Americans, especially blacks, spend substantial periods of time uninsured

Research Activities, July 2011, No. 371

Millions of Americans do not have health insurance. In fact, 46 million people were uninsured in 2008. Little research has been done that examines the risk of being uninsured and simultaneously being in poor health. James B. Kirby, Ph.D., from the Agency for Healthcare Research and Quality (AHRQ), and Toshiko Kaneda, Ph.D., from the Population Reference Bureau, shed light on this in their new study. They found that the typical American can expect to be uninsured for well over a decade during their life. Unfortunately, 40 percent of these uninsured years will be spent in less than excellent health and, therefore, at a high risk for medical need. Blacks spend more of their lives uninsured than whites, and the difference between blacks and whites in uninsured life expectancy comes entirely in less healthy years.

The study used mortality data from published period life tables provided by the National Center for Health Statistics and data on health and insurance status on 34,403 individuals participating in the Medical Expenditure Panel Survey in 2004. The proportion of person-months with no health insurance was lowest during childhood regardless of race. Uninsured status peaked among young adults aged 20-24 and declined thereafter. Interestingly, blacks under age 20 spent less time uninsured than similar-aged whites. However, once childhood is over, blacks spend a higher proportion of time without health insurance. During ages 20-24, blacks spend 43 percent of their time being uninsured compared with 36 percent of whites.

Differences between blacks and whites were particularly large between the ages of 50 and 60, when health begins to decline and Medicare coverage has yet to take effect. For blacks, time spent being uninsured increases with age and is most prominent between ages 55 and 59. The proportion of time spent both uninsured and unhealthy continues to be high as individuals enter the near-elderly years, especially for blacks. In conclusion, although blacks have a shorter life expectancy, they have a longer uninsured life expectancy than whites and can expect to spend a higher proportion of their uninsured years in a less healthy state.

More details are in "Unhealthy and uninsured: Exploring racial differences in health and health insurance coverage using a life table approach," by Drs. Kirby and Kaneda, in the November 2010 Demography 47(4), pp. 1035-1051. Reprints (AHRQ Publication No. 11-R037) are available from the AHRQ Publications Clearinghouse.

Page last reviewed July 2011
Internet Citation: Americans, especially blacks, spend substantial periods of time uninsured: Research Activities, July 2011, No. 371. July 2011. Agency for Healthcare Research and Quality, Rockville, MD.