The National Center for Health Statistics (NCHS) reports that 18% of Americans between the ages of 18 and 64 are living without health coverage, and the proportion rises to 23% among blacks and to 40% among Hispanics. While the percentage of uninsured adults does not appear to be on the rise according to NCHS, Gallup's annual Minority Rights and Relations poll* indicates that more Americans than ever say there have been times during the past year when they were unable to pay for health expenses.
In June 2004, nearly 3 in 10 Americans (28%) said there have been times in the last year when they haven't been able to afford medical care -- nearly double the percentage who said so in 1976 (15%). And consistent with NCHS findings, the Gallup Poll shows that blacks and Hispanics are far more likely than non-Hispanic whites to report being unable to pay for healthcare at some point.
The link between race/ethnicity and the ability to pay for healthcare is strong. Hispanics are nearly twice as likely as non-Hispanic whites to report not being able to pay for healthcare (44% vs. 23%). Among blacks, 38% report that there were times in the past year when they were unable to pay for medical or health expenses. While the number of blacks reporting an inability to pay for healthcare has dropped markedly over the past 20 years (from 51% in 1984 to 38% today), the downward trend appears to have leveled more recently.
Gallup also asked respondents about their ability to pay for two other basic necessities -- food and clothing -- in the past 12 months, but here the data show no comparable increase in people's inability to pay for food and clothing over roughly the same period.
Differences by Other Demographic Groups
Naturally, socioeconomic factors such as annual household income are strongly linked to ability to pay for healthcare. Adults living in households earning less than $20,000 a year are more than twice as likely to report not being able to pay for healthcare as those with annual incomes of $50,000 to $75,000 (52% vs. 19%). Forty percent of Americans in households earning between $30,000 and $50,000 per year report not being able to pay for healthcare expenses. The proportion drops to 8% among those with household incomes of $75,000 or more.
Bottom Line
While the ranks of uninsured adults may not be on the rise, Gallup's data suggest that out-of-pocket medical costs for Americans, and especially blacks and Hispanics, may prevent some from seeking the care they need. A recent Gallup survey conducted for the College of American Pathologists found that 11% of Americans do not seek preventative health screening, either because they cannot afford it or because they have no insurance (see "Confusing Guidelines Barrier to Health Screening" in Related Items).
According to a report by the Center for Studying Health System Change, one in seven families in the United States -- most of which are already covered by health insurance -- also struggle with debt from medical expenses. Insurance or no insurance, the escalating cost of healthcare is causing financial struggles for millions of Americans.
*The results are based on telephone interviews with a national sample of 2,250 adults, aged 18 and older, conducted June 9-30, 2004. For results based on this sample, one can say with 95% confidence that the maximum margin of sampling error is ±5 percentage points. In addition to sampling error, question wording and practical difficulties in conducting surveys can introduce error or bias into the findings of public opinion polls.
For results based on the sample of 816 non-Hispanic whites, aged 18 and older, the maximum margin of sampling error is ±6 percentage points.
For results based on the sample of 801 blacks, the maximum margin of sampling error is ±8 percentage points.
For results based on the sample of 503 Hispanics, the
maximum margin of sampling error is ±8 percentage points.
(164 out of the 503 interviews with Hispanics were conducted in
Spanish.)