Health Insurance, Access, and Health Status of Nonelderly Adults

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Welfare reform, the nation's economic expansion, changes in employers' offers of health insurance and workers' acceptance of such offers have all contributed to recent shifts in health insurance coverage among nonelderly adults. Whatever the reasons, changes in coverage can affect access to care and health status. At present, policies designed to expand coverage are likely to target specific groups of individuals instead of aiming for universal coverage. It is therefore important to understand both how insurance coverage has been changing and how these changes have affected different subgroups, especially the poor, minorities, and people in poor health, who are at greater risk of being without coverage (Holahan and Brennan 2000).

This Snapshot uses data from the National Survey of America's Families (NSAF) to describe changes and variations in the health insurance coverage of nonelderly adults (ages 19 to 64) between 1997 and 1999. The NSAF asked questions about insurance coverage at the time of the survey. Responses allowed researchers to classify people as having employer-sponsored insurance (ESI, which includes coverage through the military), Medicaid or state program coverage (called Medicaid/State), other coverage (including private nongroup plans and Medicare), or as being uninsured.

This Snapshot also provides data on changes in access and health status indicators from 1997 to 1999. Presenting these data in the same Snapshot with coverage data does not imply that changes in insurance coverage were responsible for changes in access or health status. The determinants of access and health status go beyond health insurance and include factors related to individuals, their families and communities, and the health care system. This topic will be the subject of more in-depth future research.

Note: The Portable Document Format (PDF) of this report includes all tables and charts.

The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.

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