Products - Data Briefs - Number 11 - December 2008 - CDC

Marriage affects health insurance coverage. As marriage rates in the United States decline (1), fewer women will have the opportunity to obtain ... Skipdirectlytositecontent Skipdirectlytopageoptions SkipdirectlytoA-Zlink NationalCenterforHealthStatistics SectionNavigation CDCHome Facebook Twitter LinkedIn Syndicate MaritalStatusisAssociatedWithHealthInsuranceCoverageforWorking-ageWomenatallIncomeLevels,2007 Minus RelatedPages OnThisPage KeyfindingsOverall,unmarriedwomenaged25-64yearsareabout60%morelikelythanmarriedwomentolackhealthinsurancecoverage,butthatdisadvantageisnotconsistentacrosspovertystatusgroups.Atanyleveloffamilyincome,unmarriedwomenaged25-64yearsaremorelikelythanmarriedwomentohaveMedicaidorotherpubliccoverage.Marriedwomenaged25-64yearsaremorelikelythanunmarriedwomentohaveprivatehealthinsurancecoverage.MarriedwomenandtheirspousesaremorelikelytohaveanofferofprivatehealthinsurancethroughanemployerthanunmarriedwomenSummaryDefinitionsDatasourceandmethodsAbouttheauthorsReferencesSuggestedcitation NCHSDataBriefNo.11,December2008 PDFVersionpdficon(453KB) byAmyB.Bernstein,Sc.D.;RobinA.Cohen,Ph.D.;KateM.Brett,Ph.D.;andMaryAnnBush,M.S. Keyfindings DatafromtheNationalHealthInterviewSurvey Overall,unmarried(divorcedornevermarried)womenaged25-64yearsaremorelikelytobeuninsured(21%)thanmarriedwomen(13%)inthesameagegroup.. Poormarriedwomenaremorelikelytobeuninsuredthanpoorunmarriedwomen,inpartbecausetheyarelesslikelytohaveMedicaidcoverage. Marriedwomenaremorelikelytohaveprivateinsurance,andlesslikelytohaveMedicaid,thanunmarriedwomen. Theprobabilityofanofferofhealthinsurancethroughanemployerincreaseswithfamilyincomeforbothmarriedandunmarriedwomen. Marriageaffectshealthinsurancecoverage.AsmarriageratesintheUnitedStatesdecline(1),fewerwomenwillhavetheopportunitytoobtainhealthinsurancecoveragethroughtheirspouse.Marriagecanalsoincreasefamilyincomeandmaymakehealthinsurancemoreaffordable.Becausepoorandlow-incomeunmarriedwomenaremorelikelytobeeligibleforMedicaidthantheirmarriedcounterparts,changesinMedicaideligibilitymayalsoaffectcoverageratesdisproportionatelyforpoorandlow-incomeunmarriedwomen. Keywords:Medicaid,privatehealthinsurance,maritalstatus,NationalHealthInterviewSurvey Overall,unmarriedwomenaged25-64yearsareabout60%morelikelythanmarriedwomentolackhealthinsurancecoverage,butthatdisadvantageisnotconsistentacrosspovertystatusgroups. Marriedwomenarelesslikelythanunmarriedwomentobepoor,butpoormarriedwomenaremorelikelythanpoorunmarriedwomentobeuninsured. Morethantwo-thirdsofwomenhavefamilyincomeat200%ofthefederalpovertylevelormore.Inthisincomegroup,unmarriedwomenaremorelikelytobeuninsuredthanmarriedwomen. Evenamongthosewithfamilyincomeatorabove400%ofthefederalpovertylevel,8%ofunmarriedwomenareuninsured-almostthreetimestherateformarriedwomen. Atanyleveloffamilyincome,unmarriedwomenaged25-64yearsaremorelikelythanmarriedwomentohaveMedicaidorotherpubliccoverage. UnmarriedwomenarealmostfourtimesaslikelyasmarriedwomentohaveMedicaid. Almostone-half(45%)ofpoorunmarriedwomenhaveMedicaidcomparedwithaboutone-quarterofpoormarriedwomen. Marriedwomenaged25-64yearsaremorelikelythanunmarriedwomentohaveprivatehealthinsurancecoverage. Thepercentagesofbothmarriedandunmarriedwomenwithprivateinsuranceincreasewithfamilyincome. Alargemajorityofmarriedandunmarriedwomenwithfamilyincomeatorabove400%ofthefederalpovertylevelhaveprivatecoverage. Marriedwomenwithfamilyincomesatorabove400%ofthefederalpovertylevelarealmostfourtimesaslikelytohaveprivateinsuranceasmarriedwomenlivinginpoverty;unmarriedwomeninthewealthiestgrouparemorethanfourtimesaslikelytohaveprivateinsuranceasunmarriedpoorwomen. Marriedwomenandtheirspousesaremorelikelytohaveanofferofprivatehealthinsurancethroughanemployerthanunmarriedwomen Thepercentageofwomenwiththeirownofferofhealthinsurancethroughanemployerincreaseswithincreasingfamilyincomeregardlessofmaritalstatus. Marriedwomenaremorelikelytohaveanofferofhealthinsurancethroughanemployerthanunmarriedwomen,becausetheymayhaveanoffereitherthroughtheirownworkplaceorthatoftheirspouse. Atalllevelsoffamilyincome,marriedwomenarelesslikelythanunmarriedwomentohavetheirownofferofprivateinsurancethroughtheiremployer. Summary Maritalstatusisanimportantpredictorofhavinghealthinsurancecoverageforwomenaged25-64years,inallpovertystatusgroups.UnmarriedwomenarelesslikelytohaveprivatehealthinsurancecoverageandmorelikelytohaveMedicaidcoverage,thanmarriedwomenacrossallincomegroups,withtheexceptionofwomenbetween150%and200%ofthefederalpovertylevel. PoorwomenaremorelikelythanwomenathigherincomestohaveMedicaidorotherpubliccoverage,becauseMedicaidwasdevelopedasasafetynetprogramformedicallyneedypoorandlowincomepersons(2).PoormarriedwomenarelesslikelytohaveMedicaidthanpoorunmarriedwomen,andsoamongpoorandlowincomewomenlivingbelow200%ofthefederalpovertylevel,marriedwomenareactuallymorelikelytobeuninsuredthanareunmarriedwomen.Amongwomenwithfamilyincomesatorabove200%ofthefederalpovertylevel,fewwomenhaveMedicaidcoverage,andunmarriedwomenaremorelikelytobeuninsuredthanmarriedwomen. Althoughunmarriedwomenaremorelikelytobeuninsured,morewomenaged25-64yearsaremarriedthanunmarried.Therefore,themajorityofuninsuredwomenaremarried.In2007,about6.5millionuninsuredwomenweremarriedcomparedwith5millionuninsuredwomenwhowerenotmarried(unpublishedestimatesfromtheNationalHealthInterviewSurvey). Private,employer-sponsoredcoverageremainsthemostcommonlyheldtypeofhealthinsurance(3),andmarriedwomenaremorelikelytohaveprivatecoveragethanunmarriedwomeninalmostallincomegroups.However,marriedpoorwomenaged25-64yearsare32%morelikelytohaveprivateinsurancethanunmarriedpoorwomen,whereasamongwomenatorabove400%ofthefederalpovertylevel,marriedwomenareonly7%morelikelythanunmarriedwomentohaveprivatecoverage.DecliningmarriageratesintheU.S.mayincreaseuninsuranceratesinthefuture. Definitions Healthinsurancecoverage:Broadlydefinedtoincludebothpublicandprivatepayorswhocovermedicalexpendituresincurredbyadefinedpopulationinavarietyofsettings.Thisincludespeoplecoveredbyprivatehealthinsurance,whetherofferedthroughemploymentorpurchasedindividually,andcoveragethroughpublicprogramssuchasMedicare,Medicaid,StateChildren’sHealthInsuranceProgram,andotherstate-sponsoredprograms.PersonswithonlyIndianHealthServicecoverageorhavingonlyaprivateplanthatpaidforonetypeofservicesuchasaccidentsordentalcarewerenotconsideredtobecoveredbyhealthinsurance.Inthisreport,coverageismeasuredatonepointintime,whichisthedayoftheNationalHealthInterviewSurvey(NHIS)interview. Marriedwomen:Classifiedasmarriediftheyrespondedthattheycurrentlyaremarried.IntheNHISallpersonsaged14yearsandolderareasked:“Areyounowmarried,widowed,divorced,separated,nevermarried,orlivingwithapartner?” Unmarried:Isindicatedwhenwomenreportthattheywerecurrentlydivorcedorthattheyhadneverbeenmarried.Widowsandwomenwhoreportedbeingseparated,orwhoreportedlivingwithapartnerbutwhodidnotreportbeingmarried,arenotincludedintheanalysisbecausetheirhealthinsurancecoveragestatusrelativetotheircurrentorlatespouseisunclear,basedonstatelawandsurvivorbenefitsstatus.About6%ofwomenaged25-64yearsreportedbeingseparatedorwidowed. Povertystatusorpercentageofthefederalpovertylevel:Basedonfamilyincome,familysize,andthenumberofchildreninthefamily,and,forfamilieswithtwoorfeweradults,ontheageoftheadultsinthefamily.ThefederalpovertylevelisbasedondefinitionsoriginallydevelopedbytheSocialSecurityAdministration.Theseincludeasetofincomethresholdsthatvarybyfamilysizeandcomposition.Familiesorindividualswithincomebelowtheirappropriatethresholdsareclassifiedasbelowthefederalpovertylevel.ThesethresholdsareupdatedannuallybytheU.S.CensusBureautoreflectchangesintheConsumerPriceIndexforallurbanconsumers(CPI-U).Formoreinformation,seeIncome,poverty,andhealthinsurancecoverageintheUnitedStates:2005.P60-231,SeriesP-60No231.Washington,D.C.U.S.GovernmentPrintingOffice,2005.AvailablefromtheU.S.CensusBureauwebsiteexternalicon. Privateinsurance:IndicatedwhenrespondentsreporttheywerecoveredatthetimeoftheirNHISinterviewbyprivatehealthinsurancethroughanemployer,union,oriftheypurchasedapolicyontheirown.Privatehealthinsuranceincludesmanagedcaresuchashealthmaintenanceorganizations(HMOs).Itdoesnotincludemilitaryhealthplans. Offersofemployer-sponsoredhealthinsurance:Indicatedbya“yes”responsetothefollowingquestion,whichwasaskedofallpersons18yearsofageandoverwhowereworkingforpayatajoborbusiness,orwithajoborbusiness,butnotatwork,orworkingbutnotforpayatafamily-ownedjoborbusiness:“Regarding[your/name’s]joborworklastweek,washealthinsuranceofferedto[you/name]through[your/name’s]workplace? Medicaid:IndicatedwhenrespondentsreporttheywerecoveredatthetimeoftheirNHISinterviewbyMedicaidorastatesponsoredhealthprogram,andarealsoconsideredcoveredbyMedicaidiftheyreportedcoveragebytheStateChildren’sHealthInsuranceProgram(SCHIP),orotherstate-sponsoredplans.Inthisanalysis,healthinsurancecategoriesarehierarchical,andwomencoveredbybothprivateinsuranceandMedicaidareconsideredtohaveprivateinsurance. Uninsuredstatus:Indicatedwhenrespondentsindicatetheydidnothavecoverageunderprivatehealthinsurance,Medicare,Medicaid,SCHIP,astatesponsoredhealthplan,othergovernmentsponsoredprograms,oramilitaryhealthplan(TRICARE,VA,orCHAMP-VA).ApersonwasalsodefinedasuninsuredifheorshehadonlyIndianHealthServicecoverageorhadonlyaprivateplanthatpaidforonetypeofservicesuchasaccidentsordentalcare. Datasourceandmethods Datafromthe2007NationalHealthInterviewSurvey(NHIS)wereusedforthisanalysis.TheNHISisconductedcontinuouslythroughouttheyearbyinterviewersoftheU.S.CensusBureaufortheCentersforDiseaseControlandPrevention’sNationalCenterforHealthStatistics(NCHS).TheNHIScollectsinformationaboutthehealthandhealthcareofthecivilian,noninstitutionalizedU.S.population.Interviewsareconductedinrespondents’homes,butfollow-upstocompleteinterviewsmaybeconductedoverthetelephone.Questionsabouthealthinsurancecoverageandoffersofhealthinsurancecoverageareaskedoffamilyrespondentsinthefamilycomponentofthesurvey.ThequestionsmaybeviewedontheNHISwebsitetheNHISWebsite.Inthe2007NHIS,informationwascollectedonatotalof75,764personsin29,266households.Thehouseholdresponseratewas87.1%.ForfurtherinformationabouttheNHIS,includingthequestionnaire,seetheNHISWebsite. TheNHISisdesignedtoyieldanationallyrepresentativesample,andthisanalysisusesweightstoproducenationalestimates.Dataweightingproceduresaredescribedinmoredetailelsewhere(NHISMethods).PointestimatesandestimatesofcorrespondingvariancesforthisanalysiswerecalculatedusingSUDAANsoftware(4)toaccountforthecomplexsampledesignoftheNHIS.TheTaylorserieslinearizationmethodwaschosenforvarianceestimation.AllestimatesshownmeettheNCHSstandardofhavingarelativestandarderrorlessthanorequalto30%.Differencesbetweenpercentageswereevaluatedusingtwo-sidedsignificancetestsatthe0.05level.Termssuchas“higherthan”and“lessthan”indicatestatisticallysignificantdifferences.Termssuchas“similar”and“nodifference”indicatethatthestatisticsbeingcomparedwerenotsignificantlydifferent.Lackofcommentregardingthedifferencebetweenanytwostatisticsdoesnotnecessarilysuggestthatthedifferencewastestedandfoundtobenotsignificant. Onlywomenaged25-64yearsareincludedinthisanalysisoftherelationshipbetweenmaritalstatusandhealthinsurancecoverage,becausemostwomenunderage25arenotmarried,andtheMedicareprogramcoversalmostallpeopleaged65yearsandover.Womenwithunknownmaritalstatus(1.3%)orunknownhealthinsurancecoverage(1%)areexcludedfromalltabulations. Estimatesbypovertystatusarebasedonbothreportedandimputedfamilyincome.Familyincomeinformationwascompletelymissingfor10.6%ofpersonsandwasreportedonlyintobroadcategoriesforanadditional23.6%ofpersonsin2007.Therefore,familyincomewasimputedfor34.2%ofpersonsin2007usingNHISimputedincomefiles(5). AppendixI.Selectedsociodemographiccharacteristicsamongmarriedandunmarriedwomenaged25-64years:UnitedStates,2007 PercentofWomenaged25-64years Maritalstatus Total%ofgroup SE Married%ofgroup SE Divorcedornevermarried%ofgroup SE Married 64.4 0.48 … … Divorced 13.6 0.29 … … Separated 3.2 0.14 … … Widowed 3.1 0.13 … … Nevermarried 15.7 0.35 … … PercentofWomenaged25-64years Povertystatus Total%ofgroup SE Married%ofgroup SE Divorcedornevermarried%ofgroup SE Allpovertylevels 100.0 … 100.0 … 100.0 … Below100%ofpoverty 10.7 0.32 5.9 0.27 17.4 0.67 100%tolessthan150% 8.2 0.24 6.2 0.25 11.3 0.50 150%tolessthan200% 8.4 0.26 6.9 0.29 10.7 0.56 200%tolessthan400% 29.5 0.43 28.9 0.54 31.0 0.77 400%ofpovertyormore 43.3 0.56 52.1 0.65 29.7 0.84 PercentofWomenaged25-64years Age Total%ofgroup SE Married%ofgroup SE Divorcedornevermarried%ofgroup SE Allwomen25-64years 100.0 … 100.0 … 100.0 … 25-34years 24.7 0.41 21.5 0.45 34.2 0.79 35-44years 26.6 0.37 28.3 0.45 24.4 0.68 45-54years 27.8 0.36 28.9 0.48 25.2 0.69 55-64years 20.9 0.35 21.3 0.44 16.3 0.58 SEisstandarderror. …Categorynotapplicable. NOTE:Womenwithunknownmaritalstatusandunknowninsurancestatusareexcludedfromtotals. DATASOURCE:CDC/NCHS,NationalHealthInterviewSurvey. Abouttheauthors AmyBernstein,KateBrett,andMaryAnnBusharewiththeCentersforDiseaseControlandPrevention’s(CDC)NationalCenterforHealthStatistics(NCHS),OfficeofAnalysisandEpidemiology;andRobinA.CoheniswithCDC’sNCHS,DivisionofHealthInterviewStatistics. References CherlinAJ.Americanmarriageintheearlytwenty-firstcenturypdficonexternalicon.Thefutureofchildren:Marriageandchildwell-being;15(2):33-56. CentersforMedicareandMedicaidServices(CMS)websiteexternalicon.NationalCenterforHealthStatistics.Health,UnitedStates,2007withchartbookontrendsinthehealthofAmericans.HyattsvilleMD:2007. NationalCenterforHealthStatistics.Health,UnitedStates,2007withchartbookontrendsinthehealthofAmericans.HyattsvilleMD:2007 ResearchTriangleInstitute.SUDAAN(Release9.1).ResearchTrianglePark,NC:ResearchTriangleInstitute.2004. SchenkerN,RaghunathanTE,ChiuP,MakucDM,ZhangG,CohenAJ.MultipleimputationoffamilyincomeandpersonalearningsintheNationalHealthInterviewSurvey:Methodsandexamplespdficon[PDF–813KB].August28,2008. Suggestedcitation BernsteinAB,CohenRA,BrettKM,BushM.Maritalstatusisassociatedwithhealthinsurancecoverageforworking-agewomenatallincomelevels,2007.NCHSdatabrief,no11.Hyattsville,MD:NationalCenterforHealthStatistics.2008. Copyrightinformation Allmaterialappearinginthisreportisinthepublicdomainandmaybereproducedorcopiedwithoutpermission;citationastosource,however,isappreciated. 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