A Demographic Profile of Connecticut

Population Trends

Between 1970 and 1991, Connecticut's population grew by 8.5 percent, from 3.032 million to 3.289 million residents. The state's recession, beginning in early 1989 and lasting until late 1992, interrupted this pattern of steady growth, resulting in a modest decline of 0.05 percent from 1991 to 1995.

The recent improvement in Connecticut's economy is reflected in a slight increase in population. After reaching its lowest level since 1991 -- 3.271 million in 1995 -- the state's population grew last year by 3,500 to approximately 3.274 million residents.(see footnote 1)

Nevertheless, there is still reason for concern as Connecticut continues to have more people leave rather than locate to the state. Net domestic outmigration totaled 169,512 residents from 1990 to 1996. The good news is that outmigration was at its lowest level for the six-year period in 1996.

Connecticut's Diversity
The racial and ethnic composition of Connecticut is becoming increasingly diverse. As the following chart indicates, during the 5-year period from 1990 to 1994, the state's African-American, Asian, American Indian and Hispanic population increased in real terms even as the total population declined.

An Aging Population
Since 1992, the state's under-5 population of children has declined and is now below its level of 1990. The decline in the under-5 population corresponds to the state's net outmigration during this period as more families, including those with very young children, have left rather than located to the state. An improved economy, therefore, can be expected to result in an increased number of working families and a corresponding increase in the number of children under 5 years of age.

In contrast, for many years there has been a steady growth in the number of elderly state residents. Because the majority of over 65 residents are no longer working, their demographics are relatively unaffected by the economy.

Note: On December 30, 1996, the Bureau of the Census issued revised data for total state population and net domestic migration which were incorporated into the analysis of those two demographic factors. However, unrevised total figures were used in the discussion of selected age groups, because the numbers for those population segments were not updated.

The aging of Connecticut's population mirrors a national phenomenon; however, the state's median age is greater than for the country as a whole. In 1995, the national median age for the United States was 34.3; Connecticut's was 35.9.

Poverty in Connecticut
In last year's report, this office noted that 10.8 percent of state residents were below the federal poverty level in 1994. An encouraging development is the decline in the state's poverty rate in 1995, to 9.7 percent. For reference purposes, a family of four with an annual income of $15,600 or less would have been below the 1996 federal poverty level.

Demographics of the Uninsured

From 1990 to 1994, the proportion of Connecticut residents without health insurance increased from 8.5 percent to 12.2 percent of the non-elderly population. This trend mirrored Connecticut's declining economic fortunes through the recession. The state lost jobs in sectors that have traditionally included health benefits -- defense, manufacturing and insurance, for instance -- while it gained service sector jobs that are less likely to provide coverage.

In 1995, the uninsured population appears to have declined somewhat -- to 10.1 percent -- perhaps due to an improving state economy. However, this still represented 284,000 uninsured non-elderly residents, including 80,000 children according to the Census Bureau. An additional 5,000 residents age 65 or over were estimated to be uninsured in 1995 as well. Thus, it is still too early to tell whether this decrease in the uninsured population represents a one-year aberration or the beginning of a new trend.

It is important to note that the Census Bureau's point estimate represents a snapshot in time. In other words, on any given day in 1995, an estimated 289,000 Connecticut residents lacked health insurance. National data for previous years indicate that a larger number of individuals were uninsured at some point over the course of the year.

In 1993, for example, 51.3 million people -- one in five Americans -- were uninsured for some time during the year. Of these, 18.2 million (35 percent) were without insurance for the entire year. Another 22 million (or 43 percent) went without coverage for 4-11 months, while the remaining 11.1 million (22 percent) were uninsured for 1-3 months. (see footnote 2)

Who are the Uninsured?
One available source for demographic information on the uninsured comes from the March Current Population Survey (CPS), which is conducted each year by the U.S. Bureau of the Census. Nationwide, 60,000 households are interviewed on a variety of demographic and socioeconomic topics, including health insurance coverage. Due to the size of the sample, health care analysts tend to merge three years worth of data, so that meaningful conclusions can be drawn at the state level. A 1995 publication by the Urban Institute used this approach to provide a state-by-state demographic profile of the uninsured.(see footnote 3)

The merged data comes from the 1991-1993 March Current Population Surveys and covers calendar years 1990-1992 (weighted more heavily toward the most recent year). The data show Connecticut's uninsured are a diverse group, coming from different income levels, age groups and family types.(see footnote 4)

The Uninsured by Age
Virtually all Americans without health insurance are under age 65 because Medicare provides coverage for nearly all elderly citizens. The vast majority of Connecticut's uninsured population fell between the ages of 18 and 64 -- reflecting the dominance of working individuals among the uninsured. Overall, the 18 to 34 group was the most likely to be uninsured, representing 46 percent of Connecticut's uninsured. After that, the chances of being uninsured declined with age. Those 35 to 53 represented 27 percent of the uninsured, while those between 54 and 64 made up another 8 percent. Children -- those under age 18 -- represented 19 percent of the uninsured in Connecticut.

Income Level
Between 1990 and 1992, poor and moderate income families were disproportionately represented among the uninsured. In general, the higher one's income, the less likely he or she was to be uninsured. The one exception to this pattern, however, involved those below the poverty level. Those slightly above poverty were more likely to be uninsured than those below. This is due to the presence of Medicaid, which acts as a safety net for the poor who qualify for that program.

However, many low-income individuals are not eligible for Medicaid. A total of 19 percent of Connecticut's uninsured were poor, living under the federal poverty level (FPL). Another 34 percent of the uninsured were "near poor," living between 100 and 199 percent of the FPL. Families between 200 and 399 percent of the FPL made up 34 percent of the uninsured. The remaining 13% came from families living at or above 400 percent of the FPL.

In Connecticut, where health care costs are among the highest in the nation, the cost of individual non-group policies are beyond the means of many families -- even those who are well above federal poverty standards. Family premiums for these policies vary widely, but can cost $6,000 per year or more. For a family of three that earns 300 percent of the FPL ($38,940 per year) this premium would represent over 15 percent of their gross annual income.

Type of Family
About half of Connecticut's uninsured were single with no dependents between 1990 and 1992. Married people with children made up nearly a quarter of the uninsured, while couples with no children represented an additional 14 percent. Finally, single-parent families made up the remaining 12 percent of Connecticut's uninsured residents.

In part, the dominance of singles (including single parents) among the uninsured can be explained through economic factors. Overall, married couples tend to have higher incomes, especially if both adults are working. In addition, if both are in the work force, there is a higher probability that the family has access to employer-based coverage. If not for the existence of the Medicaid program -- which serves those on Aid to Families with Dependent Children (AFDC), among others -- single parent families would make up a much greater proportion of the uninsured.

Attachment to the Work Force
Significantly, during the period of 1990-1992, the vast majority of the uninsured were from working families. More than 7 in 10 uninsured households in Connecticut had at least one adult who worked full-time and another 15 percent had at least one adult who worked part-time. Only 12 percent of uninsured households were headed by adults who were not in the work force.

Size of Firm
From 1990 to 1992, Connecticut's uninsured were much more likely to work for small- and medium- size firms. About 52 percent of the uninsured were employed by firms with fewer than 25 employees. Another 13 percent worked for firms with between 25 and 99 employees. The rest (35 percent) worked for firms with 100 or more workers.

There are a number of reasons for this trend. National data show that small firms are much less likely to offer coverage to their employees than larger ones. Small firms' per capita costs for health insurance are significantly higher than their larger counterparts. In part, this is due to the higher risks and higher average administrative costs associated with small businesses. Larger firms can spread risk and administrative costs over more workers. In addition, these firms have more clout in the market place when negotiating rates with health insurers.

As a result, the employees of small firms are disproportionately represented among the uninsured. A recent ten-state survey conducted by RAND showed that even though small firms (fewer than 25 workers) employed 34 percent of the workforce, their employees represented 57 percent of uninsured workers. By contrast, while medium size firms (25-99 workers) employed 13 percent of the workforce, their employees represented 12 percent of uninsured workers. Finally, larger firms (100+ workers) employed 54 percent of the workforce; however, their employees represented 31 percent of uninsured workers.

What about Medium and Large Firms?
While the issues involving small employers are clearly very significant, they do not account for the whole problem. Over 40 percent of uninsured workers are employed by medium and large firms. How can this be explained? Are the existing gaps in the employer-based system a problem of supply -- that is, a failure of employers to offer insurance -- or a lack of demand to enroll on the part of employees? Two researchers, Long and Marquis, have done extensive work in this area and have concluded that the gaps in coverage are largely a failure of supply. Though somewhat dated, their data show near universal acceptance of insurance among employees that are offered the opportunity to participate. However, a significant group of employees are not eligible for coverage -- even if their employer does offer it to some workers. These employees are mostly part-time or temporary workers, low income, and tend to have jobs in service-related industries or agriculture.(see footnote 5)

Using national Census Bureau data (from the 1988 Current Population Survey), Long and Marquis found that over three-quarters of all workers (ages 18 to 64) are offered health insurance by their employers. Among those offered insurance, 87 percent (66 percent of all workers) participate in the plan. Eleven percent of those eligible decline it because they have other coverage, usually through a spouse. Only about 2 percent of employees who are eligible to participate turn down an employer offer and remain uninsured.

About one-quarter of workers do not have access to employer-sponsored health insurance through their own employer. About 6 percent of workers are employed in firms that offer health insurance to employees but are not eligible themselves. Full-time employment is a common requirement and over half of ineligible employees work fewer than 35 hours per week. Some of those ineligible for their employer's health coverage have been with the firm for fewer than three months (which probably reflects waiting period requirements). Eighteen percent of workers are in firms that do not offer insurance.

The researchers note that the majority of workers in firms that do not offer insurance are low wage earners. Two-thirds of them earn wages of less than $7.00 per hour, and 41 percent earn less than $5.00 per hour. In addition, many who work in firms not offering insurance and many who do not enroll in their employer plan are part-time workers. Among the former, 36 percent work fewer than 35 hours per week; among the latter, 30 percent work fewer than 35 hours per week.

Lastly, the Long and Marquis point out that about 25 percent of workers in firms of all sizes that do not offer insurance are young -- under age 25. By contrast, for firms that do offer coverage, only 15 percent of their workforce is young.

Thus, from this national data, a fairly clear profile of uninsured workers begins to emerge:

• A disproportionate number work for small firms;
• The majority are low wage earners;
• Many are part-time employees or temporary workers;
• Many experience significant amount of job turnover; and
• A quarter are young -- under age 25.

1. Last year's Comptroller's Report addressed the decline in urban population within the state by comparing various town populations. Due to the federal government shutdown in late 1995, revised estimates were not available for analysis and inclusion in this report.
2. Henry J. Kaiser Family Foundation. Uninsured in America: Straight Facts on Health Reform (April 1994). Original Source: Lewin/VHI.
3. Winterbottom, C; Liska D.; and Obermaier, K. State Level Databook on Health Care Access and Financing (The Urban Institute, January 1995).
4. For purposes of illustration, 1996 federal poverty level for annual income is: $7,740 for an individual, $10,360 for a couple, $12,980 for a family of three and $15,600 for a family of four.
5. Long, Stephen H. and Marquis, M. Susan. " Gaps in Employer Coverage: Lack of Supply or Demand?" Health Affairs (Supplement 1993).