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Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: mmwrq@cdc.gov. Type 508 Accommodation and the title of the report in the subject line of e-mail. State-Specific Prevalence of Lapses in Health-Care-Insurance Coverage -- United States, 1995Lack of health-care-insurance coverage has been associated with decreased use of preventive health services, delay in seeking medical care, and poor health status (1,2 ). In 1995, an estimated 30.5 million persons aged 18-64 years in the United States did not have health insurance (3). To determine state-specific estimates of the prevalence of persons aged 18-64 who reported either short-term (i.e., less than 12 months) or long-term (i.e., greater than or equal to 12 months) lapses in health-care coverage, CDC analyzed data from the 1995 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of that analysis and indicates that among adults who reported having no health insurance in 1995, most were without insurance for greater than or equal to 1 year and that long-term lapses were more prevalent among men than women. The BRFSS is a state-based, random-digit-dialed telephone survey of the U.S. noninstitutionalized population aged greater than or equal to 18 years. Data were obtained from all 50 states participating in the 1995 BRFSS. A total of 90,691 persons responded. Analyses were restricted to persons aged 18-64 years. Sample estimates were statistically weighted by sex, age, and race to reflect the noninstitutionalized civilian population of each state. Respondents were asked, "Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare?" Persons who reported having no health-care coverage at the time of the interview were considered to be uninsured. Persons who were uninsured were asked "How long has it been since you had health care coverage?" Persons who reported having had coverage during the preceding year were classified as having short-term lapse, and those reporting not having had coverage for greater than or equal to 1 year were classified as having long-term lapse. During 1995, the prevalence of persons who reported having health-care-insurance coverage ranged from 76.5% (Louisiana) to 93.3% (Hawaii) (median: 87%) (Table_1). The prevalence of reported lapses in health-care-insurance coverage of less than 1 year ranged from 1.8% (New Jersey) to 9.4% (California) (median: 4.2%); lapses of greater than or equal to 1 year ranged from 2.9% (Hawaii) to 17.1% (California) (median: 9.3%). Among men, the percentage reporting having health-care-insurance coverage ranged from 75.5% (California) to 91.5% (Hawaii) (median: 84.7%) (Table_2). The percentage of men reporting lapses in health-care-insurance coverage of less than 1 year ranged from 2.0% (South Dakota) to 10.3% (California) (median: 4.2%), and the percentage reporting lapses of greater than or equal to 1 year ranged from 3.8% (Hawaii) to 17.1% (Texas) (median: 10.6%). Among women, the percentage reporting having health-care-insurance coverage ranged from 74.6% (Louisiana) to 95.1% (Hawaii) (median: 88%). The percentage of women reporting lapses of less than 1 year in health-care-insurance coverage ranged from 1.6% (New Jersey) to 8.5% (California) (median: 4.1%), and the percentage reporting lapses of greater than or equal to 1 year ranged from 2.0% (Wisconsin) to 17.9% (Louisiana) (median: 8.6%). During 1995, having health-care-insurance coverage was reported more commonly by white respondents (median: 88%) than by respondents of other races/ethnicities (median: 80%), and more commonly by respondents who were employed for wages (median: 89%) than by those who were self-employed (median: 76%), homemakers (median: 82%), or unemployed (median: 61%). Reported by the following BRFSS coordinators: J Cook, MPA, Alabama; P Owen, Alaska; B Bender, Arizona; J Senner, PhD, Arkansas; B Davis, PhD, California; M Leff, MSPH, Colorado; M Adams, MPH, Connecticut; F Breukelman, Delaware; D McTague, MS, Florida; E Pledger, MPA, Georgia; A Onaka, PhD, Hawaii; C Johnson, MPH, Idaho; B Steiner, MS, Illinois; N Costello, MPA, Indiana; A Wineski, Iowa; M Perry, Kansas; K Asher, Kentucky; R Meriwether, MD, Louisiana; D Maines, Maine; A Weinstein, MA, Maryland; D Brooks, MPH, Massachusetts; H McGee, MPH, Michigan; N Salem, PhD, Minnesota; P Arbuthnot, Mississippi; T Murayi, PhD, Missouri; P Smith, Montana; S Huffman, Nebraska; E DeJan, MPH, Nevada; K Zaso, MPH, New Hampshire; G Boeselager, MS, New Jersey; W Honey, MPH, New Mexico; T Melnik, DrPH, New York; K Passaro, PhD, North Carolina; J Kaske, MPH, North Dakota; R Indian, MS, Ohio; N Hann, MPH, Oklahoma; J Grant-Worley, MS, Oregon; L Mann, Pennsylvania; J Hesser, PhD, Rhode Island; Y Gladman, South Carolina; M Gildemaster, South Dakota; D Ridings, Tennessee; K Condon, Texas; R Giles, Utah; R McIntyre, PhD, Vermont; L Redman, Virginia; K Wynkoop-Simmons, PhD, Washington; F King, West Virginia; E Cautley, MS, Wisconsin; M Futa, MA, Wyoming. Behavioral Surveillance Br, Div of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. Editorial NoteEditorial Note: This report documents substantial variation in the state-specific prevalence of self-reported short-term or long-term lapses in health-care-insurance coverage. State-specific variations may reflect differences in population composition (e.g., age, race/ethnicity, and sex), socioeconomic factors (e.g., per capita income, median number of years of education, and unemployment level), and other factors. Variation in health-care-insurance coverage between male and female respondents may reflect differences in coverage from public sources (e.g., Medicaid). Women are more likely than men to be covered by Medicaid through the Aid to Families with Dependent Children program because they are more likely to be caring for children (4). Race-specific differences in health-care-insurance coverage may be related to the relative income and employment status of the two groups (5). Persons employed for wages are more likely to obtain insurance through their employer, who pays all or part of the cost of coverage. In comparison, persons who are either self-employed or unemployed must pay the total cost of coverage. BRFSS estimates can differ from those of other surveys because of differences in methodology or wording of questions. For example, BRFSS estimates of the percentage of uninsured adults aged 18-64 years were lower than those reported from the March 1996 Current Population Survey (3). Unlike the Current Population Survey, BRFSS data are based on questions about insurance status at the time of the interview, rather than during the previous calendar year. In addition, BRFSS findings may underestimate persons without health-care-insurance coverage because BRFSS excludes households without telephones; persons without a telephone are more likely to be less educated, have a lower income, or be unemployed (6). Based on the findings of previous studies, being uninsured may be associated with declines in health status (7); in addition, compared with insured patients, those who are hospitalized while without health-care-insurance coverage may receive fewer inpatient services and may be at increased risk for dying while hospitalized (8,9). The risks associated with lack of insurance coverage may result in substantial increases in the number of persons with chronic conditions and the cost of providing care for these persons. Although providing health-care-insurance coverage to persons with short-term lapses is important, targeting efforts toward the long-term uninsured may be more effective because of the larger number of persons in this category and because of their potentially increased health risks. The methods and findings in this report can assist state planners in evaluating the progress of efforts to improve health-care and public health and in prioritizing programs to close insurance gaps. References
Table_1 Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.
TABLE 1. Percentage of persons aged 18-64 years with reported health-care-insurance coverage, by state -- United States,
Behavioral Risk Factor Surveillance System, 1995
===========================================================================================================================
Insured full Short-term Long-term
year lapse* lapse+
------------------------ ----------------------- ----------------------------
State Sample size % (95% CI&) % (95% CI) % (95% CI)
---------------------------------------------------------------------------------------------------------------------------
Alabama 1378 84.5 (+/-2.1%) 4.6 (+/-1.2%) 10.9 (+/-1.9%)
Alaska 1380 84.0 (+/-2.8%) 4.1 (+/-1.6%) 11.8 (+/-2.4%)
Arizona 1425 81.5 (+/-2.7%) 6.8 (+/-1.9%) 11.8 (+/-2.2%)
Arkansas 1354 82.5 (+/-2.2%) 4.8 (+/-1.3%) 12.7 (+/-1.9%)
California 3391 77.8 (+/-2.3%) 9.4 (+/-1.7%) 12.8 (+/-1.8%)
Colorado 1947 83.9 (+/-2.2%) 4.1 (+/-1.2%) 12.0 (+/-1.9%)
Connecticut 1498 89.2 (+/-1.9%) 2.5 (+/-0.9%) 8.4 (+/-1.7%)
Delaware 1674 87.2 (+/-1.9%) 3.8 (+/-1.1%) 9.0 (+/-1.6%)
Florida 2487 81.4 (+/-1.8%) 6.2 (+/-1.1%) 12.5 (+/-1.5%)
Georgia 1904 88.9 (+/-1.7%) 3.4 (+/-0.9%) 7.7 (+/-1.4%)
Hawaii 1705 93.3 (+/-1.5%) 3.9 (+/-1.2%) 2.9 (+/-0.9%)
Idaho 2160 83.6 (+/-1.7%) 5.0 (+/-1.0%) 11.3 (+/-1.4%)
Illinois 2330 86.9 (+/-1.7%) 4.5 (+/-1.1%) 8.6 (+/-1.4%)
Indiana 1880 88.0 (+/-1.6%) 4.3 (+/-1.1%) 7.7 (+/-1.3%)
Iowa 2759 88.5 (+/-1.4%) 3.5 (+/-0.8%) 8.0 (+/-1.2%)
Kansas 1560 87.6 (+/-1.8%) 3.2 (+/-1.0%) 9.3 (+/-1.6%)
Kentucky 1749 83.8 (+/-1.9%) 3.5 (+/-0.9%) 12.7 (+/-1.8%)
Louisiana 1303 76.5 (+/-2.6%) 6.4 (+/-1.6%) 17.1 (+/-2.3%)
Maine 1008 80.4 (+/-2.8%) 7.7 (+/-2.0%) 11.8 (+/-2.3%)
Maryland 4172 89.5 (+/-1.1%) 3.8 (+/-0.7%) 6.7 (+/-0.9%)
Massachusetts 1446 87.9 (+/-2.0%) 3.3 (+/-1.2%) 8.8 (+/-1.7%)
Michigan 1995 90.2 (+/-1.4%) 3.2 (+/-0.9%) 6.6 (+/-1.2%)
Minnesota 3151 90.9 (+/-1.1%) 3.1 (+/-0.7%) 6.0 (+/-0.9%)
Mississippi 1217 83.9 (+/-2.4%) 5.1 (+/-1.5%) 11.0 (+/-2.1%)
Missouri 1244 81.9 (+/-2.7%) 4.4 (+/-1.5%) 13.7 (+/-2.3%)
Montana 939 81.0 (+/-2.7%) 3.2 (+/-1.2%) 15.8 (+/-2.6%)
Nebraska 1326 90.9 (+/-1.7%) 2.8 (+/-1.0%) 6.3 (+/-1.4%)
Nevada 1435 85.2 (+/-2.2%) 5.6 (+/-1.5%) 9.2 (+/-1.7%)
New Hampshire 1232 86.2 (+/-2.5%) 4.5 (+/-1.6%) 9.3 (+/-2.0%)
New Jersey 997 91.0 (+/-2.3%) 1.8 (+/-0.9%) 7.3 (+/-2.1%)
New Mexico 1033 79.3 (+/-3.0%) 6.1 (+/-1.6%) 14.6 (+/-2.7%)
New York 2007 86.0 (+/-2.0%) 3.9 (+/-1.0%) 10.1 (+/-1.7%)
North Carolina 2503 85.9 (+/-1.6%) 4.9 (+/-1.0%) 9.2 (+/-1.3%)
North Dakota 1359 87.7 (+/-1.9%) 2.9 (+/-0.9%) 9.4 (+/-1.7%)
Ohio 1045 87.2 (+/-2.5%) 5.5 (+/-1.7%) 7.4 (+/-2.0%)
Oklahoma 1219 82.4 (+/-2.5%) 3.9 (+/-1.3%) 13.6 (+/-2.3%)
Oregon 2259 84.6 (+/-1.7%) 4.9 (+/-1.1%) 10.6 (+/-1.5%)
Pennsylvania 2817 88.8 (+/-1.5%) 3.9 (+/-0.9%) 7.3 (+/-1.2%)
Rhode Island 1420 87.5 (+/-2.0%) 5.2 (+/-1.4%) 7.3 (+/-1.5%)
South Carolina 1609 86.8 (+/-1.9%) 3.8 (+/-1.1%) 9.4 (+/-1.7%)
South Dakota 1355 89.7 (+/-1.8%) 2.5 (+/-0.9%) 7.8 (+/-1.5%)
Tennessee 1600 87.5 (+/-1.9%) 6.2 (+/-1.4%) 6.3 (+/-1.4%)
Texas 1400 80.8 (+/-2.5%) 4.1 (+/-1.1%) 15.1 (+/-2.4%)
Utah 2357 87.5 (+/-1.8%) 4.9 (+/-1.1%) 7.7 (+/-1.4%)
Vermont 2001 86.3 (+/-1.8%) 3.3 (+/-0.9%) 10.5 (+/-1.6%)
Virginia 1509 87.7 (+/-1.9%) 4.6 (+/-1.2%) 7.7 (+/-1.6%)
Washington 2813 86.7 (+/-1.4%) 4.4 (+/-0.9%) 8.9 (+/-1.2%)
West Virginia 1809 80.8 (+/-2.1%) 4.6 (+/-1.1%) 14.6 (+/-1.8%)
Wisconsin 1787 91.2 (+/-1.8%) 3.4 (+/-1.3%) 5.4 (+/-1.3%)
Wyoming 1978 81.7 (+/-1.9%) 5.5 (+/-1.2%) 12.8 (+/-1.7%)
Range 76.5-93.3 1.8-9.4 2.9-17.1
Median 86.5 4.2 9.3
---------------------------------------------------------------------------------------------------------------------------
* Lacked insurance for <12 months. + Lacked insurance for>=12 months.
& Confidence interval.
===========================================================================================================================
Return to top. Table_2 Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.
TABLE 2. Percentage of persons aged 18-64 years who reported lapses in health-care- insurance coverage, by sex and state
-- United States, Behavioral Risk Factor Surveillance System, 1995
=============================================================================================================================
Short-term Long-term
lapse* lapse+
---------------------------------------------- ---------------------------------------------------
Men Women Men Women
-------------------------- ------------------- ------------------------ -----------------------
State % (95% CI&) % (95% CI) % (95% CI) % (95% CI)
-----------------------------------------------------------------------------------------------------------------------------
Alabama 3.7 (+/-1.8%) 5.4 (+/-1.6%) 11.8 (+/-3.0%) 10.2 (+/-2.2%)
Alaska 5.6 (+/-2.8%) 2.5 (+/-1.5%) 13.8 (+/-3.7%) 9.7 (+/-3.0%)
Arizona 5.8 (+/-2.7%) 7.8 (+/-2.3%) 13.1 (+/-3.6%) 10.4 (+/-2.6%)
Arkansas 4.9 (+/-1.9%) 4.8 (+/-1.5%) 11.1 (+/-2.8%) 14.3 (+/-2.7%)
California 10.3 (+/-2.8%) 8.5 (+/-1.8%) 14.2 (+/-2.5%) 11.3 (+/-2.7%)
Colorado 4.4 (+/-1.8%) 3.9 (+/-1.6%) 13.6 (+/-3.0%) 10.4 (+/-2.4%)
Connecticut 2.5 (+/-1.6%) 2.5 (+/-1.0%) 13.0 (+/-3.1%) 3.8 (+/-1.3%)
Delaware 3.5 (+/-1.7%) 4.1 (+/-1.3%) 9.5 (+/-2.6%) 8.5 (+/-2.0%)
Florida 6.2 (+/-1.7%) 6.1 (+/-1.4%) 13.2 (+/-2.4%) 11.8 (+/-1.9%)
Georgia 2.3 (+/-1.1%) 4.5 (+/-1.5%) 9.0 (+/-2.3%) 6.4 (+/-1.7%)
Hawaii 4.7 (+/-1.9%) 3.0 (+/-1.3%) 3.8 (+/-1.5%) 2.0 (+/-1.0%)
Idaho 3.8 (+/-1.4%) 6.3 (+/-1.5%) 11.6 (+/-2.1%) 11.1 (+/-1.8%)
Illinois 4.7 (+/-1.6%) 4.2 (+/-1.2%) 9.2 (+/-2.2%) 8.0 (+/-1.8%)
Indiana 4.2 (+/-1.6%) 4.4 (+/-1.4%) 7.6 (+/-2.0%) 7.8 (+/-1.8%)
Iowa 3.0 (+/-1.1%) 4.0 (+/-1.1%) 10.0 (+/-1.9%) 6.0 (+/-1.3%)
Kansas 3.7 (+/-1.6%) 2.7 (+/-1.1%) 10.4 (+/-2.5%) 8.1 (+/-2.1%)
Kentucky 3.3 (+/-1.4%) 3.6 (+/-1.2%) 12.1 (+/-2.8%) 13.3 (+/-2.3%)
Louisiana 5.2 (+/-2.2%) 7.5 (+/-2.2%) 16.3 (+/-3.6%) 17.9 (+/-2.9%)
Maine 9.5 (+/-3.5%) 6.0 (+/-2.2%) 13.5 (+/-3.6%) 10.3 (+/-2.9%)
Maryland 3.3 (+/-1.0%) 4.2 (+/-1.0%) 8.1 (+/-1.5%) 5.4 (+/-1.0%)
Massachusetts 3.8 (+/-1.8%) 2.9 (+/-1.5%) 9.2 (+/-2.4%) 8.4 (+/-2.3%)
Michigan 3.5 (+/-1.4%) 2.9 (+/-1.1%) 7.0 (+/-1.8%) 6.1 (+/-1.6%)
Minnesota 3.0 (+/-1.0%) 3.2 (+/-0.9%) 7.3 (+/-1.5%) 4.7 (+/-1.1%)
Mississippi 5.0 (+/-2.3%) 5.2 (+/-1.9%) 12.7 (+/-3.3%) 9.5 (+/-2.6%)
Missouri 5.5 (+/-2.5%) 3.4 (+/-1.7%) 12.3 (+/-3.2%) 15.0 (+/-3.2%)
Montana 2.9 (+/-1.7%) 3.5 (+/-1.7%) 16.9 (+/-4.0%) 14.7 (+/-3.2%)
Nebraska 3.1 (+/-1.6%) 2.5 (+/-1.3%) 7.4 (+/-2.3%) 5.2 (+/-1.6%)
Nevada 4.6 (+/-2.0%) 6.8 (+/-2.1%) 9.4 (+/-2.5%) 8.9 (+/-2.2%)
New Hampshire 5.5 (+/-2.5%) 3.5 (+/-1.7%) 10.1 (+/-3.1%) 8.5 (+/-2.6%)
New Jersey 2.1 (+/-1.5%) 1.6 (+/-1.1%) 7.2 (+/-3.6%) 7.4 (+/-2.4%)
New Mexico 5.0 (+/-2.3%) 7.1 (+/-2.4%) 16.7 (+/-4.3%) 12.5 (+/-3.2%)
New York 3.6 (+/-1.5%) 4.1 (+/-1.3%) 12.1 (+/-2.8%) 8.1 (+/-1.9%)
North Carolina 5.8 (+/-1.7%) 4.1 (+/-1.2%) 9.0 (+/-1.9%) 9.4 (+/-1.7%)
North Dakota 3.3 (+/-1.4%) 2.5 (+/-1.1%) 11.2 (+/-2.7%) 7.6 (+/-2.2%)
Ohio 6.5 (+/-2.7%) 4.5 (+/-2.0%) 9.5 (+/-3.5%) 5.3 (+/-2.0%)
Oklahoma 4.1 (+/-2.0%) 3.7 (+/-1.8%) 14.9 (+/-3.4%) 12.4 (+/-2.9%)
Oregon 4.2 (+/-1.4%) 5.6 (+/-1.6%) 11.6 (+/-2.2%) 9.5 (+/-1.8%)
Pennsylvania 4.1 (+/-1.4%) 3.7 (+/-1.2%) 8.6 (+/-2.0%) 6.0 (+/-1.4%)
Rhode Island 6.4 (+/-2.3%) 4.0 (+/-1.7%) 9.8 (+/-2.6%) 5.0 (+/-1.7%)
South Carolina 3.6 (+/-1.5%) 4.0 (+/-1.5%) 8.0 (+/-2.2%) 10.7 (+/-2.5%)
South Dakota 2.0 (+/-1.1%) 3.0 (+/-1.5%) 8.4 (+/-2.3%) 7.2 (+/-1.9%)
Tennessee 7.3 (+/-2.4%) 5.2 (+/-1.6%) 7.5 (+/-2.2%) 5.1 (+/-1.6%)
Texas 3.8 (+/-1.7%) 4.5 (+/-1.5%) 17.1 (+/-3.9%) 13.1 (+/-2.6%)
Utah 5.2 (+/-1.7%) 4.5 (+/-1.5%) 8.5 (+/-2.3%) 6.8 (+/-1.6%)
Vermont 4.2 (+/-1.5%) 2.4 (+/-1.0%) 11.8 (+/-2.4%) 9.2 (+/-2.0%)
Virginia 3.2 (+/-1.6%) 6.0 (+/-1.6%) 6.7 (+/-2.3%) 8.6 (+/-2.1%)
Washington 4.5 (+/-1.3%) 4.4 (+/-1.2%) 10.7 (+/-2.0%) 7.1 (+/-1.4%)
West Virginia 3.9 (+/-1.6%) 5.2 (+/-1.4%) 13.5 (+/-2.8%) 15.7 (+/-2.5%)
Wisconsin 4.3 (+/-2.3%) 2.5 (+/-1.2%) 5.6 (+/-2.0%) 5.2 (+/-1.7%)
Wyoming 5.3 (+/-1.6%) 5.7 (+/-1.6%) 13.4 (+/-2.5%) 12.3 (+/-2.2%)
Range 2.0-10.3 1.6-8.5 3.8-17.1 2.0-17.9
Median 4.2 4.1 10.6 8.6
-----------------------------------------------------------------------------------------------------------------------------
* Lacked insurance for <12 months. + Lacked insurance for>=12 months.
& Confidence interval.
=============================================================================================================================
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