Health Care Facts:

Health Insurance Coverage

Most Americans have health insurance through their employers, yet employment is no longer a guarantee of
health insurance coverage. As America continues to move from a manufacturing-based economy to a
service economy, and employee
working patterns continue to Health Insurance Coverage of Workers, by
evolve, health insurance coverage
has become less stable. The Firm Size, 2007
service sector offers less access to 100%
health insurance than its 90% 87%

manufacturing counterparts. 80% 76% 78% 78%

68%
70%
Due to rising health insurance 60%
52%
premiums, many small employers 50% 47%

cannot afford to offer health 40%

32%
benefits. Companies that do offer 30% 27%
20% 21%
health insurance, often require 20% 16%
8% 13% 13%
employees to contribute a larger 10% 6% 8% 5%6% 5% 6% 6% 4%6%
4% 4% 3%
share toward their coverage. As a 2%
0%
result, an increasing number of Self- <25 Workers 25-99 100-499 500-999 1000 or More Public Sector
Employed Workers Workers Workers Workers
Americans have opted not to take
Source: Chart taken from Kaiser Family Foundation at www.kff.org: Employer
advantage of job-based health Kaiser Commission on Medicaid and the Uninsured and Urban Institute Individual
insurance because they cannot analysis of the 2008 ASEC Supplement to the Current Population Survey.
Medicaid/Other Public
afford it. Uninsured

HOW MANY AMERICANS ARE UNINSURED?

•
Several studies estimate the number of uninsured Americans. According to the U.S. Census Bureau, nearly
47 million Americans, or 20 percent of the population under the age of 65, were without health insurance
in 2008, their latest data available.1
• The Agency for Healthcare Research and Quality, using the Medical Expenditure Panel Survey (MEPS)
estimated that the percentage of uninsured Americans under age 65 represented 27 percent of the
population. According to the MEPS data, nearly 54 million Americans under the age of 65 were uninsured
in the first-half of 2007. 2
• A recent study shows that based on the effects of the recession alone (not job loss), it is projected that
nearly seven (7) million Americans will lose their health insurance coverage between 2008 and 2010. 3
Urban Institute researchers estimate that if unemployment reaches 10 percent, another six (6) million
Americans will lose their health insurance coverage. Taking these numbers together, it is conceivable that
by next year, 57 to 60 million Americans will be uninsured.
• The Urban Institute estimates that under a worse case scenario, 66 million Americans will be uninsured
by 2019. 4
• Nearly 90 million people – about one-third of the population below the age of 65 spent a portion of either
2007 or 2008 without health coverage.5

National Coalition on Health Care September 2009

 WHO ARE THE UNINSURED?
•
The large majority of the uninsured (85 percent) are native or naturalized citizens.6
• Nearly 1.1 million part-time workers lost their health insurance in 2008. 1
• Over 8 in 10 uninsured people come from working families – almost 70 percent from families with one or 7
• The percentage and the number of uninsured Hispanics was 31 percent and nearly 15 million in 2008.1

WHY IS THE NUMBER OF UNINSURED PEOPLE INCREASING?

• Even if employees are offered coverage on the job, they can’t always afford their portion of the premium.
Health insurance premiums have increased 131 percent for employers since 1999 and employee spending
for health insurance coverage (employee’s share of family coverage) has increased 128 percent between
1999 and 2008.7
•
Rapidly rising health insurance premiums are the main reason cited by all small firms for not offering
coverage. Health insurance premiums are rising at extraordinary rates. The average annual increase in
inflation has been 2.5 percent while health insurance premiums for small firms have escalated an average of
12 percent annually.7

HOW DOES BEING UNINSURED HARM INDIVIDUALS AND FAMILIES?

• Studies estimate that the number of excess deaths among uninsured adults age 25-64 is in the range of
22,000 a year. This mortality figure is more than the number of deaths from diabetes (17,500) within the
same age group.8
• Lack of insurance compromises the health of the uninsured because they receive less preventive care, they
are diagnosed at more advanced disease stages, and once diagnosed, tend to receive less therapeutic care
and have higher mortality rates than insured individuals.9
• Controlling for age, race, sex, and income, uninsured cancer patients are 1.6 times more likely than insured
patients to die within five years of diagnosis. 10
• The high cost of health care can damage the overall economic well-being of families. One in three low-
income parents without coverage report medical bills have a major financial impact on their families.11
• On average, the uninsured are 9 to 10 times more likely to forgo medical care because of cost and twice as
likely to have medical debt. 9
• The uninsured are increasingly paying “up front” -- before services will be rendered. When they are unable to
pay the full medical bill in cash at the time of service, they can be turned away except in life-threatening
circumstances.12
• Access to an emergency room for uninsured patients does not qualify as access to coordinated care. While
physicians are required to stabilize patients in an emergency, they are not required to treat the condition
comprehensively. 13
• Over the last decade, disparities between the uninsured and insured widened in access to a usual source of
care, annual check-ups, and preventive care, and are the greatest in disparities and our growing. 6
This fact sheet was research and prepared by Joel Miller and Julie Bromberg.

National Coalition on Health Care September 2009

 References
1. DeNavas-Walt, C.B. Proctor, and J. Smith. Income, Poverty, and Health Insurance Coverage in the United States: 2008. U.S.
Census Bureau., September 2009.
2. Chu, M. C. and J. Rhoades, The Uninsured in America, 1996-2007: Estimates for the the U.S. Civilian Noninstitutionalized
Population Under Age 65, Medical Expenditure Panel Survey, AHRQ, Statistical Brief #214, July 2008.
3. Gilmer, T. P. and R. G. Kronick, Hard Times And Health Insurance: How Many Americans Will Be Uninsured By 2010?,
Health Affairs Web Exclusive, May 28, 2009.
4. Holahan, J., et. al, Health Reform – The Cost of Failure. Robert Wood Johnson Foundation and the Urban Institute, May 21,
2009.
5. Families USA. Americans at Risk: One in Three Uninsured, Familes USA, March 2009.
6. The Henry J. Kaiser Family Foundation. The Uninsured: A Primer, Key Facts About Americans without Health Insurance.
April 2009.
7. The Henry J. Kaiser Family Foundation. Employee Health Benefits: 2009 Annual Survey. September 2009.
http://www.kff.org/pdf/2009/7936.pdf
8. Dorn, S, “Uninsured and Dying Because of It: Updating the Institute of Medicine Analysis on the Impact of Uninsurance on
Mortality,” Urban Institute, 2008.
9. National Center for Health Statistics. “Health, United States, 2007: with Chartbook on Trends in the Health of Americans,”
2007; Center for American Progress, The Case for Health Reform, February 2009.
10. Ward, E. , et all., “Association of Insurance with Cancer Care Utlization and Outcomes,” CA: A Cancer Journal for
Clinicians (58), 2008.
11. Schwartz, K., Spotlight on Uninsured Parents: How Lack of Coverage Affects Parents and Their Families, Kaiser
Commission on Medicaid and the Uninsured , 2008.
12. Anderson, G., “From ‘Soak the Rich’ to ‘Soak the Poor’: Recent Trends in Hospital Pricing,” Health Affairs (26) 2007.
13. Emergency Medical Treatment and Active Labor Act, 42 U.S.C. 1395dd, www.emtala.com.

National Coalition on Health Care September 2009