A Portrait of the Uninsured

1. A Portrait of the Uninsured The Institute for Urban Family Health Susanne Callahan Kenya Lucas

2. Question #1 Which of the following statements is true? a. The number of Americans without health insurance has grown, even when the economy is strong. b. The uninsured represent about 15% percent of the population. c. Uninsured Americans come from every race, age, and ethnic group. d. All of the above.

3. Answer #1 Which of the following statements is true? a. The number of Americans without health insurance has grown, even when the economy is strong. b. The uninsured represent about 15 percent of the population. c. Uninsured Americans come from every race, age, and ethnic group. d. All of the above.

4. Explanation • More than 41 million Americans lack health insurance. • Of these, 8.5 million are children under age 18. • Over the past quarter century, the number of uninsured Americans has increased by about 1 million a year -- faster than the rate of the overall population growth.

5. Percentage Uninsured Among Adults Ages 18-64, by Age, 2001 Source: Employee Benefit Research Institute estimates from the March Current Population Survey, 2002 Supplement.

6. What does this mean for NYC?

7. Question #2 Who is most likely to be uninsured? People who: a. Earn low incomes. b. Have less education. c. Are Hispanic. d. Are 18 to 24 years old. e. All of the above.

8. Answer #2 Who is most likely to be uninsured? People who: a. Earn low incomes. b. Have less education. c. Are Hispanic. d. Are 18 to 24 years old. e. All of the above.

9. Explanation • Being poor doesn’t necessarily mean a person will be covered by Medicaid. • Most low-income workers work in businesses that don’t provide health coverage. • Having a college degree leads to higher paying jobs which often include health benefits. • Hispanics and blacks are more likely to lack health coverage than non-Hispanic whites.

10. Explanation “My patients are hard-working people who often hold not one but as many as three jobs to pay their bills, clothe their children, and put food on the table. Most of them earn just enough to be ineligible for Medicaid…They are forced to decide between paying rent and getting the health care they need.” Margaret Pereyda, physician

11. Question #3 Which of the following statements are true? a. African Americans are twice as likely as non-Hispanic whites to be without health insurance. b. Hispanics are three times as likely as whites to be without health insurance. c. All of the above. d. None of the above.

12. Answer #3 Which of the following statements are true? a. African Americans are twice as likely as non-Hispanic whites to be without health insurance. b. Hispanics are three times as likely as whites to be without health insurance. c. All of the above. d. None of the above.

13. Explanation • Lower rates of health coverage from jobs • Lower family incomes • No national health care coverage

14. What does this mean for NYC? % Publicly Insured by Race

15. What does this mean for NYC? % Uninsured by Race

16. Question #4 What proportion of adults and children without health insurance live in families in which someone works? a. 7 percent b. 20 percent c. 40 percent d. 80 percent

17. Answer #4 What proportion of adults and children without health insurance live in families in which someone works? a. 7 percent b. 20 percent c. 40 percent d. 80 percent

18. Explanation • More than 80 percent of uninsured children and adults under age 65 live in working families. • Even members of families with two full-time wage earners have a good chance of being uninsured.

19. Distribution of Uninsured Workers, Ages 18-64, by Work Status, 2001 Source: Employee Benefit Research Institute estimates from the March Current Population Survey, 2002 Supplement.

20. Explanation “It’s gotten to the point where some people are working just to get health insurance. I know someone who makes $9 an hour, and pays $8 an hour for childcare. They take home nothing, but the job comes with health coverage, so they keep it.” Joe Babbitt, physician

21. Question #5 What proportion of people without health insurance are members of lower income families? a. one-fourth b. one-half c. two-thirds d. three-fourths

22. Answer #5 What proportion of people without health insurance are members of lower income families? a. one-fourth b. one-half c. two-thirds d. three-fourths

23. Explanation • Two-thirds of all uninsured people are members of families earning less than 200 percent of the federal poverty level. • For a family of four, that means they earned less than $34,000 in 1999. • Many low-income families are ineligible for public health insurance such as Medicaid.

24. Percentage Uninsured Among the Nonelderly Population, by Family Poverty Status, 2001 Source: Employee Benefit Research Institute estimates from the March Current Population Survey, 2002 Supplement

25. Question #6 Immigrants account for which proportion of people without health insurance? a. 1 in 2 b. 1 in 3 c. 1 in 4 d. Fewer than 1 in 5

26. Answer #6 Immigrants account for which proportion of people without health insurance? a. 1 in 2 b. 1 in 3 c. 1 in 4 d. Fewer than 1 in 5

27. Explanation • Recently arrived immigrants -- those who have been in the country four years or less -- have a higher than average uninsured rate, but they comprise a relatively small proportion of the total population.

28. Question #7 What could cause you to lose your health insurance? a. You could lose your job and the employment-based insurance that came with it. b. You could get divorced and no longer be considered a dependent on your ex-spouse's coverage. c. Your insurance payment could be increased beyond the level you can afford. d. All of the above.

29. Answer #7 What could cause you to lose your health insurance? a. You could lose your job and the employment-based insurance that came with it. b. You could get divorced and no longer be considered a dependent on your ex-spouse's coverage. c. Your insurance payment could be increased beyond the level you can afford. d. All of the above.

30. Explanation • Many common life events can trigger a loss or gain of health insurance coverage. • The average time without coverage is 5 -6 months, but people with low income and less education are likely to be without coverage for even longer. • Changes in Medicaid or other public insurance programs can cause gaps in coverage

31. Question #8 How likely are people without health insurance to gain access to the health services they need? a. Very likely -- they have access to emergency medical care, public clinics, and other services. b. Significantly less likely than people with insurance-- they receive fewer preventive services (like pap smears and check-ups) and less care for chronic conditions (like diabetes and hypertension). c. Having health insurance makes little difference in the type of care people receive. d. None of the above.

32. Answer #8 How likely are people without health insurance to gain access to the health services they need? a. Very likely -- they have access to emergency medical care, public clinics, and other services. b. Significantly less likely than people with insurance-- they receive fewer preventive services (like pap smears and check-ups) and less care for chronic conditions (like diabetes and hypertension). c. Having health insurance makes little difference in the type of care people receive. d. None of the above.

33. Explanation • People without insurance are much less likely than people with insurance to get the health care they need – they receive fewer preventive services and less care for chronic conditions.

34. What does it mean for NYC?

35. Explanation One woman described trying to get help for her child who had become cross-eyed. “It wasn’t until I got a job and I had job insurance” that she was able to get a doctor to pay attention. “Just the way I was treated with that job coverage, as opposed to Medicaid. It felt really good. I felt like I had money!” Patient

36. Explanation “ If you ain’t got money, you just got to have patience cause places is overcrowded….You’ve got to have money. That’s the bottom line. You got to brace yourself to that.” Patient