Lack of Health Insurance Coverage Among Working-age Adults, 1993-2006
To use data from the Behavioral Risk Factor Surveillance System (BRFSS) to examine trends in the lack of health insurance coverage among working-age US adults and to identify populations without coverage. The BRFSS data from 1993 to 2006 were analyzed. SUDAAN software was used to generate estimates of prevalence and corresponding standard errors, and logistic regression techniques were used to examine trends in the data. An estimated 18.59% of working adults (aged 18-64 years) did not have health insurance coverage in 2006. Trend in uninsurance remained somewhat stable from 1993 to 2000 (OR = 1.01; 95% CI 1.00-1.02); however, it changed more rapidly from 2001 to 2006 (OR = 1.03; 1.02-1.03). Similar patterns were observed from 2001 to 2006 for those <35 years of age, employed, Hispanics and those with less than or high school education. Effective approaches to reducing uninsurance and the consequences related to lack of coverage are needed in the face of increasing health disparities in the United States.

Having health insurance is one indicator of access to health care and preventive services, and numerous studies have shown an association between lack of health insurance and poor health. Data from the National Health Interview Survey (NHIS) and the US Census' Current Population Survey show that the number of people without health insurance continues to grow, and per estimates from 2005, approximately 34.5 to 37.8 million adults aged 18-64 years were uninsured in that year. The 2005 Census data also show that the percentage of people covered by employment-based health insurance had decreased from the previous year. The Kaiser Commission on Medicaid, using several data sources, reviewed the dimensions of health insurance coverage in the United States, particularly employment-based coverage and public coverage. The findings for non-elderly working-age adults show that 61% were covered by employer sponsored programs, 5% had private non-group coverage, 16% were covered by Medicaid or other public programs and the remaining 18% were uninsured in 2005. In addition, we know that there is quite a large variation by state and by demographic group in lack of coverage. Estimates of uninsurance are available from a variety of sources, and these estimates have implications for informing policies and programs in a variety of areas that have been a significant point of discussion in the literature.

The Behavioral Risk Factor Surveillance System (BRFSS) is an important and consistent source of data on myriad health issues, including health insurance and access to care. We examined health insurance coverage among BRFSS participants from 1993 to 2006. In addition to examining coverage over time, we identified population groups that might be at risk for not having access to care because they lacked health insurance.