Introduction

Preface

Contents

Sample
Tables

Ordering Info

Since the publication of the last edition of this series, the public policy arena for the health care insurance debate has changed dramatically. Previous discussions about a major expansion of employer-sponsored insurance have been replaced by more incremental approaches. The political obstacles to national health insurance proved to be too difficult to overcome in 1993 and 1994, leading many policymakers to “less ambitious” efforts focused on the income-oriented approaches that have a greater political chance of success. As a result, we have shifted the focus of this edition by providing more data by family income. The book is organized into eight separate sections, A–H, as follows:

A. Health Insurance Coverage by Demographic/Work Characteristic: Health Insurance Coverage: Health insurance coverage by age, gender, race, family type, work status, and employer characteristics.

B. Health Insurance Coverage and Income: Health insurance coverage by age, gender, and family income.

C. Characteristics of the Uninsured: Profiles of individuals classified as lacking health insurance for the entire year by age, gender, race, family type, work status, and employer characteristics.

D. Medicaid: Profiles of enrollment and expenditures for individuals reporting Medicaid coverage, with categorizations by basis of enrollment and type of medical service.

E. Health Status and Mortality: Health status of state populations, including general and infant mortality rates, fertility, acquired immune deficiency syndrome (AIDS), and immunizations.

F. Health Care Costs, Access, and Utilization: Indicators of health care costs, including hospital costs; physician costs; Medicare spending; access; and utilization, including the number of hospital and nursing home beds, length of hospital stays, number of physicians, and enrollment in health maintenance organizations (HMOs).

G. State Demographic and Income Profiles: State population characteristics, including data on age, race, sex, family type, family income, and employment.

H. State Employment and Economic Profiles: Data on state economic indicators such as state budgets and expenditures.

Each section begins with a short introduction that discusses the measure included and highlights a few results to provide a contextual basis for the data presented. We also mention important differences between the data in this volume and the previous two editions. However, since this volume is intended to serve primarily as a data reference, we do not attempt to analyze all the differences in these measures or to draw policy conclusions.

Data Sources

Current Population Survey

The CPS provides data on work status and income, demographic characteristics, health insurance coverage, and other family and individual characteristics for the civilian noninstitutionalized population of the United States. In one year, the survey interviews approximately 140,000 people in about 53,000 households in a national random sample. However, the sample size for some states can be prohibitively small, leading to less reliable estimates of state-level population characteristics. To produce more reliable estimates and reduce standard errors (see Appendixes One and Two), we used a two-year average of the March 1995 and March 1996 CPS files. The CPS data files relate to the previous calendar year, so the CPS-based estimates presented in this report represent the average characteristics for the years 1994 and 1995.

In many cases, data from the CPS have been augmented by estimates derived from the Urban Institute’s microsimulation model, the Transfer Income Model (TRIM2). TRIM2 has been used by various government agencies over the last 20 years to provide more information about the tax, health benefit, and income transfer systems in the United States. It includes modules that simulate the program rules for Medicaid, Aid to Families with Dependent Children (AFDC, now Temporary Assistance for Needy Families [TANF]), and Supplemental Security Income (SSI). These modules correct for underreporting of benefits on the Current Population Survey (see Appendix One) and generate estimates of the size of the population eligible for benefits.

This edition, like the last, continues to define a “family” as a health insurance unit. A health insurance unit includes the members of a nuclear family who can be covered under one health insurance policy. The standard we use follows a typical insurance industry standard: a policyholder may cover his or her spouse, all children under 18, and children between 18 and 21 who are full-time students. Thus, while a single 25-year-old child living with his or her parents may be included in the parents’ nuclear family, he or she would be treated as a separate, single health insurance unit. This definition is used because most health reform initiatives traditionally adopt this approach as well. Using the nuclear family definition would overstate the number of dependents who could gain coverage through a worker in the family because older children usually cannot be covered through employer plans.

Medicaid Administrative Data

The two primary data sources used for Medicaid (Section D) are HCFA Form 2082 (Statistical Report on Medical Care: Eligibles, Recipients, Payments, and Services) and HCFA Form 64 (Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program). Form 2082 collects state-level data on Medicaid enrollment, reasons for enrollment, types of medical services provided, and expenditures for these services. Form 64 is the report used to determine federal reimbursement levels to states, and therefore it contains expenditure data generally considered more reflective of actual spending. Unfortunately, Form 64 does not include enrollment data, and it reports only total state spending by type of medical service. To draw on the strengths of both forms, a “crosswalk” was developed by Urban Institute staff. Expenditure data from Form 2082 were used to determine relative expenditures by age, disability, and eligibility group; total expenditures were then adjusted to match the figures reported on Form 64.

Furthermore, the data reported in Section D reflect an extensive editing process by Urban Institute staff for the purposes of correcting for gaps in state reporting, inconsistent responses by states, and inconsistent interpretation by states of reporting instructions. Appendix Two describes these corrections in detail.

Other Sources

Other data sources are also utilized in this volume, covering health costs, status, access, and utilization, as well as background data on states and summary information on state finances and spending. In all cases the most recently available data are presented. Data sources are cited for each table, and explanatory notes defining variables and concepts are included at the end of each section.

Changes to this Edition