Health Insurance:

An Overview of the Working Uninsured

HRD-89-45: Published: Feb 24, 1989. Publicly Released: Mar 8, 1989.

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In response to a congressional request, GAO provided information on the: (1) characteristics of working uninsured persons and their employers; (2) delivery and payment of their health care; (3) policy options available for providing health care to uninsured persons; and (4) limitations in existing data that make it difficult for policymakers to design comprehensive solutions to reduce the number of working uninsured persons.

GAO found that: (1) the uninsured were mostly young, nonwhite, single, poorly educated, and employed in low-income part-time jobs; (2) the businesses least likely to offer health insurance were those that provided low-wage, low-skill employment opportunities, businesses with fewer than 100 employees, new businesses, and businesses in the southern and western United States; (3) employers most frequently cited insufficient profits, high insurance costs, and restrictions on insurance availability to small businesses as reasons for not offering health insurance; and (4) health care costs rose nearly 280 percent between 1974 and 1984, while insurance premiums rose about 45 percent between 1980 and 1983. GAO also found that the uninsured: (1) were most likely to obtain health care at public and teaching hospitals in metropolitan areas; (2) incurred most of their medical expenses for maternity and accidents; and (3) typically experienced more complex and acute health problems and, due to lack of health care, often required multiple medical treatments and more intense services. In addition, GAO found that: (1) federal, state, and local funds usually paid for health care services provided to the uninsured; (2) public and private hospitals frequently increased their charges to paying patients to cover their uncompensated care costs and charity care; (3) although the uninsured had lower total health care expenditures, they had higher out-of-pocket expenses than insured persons; and (4) policymakers had difficulty designing programs to reduce the number of uninsured workers because of the diversity of the working uninsured population and the lack of knowledge about the reasons workers did not have health insurance.

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