Figure 1. Employers Provide Health Benefits to More than 160 Million Working Americans and Family Members

Source: S. R. Collins, C. White, and J. L. Kriss, Whither Employer-Based Health Insurance? The Current and Future Roleof U.S. Companies in the Provision and Financing of Health Insurance (New York: The Commonwealth Fund, Sept. 2007).Data: Current Population Survey, Mar. 2007.

Uninsured47.0

(16%) Employer 163.3(55%)

Numbers in millions, 2006

Medicaid27.9(9%)

Medicare39.1

(13%)

Total population = 296.7 Under-65 population = 260.7

Employer 160.8(62%)

Uninsured46.4

(18%)

Medicaid27.9

(11%)

Medicare6.4

(2%)

Military3.4

(1%)Military

3.4(1%)

Individual16.0(5%)

Individual15.8(6%)

Adults ages 19–64 with individual coverage or who thought about or tried to buyit in past three years who: Total

Health problem

No health

problem<200% poverty

200%+ poverty

Found it very difficult or impossible to find coverage they needed

34% 48% 24% 43% 29%

Found it very difficult or impossible to find affordable coverage

58 71 48 72 50

Were turned down or charged a higher price because of a pre-existing condition

21 33 12 26 18

Never bought a plan 89 92 86 93 86

Figure 2. Individual Market InsuranceIs Not an Affordable Option for Many People

Source: S. R. Collins, J. L. Kriss, K. Davis, M. M. Doty, and A. L. Holmgren, Squeezed: Why Rising Exposure to Health CareCosts Threatens the Health and Financial Well-Being of American Families (New York: The Commonwealth Fund, Sept. 2006).

Figure 3. People with Employer Insurance Have More Stable Coverage than Those with Individual Market Insurance

Source: K. Klein, S. A. Glied, and D. Ferry, Entrances and Exits: Health Insurance Churning, 1998–2000 (New York: The Commonwealth Fund, Sept. 2005). Data: Authors’ analysis of the 1998–2000 Medical Expenditure Panel Survey.

Employer insurance Individual insurance

Retained initial insurance status

One or more spells uninsured

Other transition

86%

12%

2%

53%

21%

26%

Retention of initial insurance over a two-year period, 1998–2000

Source: J. C. Cantor, C. Schoen, D. Belloff, S. K. H. How, and D. McCarthy, Aiming Higher: Results froma State Scorecard on Health System Performance (New York: The Commonwealth Fund, June 2007).Updated data: Two-year averages 1999–2000, updated with 2007 CPS correction, and 2005–2006 fromthe Census Bureau’s March 2000, 2001 and 2006, 2007 Current Population Surveys.

Figure 4. Percent of Uninsured Children DeclinedSince Implementation of SCHIP, But Gaps Remain

WA

ORID

MT ND

WY

NV

CAUT

AZ NM

KS

NE

MN

MO

WI

TX

IA

ILIN

AR

LA

AL

SCTN

NCKY

FL

VA

OH

MI

WV

PA

NY

AK

MD

MEVTNH

MARI

CT

DE

DC

HI

CO

GAMS

OK

NJ

SD

10%–15.9%

Less than 7%

7%–9.9%

16% or more

1999–2000

DE

MARI

WA

ORID

MT ND

WY

NVUT

KS

NE

MN

MO

WI

TX

IA

ILIN

LA

AL

SCTN

NCKY

FL

VA

OH

MI

WV

PA

NY

AK

ME

DC

HI

CO

GAMS

NJ

SD

2005–2006

CT

VTNH

MD

AR

CA

AZ NMOK

U.S. Average: 11.3%U.S. Average: 12.0%

Figure 5. Number of States with 23 Percent or MoreUninsured Nonelderly Adults Rose from 2 to 9 in Last Six Years

WA

ORID

MT ND

WY

NV

CAUT

AZ NM

KS

NE

MN

MO

WI

TX

IA

ILIN

AR

LA

AL

SCTN

NCKY

FL

VA

OH

MI

WV

PA

NY

AK

MD

MEVTNH

MARI

CT

DE

DC

HI

CO

GAMS

OK

NJ

SD

WA

ORID

MT ND

WY

NV

CAUT

AZ NM

KS

NE

MN

MO

WI

TX

IA

ILIN

AR

LA

AL

SCTN

NCKY

FL

VA

OH

MI

WV

PA

NY

AK

ME

DE

DC

HI

CO

GAMS

OK

NJ

SD

19%–22.9%

Less than 14%

14%–18.9%

23% or more

1999–2000 2005–2006

MA

RI

CT

VTNH

MD

U.S. Average: 20.1%U.S. Average: 17.3%

Source: J. C. Cantor, C. Schoen, D. Belloff, S. K. H. How, and D. McCarthy, Aiming Higher: Results froma State Scorecard on Health System Performance (New York: The Commonwealth Fund, June 2007).Updated data: Two-year averages 1999–2000, updated with 2007 CPS correction, and 2005–2006 fromthe Census Bureau’s March 2000, 2001 and 2006, 2007 Current Population Surveys.

Figure 6. The Majority of Uninsured AdultsAre in Working Families

Family work statusAdult work status

At least onefull-time worker67%

Onlypart-time worker(s)

11%

Full-time49%

Part-time15%

No worker in family

21%

Not currently employed

36%

Note: Percentages may not sum to 100% because of rounding.Source: S. R. Collins, K. Davis, M. M. Doty, J. L. Kriss, and A. L. Holmgren, Gaps in Health Insurance:An All-American Problem (New York: The Commonwealth Fund, Apr. 2006).

Adults ages 19–64 with any time uninsured

Figure 7. Employer-Provided Health Insurance,by Income Quintile, 2000–2006

88% 88% 87% 87% 87% 87% 86%

86% 85% 84% 84% 83% 82% 82%77% 77% 75% 74% 74% 72% 72%

62% 60%57% 55% 54% 54% 53%

22%29% 26% 25% 23% 23% 22%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2000 2001 2002 2003 2004 2005 2006

HighestQuintile

Fourth

Third

Second

Lowestquintile

Source: E. Gould, The Erosion of Employment-Based Insurance: More Working Families Left Uninsured,EPI Briefing Paper No. 203 (Washington, D.C.: Economic Policy Institute, Nov. 2007).

Percent of population under age 65 with health benefits from employer

Figure 8. Uninsured Rates High Among Adultswith Low and Moderate Incomes, 2001–2005

15 17 18

33 37 37

1724 28

9 9 9

1615 16

11

1113

9

96 7

97

3 320

25

50

75 Insured now, time uninsured in past year

Uninsured now

Percent of adults ages 19–64

Note: Income refers to annual income. In 2001 and 2003, low income is <$20,000, moderate income is $20,000–$34,999, middle income is $35,000–$59,999, and high income is $60,000 or more. In 2005, low income is <$20,000, moderate income is $20,000–$39,999, middle income is $40,000–$59,999, and high income is $60,000 or more. Source: The Commonwealth Fund Health Insurance Surveys (2001, 2003, and 2005).

26

52

35

16

4

24

49

28

13

4

Total Low income

Moderate income

Middle income

High income

2001 2003 2005

28

53

41

18

7

2001 2003 2005 2001 2003 2005 2001 2003 2005 2001 2003 2005

Figure 9. Workers Who Are Offered, Eligible for, and Participate in Their Employer’s Health Plan, by Firm Size and Hourly Wage

98

89

51

4234

50

75

95

83

57

45

21

0

25

50

75

100

Less than $15/hr More than $20/hr Less than $15/hr More than $20/hr

Employer offers a planEligible for employer planCovered through own employer

^ Includes both part-time and full-time workers.Source: S. R. Collins, C. Schoen, D. Colasanto, and D. A. Downey, On the Edge: Low-Wage Workersand Their Health Insurance Coverage (New York: The Commonwealth Fund, Apr. 2003).Updated data from The Commonwealth Fund Biennial Health Insurance Survey (2005).

Small employer(fewer than 50 employees)

Percent of working adults^ ages 19–64

Medium to large employer(50 or more employees)

Figure 10. Percent Uninsured Workersby Firm Size and Hourly Wage

1

1715

39

0

25

50

75

Less than $15/hr More than $20/hr Less than $15/hr More than $20/hr

Small employer(fewer than 50 employees)

Percent of working adults^ ages 19–64 who are uninsured

Medium to large employer(50 or more employees)

^ Includes both part-time and full-time workers.Source: S. R. Collins, C. Schoen, D. Colasanto, and D. A. Downey, On the Edge: Low-Wage Workersand Their Health Insurance Coverage (New York: The Commonwealth Fund, Apr. 2003).Updated data from The Commonwealth Fund Biennial Health Insurance Survey (2005).

Figure 11. Nonstandard Workers Are Less Likely to HaveHealth Insurance Coverage Through Their Own Job, 2001

74%

21%

11%

39%

3%

10%

12%

5%

1% 24%

0%

20%

40%

60%

80%

100%

Standard

workers

All nonstandard

workers

Uninsured

Medicare/Medicaid/ other government source

Other source of healthinsurance

Spouse/family member plan

Own employer's healthinsurance

Notes: Self-employed independent contractors are excluded from analysis. “Other source of health insurance” includes insurance from the individual market, from another job, from a previous job, or from an association, school, or other unidentified source.Source: E. Ditsler, P. Fisher, and C. Gordon, On the Fringe: The Substandard Benefits of Workers in Part-Time, Temporary, and Contract Jobs (New York: The Commonwealth Fund, Dec. 2005).Data: Authors’ analysis of the 2001 Contingent Work Supplement to the Current Population Survey.

Figure 12. Distribution of Uninsured Young Adults Ages 19–29,by Poverty Status and Race/Ethnicity, 2005

Source: S. R. Collins, C. Schoen, J. L. Kriss, M. M. Doty, and B. Mahato, Rite of Passage? Why Young AdultsBecome Uninsured and How New Policies Can Help (New York: The Commonwealth Fund, updated Aug. 8, 2007).Data: Analysis of the March 2006 Current Population Survey by S. Glied and B. Mahato for The Commonwealth Fund.

Other7%

Hispanic32%

African American

15%

White46%

Uninsured young adults = 13.3 million

100%– 199% FPL

31%

Less than 100% FPL

41%

200% FPL or more

28%

Figure 13. Percent Uninsured, Children and Young Adults,by Poverty Level, 2005

Percent Uninsured

ChildrenAge 18 and Under

Young AdultsAges 19–29

Total 11% 30%

<100% FPL 20 51

100%–199% FPL 16 42

>200% FPL 7 16

Source: S. R. Collins, C. Schoen, J. L. Kriss, M. M. Doty, and B. Mahato, Rite of Passage? Why Young AdultsBecome Uninsured and How New Policies Can Help (New York: The Commonwealth Fund, updated Aug. 8, 2007).Data: Analysis of the March 2006 Current Population Survey by S. Glied and B. Mahato for The Commonwealth Fund.

Figure 14. Uninsured Rates Are HighAmong Hispanics and African Americans, 2005

18 13 19

4898

13

14

0

25

50

75

Total White African

American

Hispanic

Insured now, time uninsured in past year

Uninsured now

Percent of adults ages 19–64

Note: Because of rounding, totals above stacked bars may not reflect the sum of each insurance category.Source: M. M. Doty and A. L. Holmgren, Health Care Disconnect: Gaps in Coverage and Care for Minority Adults (New York: The Commonwealth Fund, Aug. 2006).

28

62

33

20

Source: J.L. Lambrew, How the Slowing U.S. Economy Threatens Employer-Based Health Insurance(New York: The Commonwealth Fund, Nov. 2001).Updated with data from the Commonwealth Fund Biennial Health Insurance Survey (2005).

Figure 15. More Than Half of Unemployed AdultsAre Uninsured

52

1518

0

20

40

60

80

100

All nonelderly adults Employed nonelderly

adults

Unemployed

nonelderly adults

Percent uninsured, 2005

Below 200% poverty 200% poverty or more

Other insurance 8%

Uninsured 32%

COBRA-eligible75%

ESI**small firm

11%

ESI** small firm8%

Other insurance 20%

COBRA-eligible

40%

Uninsured 6%

Figure 16. Lower Income Workers Are Least Likely to Be Eligible for COBRA*

* The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) requires employers with 20 or more employeesto offer continuation of health insurance coverage to former employees. ** Employer-sponsored insurance coverage.Source: L. Duchon, C. Schoen, M. M. Doty, K. Davis, E. Strumpf, and S. Bruegman, Security Matters: How Instabilityin Health Insurance Puts U.S. Workers at Risk (New York: The Commonwealth Fund, Dec. 2001).

Figure 17. People with Disabilities in the Waiting Periodfor Medicare in 2007, by Source of Coverage

Note: Number of people in the waiting period was estimated using the number of SSDI awards to disabled workers, widowers, and adult children in 2004 and 2005 from the Social Security Administration Annual Statistical Supplement (2005 and 2006).Source: S. R. Collins, K. Davis, and J. L. Kriss, An Analysis of Leading Congressional Health Care Bills, 2005-2007:Part I, Insurance Coverage (New York: The Commonwealth Fund, Mar. 2007).

Uninsured264,504(15%)

CHAMPUS106,697

(6%)

Medicaid644,520(37%)

Employer567,501(33%)

Non-Group150,121

(9%)

Total people currently in waiting period = 1,733,343

Figure 18. Nearly One-Quarter of Medicare BeneficiariesWere Uninsured Just Before Enrolling

11

3841

1824

0

25

50

75

All on

Medicare

Ages 65–70 Ages 50–64,

disabled

Less than

200% poverty

200% poverty

or more

Percent of Medicare beneficiaries ages 50–70

Source: S. R. Collins, K. Davis, C. Schoen, M. M. Doty, S. K. H. How, and A. L. Holmgren, Will You Still Need Me? The Health and Financial Security of Older Americans (New York: The Commonwealth Fund, June 2005).Data from the Commonwealth Fund Survey of Older Adults, 2004.

28

15131018

60

443633

39 39

4959

3743

0

25

50

75

Did not fill a

prescription

Did not see

spec ialist when

needed

Skipped

medical test,

treatment, or

follow-up

Had medical

problem, did

not see doctor

or c linic

Any of the four

access

problems

Insured all year Insured now, time uninsured in past year Uninsured now

Figure 19. Lacking Health Insurance for Any PeriodThreatens Access to Care

Source: S. R. Collins, K. Davis, M. M. Doty, J. L. Kriss, and A. L. Holmgren, Gaps in Health Insurance:An All-American Problem (New York: The Commonwealth Fund, Apr. 2006).

Percent of adults ages 19–64 reporting the following problemsin past year because of cost:

Figure 20. Adults Without Insurance Are Less Likelyto Be Able to Manage Chronic Conditions

161827

58

35

59

0

25

50

75

Skipped doses or did not fill

prescription for chronic condition

because of cost

Visited ER, hospital, or both for chronic

condition

Insured all year Insured now, time uninsured in past year Uninsured now

Percent of adults ages 19–64 with at least one chronic condition*

* Hypertension, high blood pressure, or stroke; heart attack or heart disease; diabetes; asthma, emphysema, or lung disease. Source: S. R. Collins, K. Davis, M. M. Doty, J. L. Kriss, and A. L. Holmgren, Gaps in Health Insurance:An All-American Problem (New York: The Commonwealth Fund, Apr. 2006).

Figure 21. Many Americans Have Problems Paying Medical Bills or Are Paying Off Medical Debt

34

211413

23 2618

98

16

53

292626

42

0

25

50

75

Not able to pay

medical bills

Contacted by

collection

agency*

Had to change

way of life to pay

medical bills

Medical bills/

debt being paid

off over time

Any medical bill

problem or

outstanding debt

Total Insured all year Uninsured during the year

Percent of adults ages 19–64 who had the following problems in past year:

* Includes only those who had a bill sent to a collection agency when they were unable to pay it.Source: S. R. Collins, K. Davis, M. M. Doty, J. L. Kriss, and A. L. Holmgren, Gaps in Health Insurance:An All-American Problem (New York: The Commonwealth Fund, Apr. 2006).

Percent of adults reporting: TotalInsured all year

Insured now, time uninsured

during year

Uninsured now

Unable to pay for basic necessities (food, heat or rent) because of medical bills

26% 19% 28% 40%

Used up all of savings 39 33 42 49

Took out a mortgage against your home or took out a loan

11 10 12 11

Took on credit card debt 26 27 31 23

Figure 22. One-Quarter of Adults with Medical Bill Burdens and Debt Were Unable to Pay for Basic Necessities

Source: S. R. Collins, K. Davis, M. M. Doty, J. L. Kriss, and A. L. Holmgren, Gaps in Health Insurance:An All-American Problem (New York: The Commonwealth Fund, Apr. 2006).

Percent of adults ages 19–64 with medical bill problemsor accrued medical debt: