Four-Tenths of US Population Went Uninsured From 1996-99

November 12, 2003 ( - Nearly four out of 10 (38%) Americans under age 65, and 68% of those with low incomes, had no health insurance at some point during 1996-1999.

Overall, the number of people with a time uninsured during these four years – 85 million – is more than double the number who were uninsured at any one point in time or any one year during 1996 to 1999. Further, 54% of those uninsured during the four-year period lacked coverage for 13 months or more and n early 30 million people were uninsured for more than two years, according to the “Churn, Churn, Churn: How Instability of Health Insurance Shapes America’s Uninsured Problem” report by The Commonwealth Fund.

These high rates of non-coverage and instability of health coverage disproportionately affect low-income Americans, minorities, and young adults. Two-thirds (68%) of low-income adults – those living under 200% of the poverty level – and children, 61% of Hispanics, and half of African Americans and young adults had a time without health coverage during the four years.

Contributing to this problem was insurance “churning,” participants cycling on and off coverage. Overall, this practice added an average of two million people to the insurance rolls each month during the study period. One-third of Americans with any time uninsured (28 million people) were repeatedly uninsured as they moved in and out of public or private coverage. In fact, two-thirds of those leaving Medicaid or other public insurance programs became uninsured. To The Commonwealth Fund, this is an indication that these programs need to be improved to ensure continuity of coverage and protection for the low-income families they serve.

“These high rates of uninsured indicate that far greater numbers of Americans are at risk of going without needed health care, having difficulties paying medical bills, and experiencing financial stress than we see in any annual survey,” said Cathy Schoen, vice president at The Commonwealth Fund. “Insurance churning disrupts and undermines efforts to provide timely medical care and likely raises public and private health insurance costs due to frequent cycling on and off coverage.”

Particularly unstable as a source of coverage is Medicaid and transitions off Medicaid usually resulted in a time uninsured. Two-thirds (65%) of those who lost Medicaid coverage during the four years became uninsured. Further, a large proportion (40%) of those ever on Medicaid lost coverage and then reenrolled later, in a repeated pattern of cycling in and out of public coverage.

More information and a copy of the full report are available at .