January 2001 (Vol. 1, No. 6)
Who Are The Uninsured in Wisconsin?
By Catherine Frey

Catherine Frey, MPH, MPA was formerly the Director of Outreach and is currently consultant to the Network.

According to the 1999 Wisconsin Family Health Survey (FHS), 4% or 220,000 people in Wisconsin did not have health insurance for the entire year. Compared to 1998, this number has remained steady and Wisconsin continues to have one of the lowest uninsured rates in the country. Nevertheless, the number of people who had gaps in health insurance coverage or were insured for only part of the year increased from 6% in 1998 to 8% in 1999. Combined, it means that an estimated total of 646,000 or13% of people in Wisconsin were uninsured for all or part of 1999.1

For the thousands of people in Wisconsin who do not have health insurance, financial barriers are the most common reason for lack of health coverage. Persons who are uninsured are more likely to be in fair or poor health for reasons related to access to health care providers and lower utilization rates of health care services. This Issue Brief will focus on who the remaining uninsured are in Wisconsin and current State initiatives to improve health insurance coverage and reduce the number of uninsured.

Characteristics of the Uninsured and Health Insurance Coverage

Employment and Education
The uninsured in Wisconsin are predominantly workers and their families. According to the 1999 FHS, 80% of the uninsured adults were employed, with about 62% being full time workers (Figure 1). Furthermore, 96% of children 17 and under who were uninsured for all or part of the past year, lived in households where there was an employed adult. Persons with less than a high school diploma were more that twice as likely to be uninsured for the entire year than those with a high school diploma or beyond.
Figure 1

Family Income
Low income individuals and families are disproportionately uninsured in Wisconsin. In the FHS, 63% of the population who were uninsured for all or part of the year were poor or near poor or below 200% of the Federal Poverty Guidelines. While affording health insurance is not just a problem for families or individuals with lower incomes, the percentage is significantly lower in comparison with only 7% of not poor persons being uninsured for part or all of the year. (Figure 2)
Figure 2

Gender and Age
The uninsured are predominantly under the age of 65 because almost all elderly have health insurance coverage through the Medicare program. In Wisconsin, young adults between 18-44 were most likely to be uninsured for all or part the year. For children between 0 and 17 years, 14% or nearly one out of every 6 children in Wisconsin were uninsured for part or all of the past year. Adult males have a slightly higher in Wisconsin were uninsured for part or all of the past year. Adult males have a slightly higher percentage rate of being uninsured than females over the age of 45, while males and females have similar percentages between the ages of 18 and 44. (Figure 3)
Figure 3

Among ethnic groups, Hispanics and African Americans were disproportionately uninsured for part or all of the past year compared to white, non-Hispanics. Hispanics were far more likely to be uninsured for the entire year than the other two population groups. From the FHS, 33% of African Americans were uninsured for part or all of the year compared with 26% for Hispanic and 11% for white, non-Hispanic. (Figure 4)
Figure 4

Families and individuals living in non-metropolitan as well as metropolitan areas experience problems with lack of health insurance in Wisconsin. Among the uninsured for all or part of the year, the greatest percentage of individuals were persons living in Milwaukee County at 23%. However, persons living in non-metropolitan areas were slightly more likely to be uninsured uninsured for all or part of the year at 14% compared to those living in metropolitan areas (excluding the city of Milwaukee) at 10%. By definition metropolitan areas include 20 Federally designated counties in Wisconsin including Milwaukee County. The other 52 counties are designated as non-metropolitan.

State Programs and Initiatives

Wisconsin has several current and relatively new initiatives and programs that have been implemented to provide or extend health insurance coverage to individuals and families. The nature of employer-based coverage, the percentage of families who are low-income or high risk and the extent of the State Medicaid program provide the basis for these initiatives. Wisconsin programs include the HIRSP (Health Insurance Risk Sharing Plan) and Medicaid expansion programs including Healthy Start and BadgerCare. Other initiatives include guaranteed availability for small employers, limits on premium variation for small employers and state tax credits or deductions for private coverage.

Evidence of Wisconsin’s success in lowering the rate of uninsurance among children and lower income families is encouraging. The 1999 FHS result did not reflect the impact of the BadgerCare program, Wisconsin’s nationally recognized state health insurance plan that began on July 1, 1999. December 2000 figures from Wisconsin Department of Health and Family Services (DHFS) reports that over 78,000 lower income adults and children have been enrolled in BagerCare since the program began.

In September of last year, Wisconsin was one of 11 states that was awarded a US Department of Health and Human Services State Planning Grant to provide an in depth analysis of the uninsured in the State. In Wisconsin, the $1.3 million grant will support new research to gain a better understanding of the demographic and economic characteristics of the uninsured in Wisconsin and analyze options to extend coverage to this population. To accomplish this, DHFS has two primary strategies. First, to maximize the effectiveness of the State’s current program models through Medicaid and the BadgerCare program as well as the private employer purchasing pool. Second, to identify effective use of resources to target and expand access for the remaining uninsured.

In summary, the 1999 Family Health Survey shows that the uninsured in Wisconsin are most likely to be low income but working adults or children in families with working parents. Many of these families reside throughout the state in rural as well as urban areas. They are also disproportionately African American or Hispanics. Tackling the uninsured problem requires an understanding of the nature of these population groups. The State Planning Grant will play a vital role in characterizing the needs of this diverse population.

1 Wisconsin Health Insurance Coverage 1999, Family Health Survey (FHS), Wisconsin Department of Health and Family Services, Bureau of Health Information.