Public versus employment-related health insurance: experience and implications for black and nonblack Americans.

Despite a complex web of private and public health insurance programs, over 6 million black and almost 31 million nonblack Americans were uninsured in 1985. Although the situation since 1980 had deteriorated relatively less for them, nonelderly blacks remained 1.5 times more likely to be uninsured. Because of differences in family structure and economic circumstances, blacks less frequently have employment-related insurance and are more often covered by a public program. Mandated employment-related insurance is less likely to benefit blacks than would expansion of Medicaid. A combined approach may be needed to reduce the total number of uninsured Americans.