Coverage Trends Among New Yorkers United Hospital Fund August 2001

About the United Hospital Fund and its Health Insurance Studies Project The United Hospital Fund is a health services research and philanthropic organization that addresses critical issues affecting hospitals and health care in New York City. Since 1996, the Fund’s Health Insurance Studies Project has been documenting the growing problem of New Yorkers without health insurance coverage. Fund analysts track the dimensions of the problem and identify potential solutions. Fund publications on the issue include Taking Steps, Losing Ground: The Challenge of New Yorkers without Health Insurance Coverage and From Promise to Practice: Expanding Health Insurance for New Yorkers. In addition to this analytic work, the Fund regularly convenes legislators, regulators, advocates, health plan representatives, and health care providers to discuss options to expand coverage. The Fund also devotes significant grant funds to support the development of solutions to the problem. For more information on the Fund’s work on the uninsured, see its web site, This publication was prepared by Danielle Holahan, health policy analyst, Kathryn Haslanger, vice president and director, policy analysis, and interim director of reseach, and Kathleen Finneran, senior staff associate. Sources Data shown are from the March supplements to the Current Population Survey and the February 1999 supplement, known as the Contingent Worker Survey, tabulated by Kenneth E. Thorpe, Ph.D., Professor of Health Policy and Management at the Rollins School of Public Health at Emory University, and his colleagues Jennifer Flome, Peter Joski, and Curtis Florence. New York specific tabulations from the Kaiser/HRET Employer Health Benefits 2000 Annual Survey were prepared for the United Hospital Fund by Jeremy Pickreign, statistician, Health Research and Educational Trust. Notes and Explanations As shown on tables 1 and 2, the confidence intervals for some New York City data are relatively wide. These estimates should therefore be considered approximations and interpreted accordingly, particularly when using a single year estimate for New York City. Please also note that some numbers do not add to totals due to rounding. Data are shown for New York City, New York State, Rest of State, and the United States. “New York State” data include New York City while “Rest of State” data exclude New York City. Definitions Employer-sponsored coverage - includes coverage from a person’s own employer and coverage from a family member’s employer. Directly purchased coverage - is coverage a person purchases individually, as opposed to coverage through an employer or other group. Public coverage - includes Medicaid, Medicare, and CHAMPUS. Full-time worker - a person who worked 35 hours or more per week in the majority of weeks worked during the preceding calendar year. Part-time worker - a person who worked less than 35 hours per week in the majority of weeks worked during the preceding calendar year. Small Firm - a firm that employs workers, unless noted otherwise.

Section 1 Coverage Trends New York State and New York City

One in four New York City residents and one in five New York State residents do not have health insurance. Source: March 2000 Current Population Survey. Tabulations prepared for the United Hospital Fund by Kenneth E. Thorpe, Jennifer Flome, and Peter Joski. Note: Data are for 1999 and include all persons below age % 21% 3% 25% 63% 19% 15% 4% New York City New York State Employer- Sponsored Employer- Sponsored - 1 -

21% 25% 71% 5% 10% 14% 4% 15% 19% 50% 3% 63% 0% 20% 40% 60% 80% 100% Employer- Sponsored Directly PurchasedPublicUninsured New York CityRest of StateNew York State New Yorkers outside of New York City are more likely to have employer- sponsored coverage. Source: March 2000 Current Population Survey. Tabulations prepared for the United Hospital Fund by Kenneth E. Thorpe, Jennifer Flome, and Peter Joski. Note: Data are for 1999 and include all persons below age

The uninsured rate is higher in New York City than in the nation as a whole. Source: March 1991 through 2000 Current Population Survey. Tabulations prepared for the United Hospital Fund by Kenneth E. Thorpe, Jennifer Flome, and Peter Joski. Note: Data include all persons below age 65. Due to relatively wide confidence intervals for some New York City estimates, these numbers should be considered approximations and interpreted accordingly

At every income level, persons in New York City are less likely to have employer-sponsored coverage than persons in New York State as a whole. 13% 2% 53% 32% 35% 3% 22% 41% 61% 6% 8% 25% 4% 2% 13% 81% 0% 20% 40% 60% 80% 100% Employer-SponsoredDirectly PurchasedPublicUninsured <100% FPL % FPL % FPL301%+ FPL Source: March 2000 Current Population Survey. Tabulations prepared for the United Hospital Fund by Kenneth E. Thorpe, Jennifer Flome, and Peter Joski. Note: These charts show source of coverage by income. Data include all persons below age 65. In 1999, 100% of the Federal Poverty Level (FPL) was $8,240 for an individual. New York City New York State - 4 -

Most of the uninsured are low-income.* New York City New York State Source: March 2000 Current Population Survey. Tabulations prepared for the United Hospital Fund by Kenneth E. Thorpe, Jennifer Flome, and Peter Joski. Note: Data are for 1999 and include all persons below age 65. *On this chart, low-income refers to persons whose annual income is below 200% of the Federal Poverty Level (FPL). In 1999, 200% FPL was $16,480 for an individual. 1.7 Million Uninsured3.0 Million Uninsured 35% 32% 13% 20% 34% 30% 13% 23%

Source: March 2000 Current Population Survey. Tabulations prepared for the United Hospital Fund by Kenneth E. Thorpe, Jennifer Flome, and Peter Joski. Note: Data are for 1999 and include all persons below age 65. Children are defined as persons aged % Approximately 80 percent of the uninsured in New York are adults. 82% 21% 79% 1.7 Million Uninsured3.0 Million Uninsured New York City New York State

Uninsurance rates for children in New York State have been declining since Source: March 1991 through 2000 Current Population Survey. Tabulations prepared for the United Hospital Fund by Kenneth E. Thorpe, Jennifer Flome, and Peter Joski. Note: Data include all persons below age 65. Children are defined as persons aged 0-18 and adults as persons aged

Source: March 2000 Current Population Survey. Tabulations prepared for the United Hospital Fund by Kenneth E. Thorpe, Jennifer Flome, and Peter Joski. Note: This chart shows source of coverage by race/ethnicity. Data are for 1999 and include all persons below age 65. Blacks and Hispanics are more likely than Whites to be uninsured. New York State New York City

Over half of the uninsured in New York City and nearly 70 percent of the uninsured in New York State are citizens... Source: March 2000 Current Population Survey. Tabulations prepared for the United Hospital Fund by Kenneth E. Thorpe, Jennifer Flome, and Peter Joski. Note: Data are for 1999 and include all persons below age % New York City New York State 58% 31% 69% 1.7 Million Uninsured3.0 Million Uninsured - 9 -

…however, non-citizens in New York City are more than twice as likely as citizens to be uninsured, and in New York State, non-citizens are three times more likely than citizens to be uninsured. Source: March 2000 Current Population Survey. Tabulations prepared for the United Hospital Fund by Kenneth E. Thorpe, Jennifer Flome, and Peter Joski. Note: Data are for 1999 and include all persons below age New York City New York State

An estimated 1.5 million New York State residents are uninsured but eligible for public coverage. Source: March 1999 Current Population Survey. Tabulations prepared for the United Hospital Fund by Kenneth E. Thorpe and Curtis Florence. Note: Data are for Medicaid data for children include children aged 0-21 while Child Health Plus data include children aged

Source: March 1999 Current Population Survey. Tabulations prepared for the United Hospital Fund by Kenneth E. Thorpe and Curtis Florence. Note: Data are for Medicaid data for children include children aged 0-21 while Child Health Plus data include children aged An estimated three-quarters of uninsured children are eligible for a public insurance program compared to one-third of uninsured adults. Eligible but unenrolled Eligible but unenrolled

Section 2 Coverage For Workers New York State 1999

3.0 Million Uninsured Most of the uninsured are working. Source: March 2000 Current Population Survey. Tabulations prepared for the United Hospital Fund by Kenneth E. Thorpe, Jennifer Flome, and Peter Joski. Note: Data are for New York State in 1999 and include all persons below age 65. Children are shown by their parents’ work status % 63% 12%

9.0 Million Workers Twenty percent of workers do not have coverage. Source: March 2000 Current Population Survey. Tabulations prepared for the United Hospital Fund by Kenneth E. Thorpe, Jennifer Flome, and Peter Joski. Note: Data are for New York State in 1999 and include workers below age % 4% 20%

Two out of three uninsured workers are in firms with less than 100 employees. One-half are in firms with less than 25 employees. Source: March 2000 Current Population Survey. Tabulations prepared for the United Hospital Fund by Kenneth E. Thorpe, Jennifer Flome, and Peter Joski. Note: Data are for New York State in 1999 and include workers below age Million Uninsured Workers % 16% 48%

Workers in larger firms are more likely to have coverage. Source: March 2000 Current Population Survey. Tabulations prepared for the United Hospital Fund by Kenneth E. Thorpe, Jennifer Flome, and Peter Joski. Note: Data are for New York State in 1999 and include workers below age

Nearly 9 out of 10 uninsured workers do not have access to employer-sponsored coverage. Source: February 1999 Contingent Worker Survey. Tabulations prepared for the United Hospital Fund by Kenneth E. Thorpe, Jennifer Flome, and Peter Joski. Note: Data are for uninsured workers in New York State in 1999 and include workers aged Contingent Worker Survey estimates differ from Current Population Survey estimates; the Contingent Worker Survey counts workers during a specific sample week while the Current Population Survey counts work activity at any point during the previous year % 74% 14%

Nearly half of all workers not offered coverage are uninsured. Workers Not Offered Coverage Source: February 1999 Contingent Worker Survey. Tabulations prepared for the United Hospital Fund by Kenneth E. Thorpe, Jennifer Flome, and Peter Joski. Note: Data are for workers not offered coverage in New York State in 1999 and include workers aged Contingent Worker Survey estimates differ from Current Population Survey estimates; the Contingent Worker Survey counts workers during a specific sample week while the Current Population Survey counts work activity at any point during the previous year. *Refers to coverage through a family members’ employer. **Directly purchased/other coverage includes individually purchased coverage, as well as coverage from previous employers, other employer, or own company (if self-employed or independent contractor) % 24% 4%

Eighty percent of workers who decline their employer’s coverage offer receive coverage through another source. Source: February 1999 Contingent Worker Survey. Tabulations prepared for the United Hospital Fund by Kenneth E. Thorpe, Jennifer Flome, and Peter Joski. Note: Data are for workers declining coverage in New York State in 1999 and include workers aged Contingent Worker Survey estimates differ from Current Population Survey estimates; the Contingent Worker Survey counts workers during a specific sample week while the Current Population Survey counts work activity at any point during the previous year. *Refers to coverage through a family members’ employer. **Directly purchased/other coverage includes individually purchased coverage, as well as coverage from previous employers, other employer, or own company (if self-employed or independent contractor). Workers Declining Coverage % 68% 10% 3%

Fewer small firms offer insurance. % of Firms Offering Health Insurance Source: Kaiser/HRET Employer Health Benefits 2000 Annual Survey. Tabulations prepared for the United Hospital Fund by Jeremy Pickreign. Note: Data are for New York State in Small firms are defined as those with employees and large firms as those with 200 or more employees

Workers in “low-wage” firms are less likely to be covered. % of Workers Covered Source: Kaiser/HRET Employer Health Benefits 2000 Annual Survey. Tabulations prepared for the United Hospital Fund by Jeremy Pickreign. Note: Data are for New York State in Low-wage firm is defined as one where more than 30% of employees earn below $20,000 and higher-wage firm is defined as one where 30% or fewer employees earn below $20,

% of Premium Paid by Employee for Coverage In New York State employees contribute a smaller share of the premium for family coverage than employees in the United States as a whole. Source: Kaiser/HRET Employer Health Benefits 2000 Annual Survey. Tabulations prepared for the United Hospital Fund by Jeremy Pickreign. Note: Data are for New York State in 2000 and pertain to all firm sizes and all plan types