Insurance Gap Touches One in Three Americans

March 11, 2003 ( - Approximately one in three Americans, or 74.7 million people under the age of 65, were without health insurance at some point in 2001 and 2002.

Those experiencing a gap in health insurance coverage represent 30.1% of the entire United States population with almost two-thirds being uncovered for a period of longer than six months.   The number grows even larger in 10 states, with more than one out of three people going without health insurance, according to a report by the Robert Wood Johnson (RWJ) Foundation.

Overall, the 10 states with the largest percentage of the under-65 population that spent part of the period without health insurance coverage were:

 Texas 39.9%
 New Mexico 38.6%
 Louisiana 36.0%
 California 35.5%
 Mississippi 34.9%
 Arizona 34.7%
 Arkansas 34.0%
 Florida 33.8%
 Oklahoma 33.7%
 North Carolina 32.5%

The findings confirm an earlier report by United Health that found overall the state with the highest percentage of its population being uninsured is Texas’ 23.5% (See  New Hampshire Again The Healthiest State ).  In fact, at least one state, California, is taking steps to correct its problem of a high percentage of uninsured.   Recently, Blue Shield of California proposed a plan to provide universal healthcare coverage for California residents.   The proposal, “Universal Coverage, Universal Responsibility,” builds on the current employer-based system and calls for employers not currently purchasing coverage to join the system (See  Universal Healthcare in California Proposed ). 

Representing the other end of the coverage spectrum was the Ocean State, coming in with only 20.9% of the observed population experiencing a gap in insurance coverage at some point between 2001 and 2002. Rhode Island was then followed by Minnesota (21.1%), South Dakota (21.7%), Iowa (22.1%), and Delaware (22.1%) rounding out the top five.

Contributing to this wide range in statewide coverage levels are factors that include:

  • jobs that offer health coverage
  • categories of people covered by a particular state’s Medicaid program
  • state demographics
  • state economies
  • income of state residents
  • presence of state COBRA-like health continuation laws.

The largest segment of the population (24.9%) devoid of coverage went without for three to five months. Likewise, 10% experienced a gap for two months or less, 12.5% were without insurance for six to eight months, 9.8% saw no coverage for nine to 12 months, 18.7% were lacking coverage for 13 to 23 months, and almost a quarter of the surveyed population (24%) were without coverage for the full two years.

Population Profile

Fifty-four million of the 74.7 million without insurance for some period between 2001 and 2002 were uninsured adults. The likelihood of being without coverage dropped among adults as they grew older, with almost half (49.6%) of adults, aged 18 to 24 lacking coverage. However, among adults ages 55 to 64, 20.8% were without coverage for some length of time during the same time span. Children fell in between with 27.9% of those up to age 17 without coverage at some point during 2001-2002.

Men made up slightly more than half (51.2%) of the uninsured.   Of all non-elderly men and boys, 30.9% went without health insurance for all or part of the two-year period.   Comparatively, the same group of females reported only 29.3% without health insurance.

Further, approximately four out of five individuals (77.9%) who went without health insurance were connected to the workforce in December 2002:   70.7% were employed and 7.2% were actively seeking employment.   The remaining 22.1% who were uninsured for some period of time were not in the labor force due to a variety of reasons ranging from disability to not actively seeking employment.

More than half (56.1%) of individuals in families with incomes at or below 100% of the federal poverty level were uninsured ($8,860 a year for a single adult and $15,020 a year for a family of three, according to RWJ).   The likelihood of being uninsured moved inversely to income levels, but a full 16.5% of the population with incomes four times the poverty level still experienced periods of a lack of coverage.

Among racial and ethnic groups, people of a White, non-Hispanic background made up the majority (52.0%) of people under age 65 without health insurance for all or part of the time frame. However, Hispanics and African-Americans were much more likely to be uninsured compared to white, non-Hispanics.   The percentage of the racial group uninsured revealed these breakdowns:

  • Hispanics – 52.2%
  • African-American – 39.3%
  • Other – 33.8%
  • Whites – 23.3%

The report, “Going Without Health Insurance: Nearly One in Three Non-Elderly Americans,” is at