Who Are the Uninsured?

Data from the U.S. Census Bureau—the most widely used source of statistics on the uninsured—show an increase in the uninsured rate to 46.6 million people in 2005 – 15.9 percent of the population – from 45.3 million people in 2004. This increase can largely be attributed to the continued erosion of employer-sponsored insurance, largely driven by the rising costs of providing health benefits. The likelihood of being covered by health insurance rises with income.

There is wide variation in rates of uninsurance across the states, ranging from approximately 25 percent of those under age 65 to 8.7 percent. The Census Bureau also provides a state-by-state breakdown of uninsurance rates¹.

Children

The number of children without health insurance increased from 7.9 million (10.8 percent) in 2004 to 8.3 million (11.2 percent) in 2005. Even though the percentage of children covered by employment-based insurance declined, the overall rate of uninsurance for children has decreased between 2000 and 2005².

While 2004 marked a higher rate of coverage for children, an additional 360,000 children became uninsured in 2005. This nearly reversed the previous gains in children's coverage that resulted from increased Medicaid and SCHIP enrollment in 2004³. Children in poverty—<200 percent of the federal poverty level (FPL)—were more likely to be uninsured than all children, with 19 percent uninsured in 2005.

Non-Elderly Adults

Eighty percent of the uninsured are adults. Non-elderly adults (ages 18–64) accounted for almost all of the growth in the number of uninsured from 2003 to 2004. Employment-based coverage has declined from covering 59.8 percent in 2004 to 59.5 percent in 2005. Although Medicaid has enrolled more adults over the last three years, the eligibility limits for adults in Medicaid are generally much lower than for children. Therefore, public coverage has not compensated for the loss of private coverage among adults.

More than 80 percent of the uninsured are either workers or live with workers. About 70 percent of the uninsured have at least one full-time worker in their family and another 12 percent have at least one part-time worker . However, the rates at which these workers are offered insurance vary significantly by firm size, industry type, and the average wage of the employee.

People with low incomes are disproportionately represented among the uninsured. Sixty-seven percent of the uninsured in 2005 were from families earning less than 200 percent of FPL (equivalent to less than $20,000 per year for a family of four.

Minorities are disproportionately represented among the uninsured. Of the 46.6 uninsured Americans, half are of a racial or ethnic minority. Hispanics have the largest percent of uninsured (34 percent) and the lowest percentage of people with employer coverage (40 percent)⁴.

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¹ Current Population Report, “ Income, Poverty, and Health Insurance coverage in the United States: 2005 ”, August 2006.

² Ibid.

³ AcademyHealth, State of the States 2007: Building Hope, Raising Expectations , January 2007.

⁴ Kaiser Family Foundation, “Key Facts: Race, Ethnicity, and Medical Care, 2007 Update”, February 2007.