Order Code 96-979 EPW Updated January 11, 2002 CRS Report for Congress Received through the CRS Web Health Insurance: Uninsured by State, 2000 Paulette C. Morgan Analyst in Social Legislation Domestic Science Policy Division Summary An estimated 14.0% of the U.S. population lacked health insurance coverage in 2000, down from 14.3% in 1999. When examined by state, estimates of the percent uninsured ranged from a low of 5.9% in Rhode Island to a high of 23.8% in New Mexico. Generally, states in the Midwest and New England have lower rates of uninsured, while states in the Southwestern portion of the nation have higher shares of their populations without coverage. These state-level estimates are based on the March 2001 Current Population Survey (CPS), and must be interpreted with caution because they are based on survey samples. When sampling variation is taken into account, to allow one to say with 90% reliability that the percent uninsured in the state lies between specified low and high estimates, the uninsured rate in 14 states and the District of Columbia is not different statistically from the uninsured rate nationwide. The uninsured rate is statistically lower than the national rate in 24 states, and statistically higher in the remaining 12 states. State-level analysis is only one way to examine data about health insurance coverage. Some factors related to the percent of a state’s population that is uninsured may be affected by the state, such as eligibility criteria for the state’s Medicaid and State Children’s Health Insurance programs or other programs for those lacking health insurance. Other factors may be beyond the state’s direct control, such as the willingness of employers to offer coverage and the financial resources of the state’s population to purchase coverage. This report will be updated annually, when new data become available. For related information, see CRS Report 96-891, Health Insurance Coverage: Characteristics of Insured and Uninsured in 2000, and CRS Report 97-310, Health Insurance: Uninsured Children by State, 1998-2000. Congressional Research Service ˜ The Library of Congress CRS-2 Estimates of The Uninsured by State An estimated 14.0% of the U.S. population lack health insurance coverage in 2000, down from 14.3% in 1999.1 Table 1 shows that the estimated percent of each state’s population that lacked health insurance2 coverage in 2000 ranged from a low of 5.9% in Rhode Island to a high of 23.8% in New Mexico. Eleven states3 had estimated uninsured rates less than 10% and 2 states4 had estimated rates greater than 20%. Generally, states with the lowest rates of uninsurance were located in the upper Midwest and Northeast; states with the highest rates were in the Southwest (Figure 1). These estimates of the percent of the state population without health insurance coverage are based on data from the March 2001 Current Population Survey (CPS). The CPS is representative of the civilian, noninstitutionalized population, and is designed to produce reliable estimates at the national, regional and state level. The small sample sizes available from the CPS for many states make it prudent to consider state-level estimates in terms of a range of values. This range is based on sampling theory, and takes into account the size of the sample. Table 1 shows the best point estimates, or single values, for the numbers of people covered and not covered by health insurance, and the percent uninsured by state.5 The table also reports a range in values for these numbers and percentages. The size of the range depends primarily upon the sample size. Table 1 shows ranges based on a 90% confidence interval. A 90% confidence interval means that given repeated sampling of health insurance coverage in a state, 9 out of 10 times, the estimate of the percent uninsured (or number covered or not covered) will lie within the range set by the low and high estimates. For example, if one surveys people in Rhode Island about health insurance coverage, in 9 out of 10 sample surveys, on average, the percent uninsured in Rhode Island will be between 4.9% and 6.9%.6 1 Due to a change in the way the number of uninsured are calculated, rates of uninsured in this report are not comparable to any previous version of this report. 2 Health insurance includes, but is not limited to: Medicare; Medicaid; S-CHIP; TRICARE or the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); the Civilian Health and Medical Program of the Department of Veteran’s Affairs (CHAMPVA); Veteran’s Administration health care; military health care; other government provided health care; employer/union-provided insurance; and privately purchased insurance. 3 Rhode Island (5.9%), New Hampshire (6.9%), Wisconsin (7.1%), Pennsylvania (7.6%), Connecticut (7.9%), Iowa (8.7%), Minnesota (9.0%), Massachusetts (9.5%), Maryland (9.8%), Michigan (9.9%), and Nebraska (9.9%). 4 Texas (21.5%), and New Mexico (23.8%). 5 Table 1 shows states sorted by the percent uninsured. Table 2 reports the same data but sorts states alphabetically. 6 Note that there is no way to determine if the results for Rhode Island in Table 1 are the 1 time out of 10 that a different result is obtained, where the real percent uninsured is outside the confidence interval (i.e., less than 4.9% or greater than 6.9%). CRS-3 Because of the uncertainty about state-level estimates of the percent uninsured, a more statistically conservative comparison across states takes ranges of values into account. This is done in Figure 2, which groups states according to differences from the nationwide percent uninsured, considering the estimated ranges in the percent uninsured by state. When statistical variation is taken into account, 14 states and the District of Columbia have percents uninsured that are not statistically different from the nationwide rate of 14.0%. (The nationwide percent uninsured has a range in estimates of between 13.8% and 14.1%.) These 14 states and the District of Columbia have percents uninsured ranging from a low point estimate of 12.7% in Virginia (with a range in estimates between 11.5% and 13.9%) to a high point estimate of 14.6% in Georgia (with a range in estimates between 13.4% and 15.8%.) Twenty-four states have percents uninsured that are statistically lower than the nationwide rate. These states include all states in New England, most states in the Midwest, a few states in the eastern United States, and South Carolina. The remaining 12 states, arrayed across the South and Southwest from Louisiana to California, as well as Florida, Idaho, Montana, and New York, have uninsured rates that are statistically higher than the nationwide rate. Reasons for Differences in the Percent Uninsured Figures 1 and 2 indicate that residents of the Southwestern United States are more likely to lack health insurance and residents of the Midwest and New England are more likely to be covered. Various state characteristics may account for these differences. Nationwide, the percent uninsured is related to employment by industry, with workers in mining, manufacturing of durable goods, professional services, finance/insurance, and public administration industries most often covered by health insurance and those employed in agriculture, and personal services least often covered. Employees who work for large firms, and their dependents, are more likely to be covered than those who work for small firms. Union members are more likely to be covered. The prevalence of particular industries, firm sizes, or unionization may account for some of the regional or state variation in percents uninsured.7 Some factors related to the percent of a state’s population that is uninsured may be affected by state’s policies, such as eligibility criteria for the state’s Medicaid program or the State Children’s Health Insurance Program. Other factors may be beyond the state’s direct control, such as the willingness of employers to offer coverage and the financial resources of the state’s population to purchase coverage. Only Hawaii has implemented state legislation mandating that an employer offer coverage, which is augmented with a health insurance program for the unemployed.8 7 For additional information, see CRS Report 96-891, Health Insurance Coverage: Characteristics of the Insured and Uninsured Populations in 2000, by Chris Peterson. 8 Hawaii received a congressional exemption from the Federal Employee Retirement and Income Security Act of 1974 (ERISA) to permit the employer mandate. No other state has received a similar exemption. CRS-4 Table 1. Number of People Covered and Not Covered by Health Insurance, and Percent Not Covered, By State, 2000 Sorted by Percent Uninsured (numbers in thousands) Rhode Island New Hampshire Wisconsin Pennsylvania Connecticut Iowa Minnesota Massachusetts Maryland Michigan Nebraska Hawaii Tennessee Delaware Vermont Missouri Ohio North Dakota Maine Kansas South Dakota South Carolina Indiana New Jersey Virginia Kentucky North Carolina Mississippi Colorado Washington Utah Alabama Illinois Oregon Arkansas West Virginia Wyoming D.C. Georgia New York Idaho Nevada Arizona Florida California Montana Louisiana Alaska Oklahoma Texas New Mexico U.S. Number covered Number not covered Point Range Point Range estimate Low High estimate Low High 881 841 921 55 45 65 1,155 1,104 1,206 85 71 99 5,032 4,842 5,222 386 333 439 11,063 10,817 11,309 905 833 977 3,056 2,922 3,190 263 224 302 2,615 2,511 2,719 248 216 280 4,354 4,186 4,522 430 377 483 5,661 5,498 5,824 595 542 648 4,618 4,425 4,811 501 437 565 8,964 8,745 9,183 982 909 1,055 1,494 1,433 1,555 164 144 184 1,039 993 1,085 117 101 133 5,003 4,805 5,201 577 509 645 705 675 735 82 72 92 564 539 589 67 59 75 4,930 4,732 5,128 586 517 655 10,284 10,039 10,529 1,255 1,168 1,342 538 515 561 69 61 77 1,121 1,072 1,170 145 127 163 2,306 2,212 2,400 301 267 335 615 590 640 82 73 91 3,321 3,181 3,461 448 396 500 5,117 4,914 5,320 701 625 777 7,257 7,072 7,442 1,049 978 1,120 6,091 5,862 6,320 886 798 974 3,462 3,325 3,599 513 460 566 6,541 6,352 6,730 980 906 1,054 2,425 2,330 2,520 364 327 401 3,665 3,524 3,806 563 507 619 5,075 4,867 5,283 780 698 862 1,913 1,843 1,983 296 269 323 3,851 3,700 4,002 600 540 660 10,627 10,381 10,873 1,659 1,560 1,758 2,935 2,813 3,057 465 416 514 2,261 2,172 2,350 364 328 400 1,524 1,465 1,583 254 230 278 418 401 435 70 63 77 434 414 454 73 65 81 6,638 6,406 6,870 1,135 1,038 1,232 15,608 15,329 15,887 2,802 2,681 2,923 1,061 1,020 1,102 196 178 214 1,680 1,614 1,746 311 283 339 4,124 3,971 4,277 793 726 860 12,537 12,275 12,799 2,620 2,498 2,742 28,454 28,012 28,896 6,281 6,064 6,498 714 685 743 162 148 176 3,423 3,285 3,561 810 743 877 522 500 544 125 114 136 2,651 2,544 2,758 636 584 688 16,167 15,837 16,497 4,425 4,248 4,602 1,366 1,309 1,423 427 395 459 237,857 n/a n/a 38,683 38,239 39,127 Percent not covered Point Range estimate Low High 5.9% * 4.9% 6.9% 6.9% * 5.8% 7.9% 7.1% * 6.2% 8.1% 7.6% * 7.0% 8.1% 7.9% * 6.8% 9.1% 8.7% * 7.6% 9.7% 9.0% * 7.9% 10.0% 9.5% * 8.7% 10.3% 9.8% * 8.6% 11.0% 9.9% * 9.2% 10.6% 9.9% * 8.7% 11.0% 10.1% * 8.8% 11.4% 10.3% * 9.2% 11.5% 10.4% * 9.2% 11.7% 10.6% * 9.4% 11.9% 10.6% * 9.4% 11.8% 10.9% * 10.2% 11.6% 11.4% * 10.1% 12.6% 11.5% * 10.1% 12.8% 11.5% * 10.3% 12.8% 11.8% * 10.5% 13.0% 11.9% * 10.6% 13.2% 12.0% * 10.8% 13.3% 12.6% * 11.8% 13.4% 12.7% 11.5% 13.9% 12.9% 11.7% 14.1% 13.0% 12.1% 13.9% 13.1% 11.8% 14.3% 13.3% 12.1% 14.5% 13.3% 12.0% 14.6% 13.4% 12.2% 14.6% 13.5% 12.2% 14.7% 13.5% 12.8% 14.3% 13.7% 12.3% 15.0% 13.9% 12.6% 15.1% 14.3% 13.0% 15.5% 14.3% 13.0% 15.7% 14.4% 12.9% 15.9% 14.6% 13.4% 15.8% 15.2% ** 14.6% 15.8% 15.6% ** 14.3% 16.9% 15.6% ** 14.3% 16.9% 16.1% ** 14.9% 17.4% 17.3% ** 16.5% 18.0% 18.1% ** 17.5% 18.7% 18.5% ** 17.1% 19.9% 19.1% ** 17.7% 20.6% 19.3% ** 17.9% 20.8% 19.3% ** 17.9% 20.8% 21.5% ** 20.7% 22.3% 23.8% ** 22.3% 25.4% 14.0% 13.8% 14.1% Source: Bureau of the Census, based on the March 2001 Current Population Survey; ranges computed by the Congressional Research Service. Notes: * indicates percent uninsured is statistically lower than the national rate; ** indicates percent uninsured is statistically higher than the national rate. Range represents low and high estimates given a 90% confidence interval. n/a indicates not applicable. CRS-5 Table 2. Number of People Covered and Not Covered by Health Insurance, and Percent Not Covered, By State, 2000 Alphabetical by State (numbers in thousands) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware D.C. Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming U.S. Number covered Number not covered Point Range Point Range estimate Low High estimate Low High 3,851 3,700 4,002 600 540 660 522 500 544 125 114 136 4,124 3,971 4,277 793 726 860 2,261 2,172 2,350 364 328 400 28,454 28,012 28,896 6,281 6,064 6,498 3,665 3,524 3,806 563 507 619 3,056 2,922 3,190 263 224 302 705 675 735 82 72 92 434 414 454 73 65 81 12,537 12,275 12,799 2,620 2,498 2,742 6,638 6,406 6,870 1,135 1,038 1,232 1,039 993 1,085 117 101 133 1,061 1,020 1,102 196 178 214 10,627 10,381 10,873 1,659 1,560 1,758 5,117 4,914 5,320 701 625 777 2,615 2,511 2,719 248 216 280 2,306 2,212 2,400 301 267 335 3,462 3,325 3,599 513 460 566 3,423 3,285 3,561 810 743 877 1,121 1,072 1,170 145 127 163 4,618 4,425 4,811 501 437 565 5,661 5,498 5,824 595 542 648 8,964 8,745 9,183 982 909 1,055 4,354 4,186 4,522 430 377 483 2,425 2,330 2,520 364 327 401 4,930 4,732 5,128 586 517 655 714 685 743 162 148 176 1,494 1,433 1,555 164 144 184 1,680 1,614 1,746 311 283 339 1,155 1,104 1,206 85 71 99 7,257 7,072 7,442 1,049 978 1,120 1,366 1,309 1,423 427 395 459 15,608 15,329 15,887 2,802 2,681 2,923 6,541 6,352 6,730 980 906 1,054 538 515 561 69 61 77 10,284 10,039 10,529 1,255 1,168 1,342 2,651 2,544 2,758 636 584 688 2,935 2,813 3,057 465 416 514 11,063 10,817 11,309 905 833 977 881 841 921 55 45 65 3,321 3,181 3,461 448 396 500 615 590 640 82 73 91 5,003 4,805 5,201 577 509 645 16,167 15,837 16,497 4,425 4,248 4,602 1,913 1,843 1,983 296 269 323 564 539 589 67 59 75 6,091 5,862 6,320 886 798 974 5,075 4,867 5,283 780 698 862 1,524 1,465 1,583 254 230 278 5,032 4,842 5,222 386 333 439 418 401 435 70 63 77 237,857 n/a n/a 38,683 38,239 39,127 Percent not covered Point Range estimate Low High 13.5% 12.2% 14.7% 19.3% ** 17.9% 20.8% 16.1% ** 14.9% 17.4% 13.9% 12.6% 15.1% 18.1% ** 17.5% 18.7% 13.3% 12.1% 14.5% 7.9% * 6.8% 9.1% 10.4% * 9.2% 11.7% 14.4% 12.9% 15.9% 17.3% ** 16.5% 18.0% 14.6% 13.4% 15.8% 10.1% * 8.8% 11.4% 15.6% ** 14.3% 16.9% 13.5% 12.8% 14.3% 12.0% * 10.8% 13.3% 8.7% * 7.6% 9.7% 11.5% * 10.3% 12.8% 12.9% 11.7% 14.1% 19.1% ** 17.7% 20.6% 11.5% * 10.1% 12.8% 9.8% * 8.6% 11.0% 9.5% * 8.7% 10.3% 9.9% * 9.2% 10.6% 9.0% * 7.9% 10.0% 13.1% 11.8% 14.3% 10.6% * 9.4% 11.8% 18.5% ** 17.1% 19.9% 9.9% * 8.7% 11.0% 15.6% ** 14.3% 16.9% 6.9% * 5.8% 7.9% 12.6% * 11.8% 13.4% 23.8% ** 22.3% 25.4% 15.2% ** 14.6% 15.8% 13.0% 12.1% 13.9% 11.4% * 10.1% 12.6% 10.9% * 10.2% 11.6% 19.3% ** 17.9% 20.8% 13.7% 12.3% 15.0% 7.6% * 7.0% 8.1% 5.9% * 4.9% 6.9% 11.9% * 10.6% 13.2% 11.8% * 10.5% 13.0% 10.3% * 9.2% 11.5% 21.5% ** 20.7% 22.3% 13.4% 12.2% 14.6% 10.6% * 9.4% 11.9% 12.7% 11.5% 13.9% 13.3% 12.0% 14.6% 14.3% 13.0% 15.5% 7.1% * 6.2% 8.1% 14.3% 13.0% 15.7% 14.0% 13.8% 14.1% Source: Bureau of the Census, based on the March 2001 Current Population Survey; ranges computed by the Congressional Research Service. Note: * indicates percent uninsured is statistically lower than the national rate; ** indicates percent uninsured is statistically higher than the national rate. Range represents low and high estimates given a 90% confidence interval. n/a indicates not applicable. CRS-6 Figure 1. Percent Uninsured by State, 2000 US average is 14.0% Percent uninsured 20% or more (2) 15.0 to 19.9% (10) 10.0 to 14.9% (28) Less than 10.0% (11) Figure 2. Percent Uninsured by State, 2000 Accounting for Statistical Variation in Estimates Percent uninsured Greater than US average (12) Same as US average (15) Less than US average (24)