence of Private Insurance in the Family
Source: ASPE tabulations of the March 1997 Current Population Survey
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 10% 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 45% of non-citizen children are uninsured.
Distribution of Uninsured and Insured Children by Country of Citizenship
Source: ASPE tabulations of the March 1997 Current Population Survey
Percentage of Children Uninsured by Country of Citizenship
Source: ASPE tabulations of the March 1997 Current Population Survey
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 9% of those in the Midwest are uninsured, while 18% of those in the South and 17% of those in the West lack insurance.
Distribution of Uninsured and Insured Children by Census Region
Source: ASPE tabulations of the March 1997 Current Population Survey
Percentage of Children Uninsured by Census Region
Source: ASPE tabulations of the March 1997 Current Population Survey
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.
Distribution of Uninsured and Insured Children by Age Class
Source: ASPE tabulations of the March 1997 Current Population Survey
Percentage of Children Uninsured by Age Class
Source: ASPE tabulations of the March 1997 Current Population Survey
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.
- 40% of uninsured children have family adults employed by firms of less than 25 employees, in contrast to only one-fourth 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 36% 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. 23% of children whose family adults work for firms with less than 25 employees are uninsured, compared to only 9% of children whose family adults work for firms with greater than 1,000 employees.
Distribution of Uninsured and Insured Children by Family Adult's Firm Size
Percentage of Children Uninsured by Family Adult's Firm Size
