Order Code 96-979 EPW Updated November 19, 2002 CRS Report for Congress Received through the CRS Web Health Insurance: Uninsured by State, 2001 Paulette C. Morgan Analyst in Social Legislation Domestic Science Policy Division Summary An estimated 14.6% of the U.S. population lacked health insurance coverage in 2001, up from 14.2% in 2000. When examined by state, estimates of the percent uninsured ranged from a low of 7.5% in Iowa to a high of 23.5% in Texas. Generally, states in the Midwest and New England have lower rates of uninsured, while states in the Southwestern and Southern portions of the nation have higher shares of their populations without coverage. These state-level estimates are based on the March 2002 Current Population Survey (CPS), and must be interpreted with caution because they are based on a survey sample. 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 3 states is not different statistically from the uninsured rate nationwide. The uninsured rate is statistically lower than the national rate in 31 states and the District of Columbia, and statistically higher in the remaining 16 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 2001, and CRS Report 97-310, Health Insurance: Uninsured Children by State, 1999-2001. Congressional Research Service ˜ The Library of Congress CRS-2 Estimates of The Uninsured by State An estimated 14.6% of the U.S. population lack health insurance coverage in 2001, up from 14.2% in 2000.1 Table 1 shows that the estimated percent of each state’s population that lacked health insurance2 coverage in 2001 ranged from a low of 7.5% in Iowa to a high of 23.5% in Texas. Thirteen 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 Midwest and Northeast; states with the highest rates were in the Southwest and South (Figure 1). These estimates of the percent of the state population without health insurance coverage are based on data from the March 2002 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 Iowa about health insurance coverage, in 9 out of 10 sample surveys, on average, the percent uninsured in Iowa will be between 6.8% and 8.2%.6 Because of the uncertainty about state-level estimates of the percent uninsured, a more statistically conservative comparison across states takes ranges of values into 1 This report uses population estimates based on the 2000 Census instead of 1990 Census. The CPS for 2001 also includes an expanded sample of households. Due to these changes, 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 Iowa (7.5%), Rhode Island (7.7%), Wisconsin (7.7%), Minnesota (8.0%), Massachusetts (8.2%), Delaware (9.2%), Pennsylvania (9.2%), South Dakota (9.3%), New Hampshire (9.4%), Nebraska (9.5%), Hawaii (9.6%), North Dakota (9.6%), and Vermont (9.6%). 4 New Mexico (20.7%), and Texas (23.5%). 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 Iowa 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 6.8% or greater than 8.2%). CRS-3 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, 3 states have percents uninsured that are not statistically different from the nationwide rate of 14.6%. (The nationwide percent uninsured has a range in estimates of between 14.4% and 14.8%.) These 3 states have percents uninsured ranging from a low point estimate of 13.6% in Montana (with a range in estimates between 12.6% and 14.6%) to a high point estimate of 14.8% in Utah (with a range in estimates between 14.0% and 15.6%.) Thirty-one states and the District of Columbia have percents uninsured that are statistically lower than the nationwide rate. These states include all states in New England and the Midwest, a few states in the eastern United States, as well as Washington, Oregon and Hawaii. The remaining 16 states, arrayed across the South and Southwest from Mississippi to California, as well as Florida, Georgia, Idaho, Wyoming, Alaska 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 Southern and 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 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 2001, 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, 2001 Sorted by Percent Uninsured (numbers in thousands) Iowa Rhode Island Wisconsin Minnesota Massachusetts Delaware Pennsylvania South Dakota New Hampshire Nebraska Hawaii North Dakota Vermont Connecticut Missouri Maine Michigan Virginia Ohio Tennessee Kansas Indiana Kentucky Maryland South Carolina D.C. Oregon Alabama New Jersey Washington West Virginia Illinois Montana North Carolina Utah New York Colorado Alaska Wyoming Idaho Arkansas Nevada Mississippi Georgia Florida Arizona Oklahoma Louisiana California New Mexico Texas U.S. Number covered Number not covered Percent not covered Point Range Point Range Point Range estimate Low High estimate Low High estimate Low High 2,645 2,581 2,709 216 198 234 7.5% * 6.8% 8.2% 963 942 984 80 73 87 7.7% * 7.2% 8.2% 4,927 4,817 5,037 409 378 440 7.7% * 7.0% 8.4% 4,530 4,426 4,634 392 361 423 8.0% * 7.3% 8.7% 5,802 5,677 5,927 520 482 558 8.2% * 7.7% 8.7% 719 699 739 73 66 80 9.2% * 8.5% 9.9% 10,983 10,805 11,161 1,119 1,061 1,177 9.2% * 8.7% 9.7% 670 654 686 69 64 74 9.3% * 8.6% 10.0% 1,139 1,113 1,165 119 111 127 9.4% * 8.7% 10.1% 1,523 1,484 1,562 160 147 173 9.5% * 8.8% 10.2% 1,096 1,068 1,124 117 107 127 9.6% * 8.9% 10.3% 561 546 576 60 55 65 9.6% * 8.9% 10.3% 549 536 562 58 53 63 9.6% * 8.9% 10.3% 3,047 2,976 3,118 346 323 369 10.2% * 9.5% 10.9% 4,960 4,842 5,078 565 524 606 10.2% * 9.5% 10.9% 1,147 1,121 1,173 132 124 140 10.3% * 9.6% 11.0% 8,864 8,703 9,025 1,028 972 1,084 10.4% * 9.9% 10.9% 6,331 6,176 6,486 774 720 828 10.9% * 10.2% 11.6% 9,943 9,767 10,119 1,248 1,184 1,312 11.2% * 10.7% 11.7% 5,042 4,904 5,180 640 591 689 11.3% * 10.5% 12.1% 2,341 2,283 2,399 301 280 322 11.4% * 10.6% 12.2% 5,322 5,204 5,440 714 670 758 11.8% * 11.1% 12.5% 3,505 3,413 3,597 492 457 527 12.3% * 11.5% 13.1% 4,673 4,561 4,785 653 610 696 12.3% * 11.5% 13.1% 3,517 3,427 3,607 493 458 528 12.3% * 11.5% 13.1% 484 469 499 70 65 75 12.7% * 11.7% 13.7% 3,018 2,939 3,097 443 413 473 12.8% * 12.0% 13.6% 3,815 3,715 3,915 573 534 612 13.1% * 12.3% 13.9% 7,361 7,221 7,501 1,109 1,055 1,163 13.1% * 12.4% 13.8% 5,151 5,018 5,284 780 727 833 13.1% * 12.3% 13.9% 1,539 1,501 1,577 234 219 249 13.2% * 12.4% 14.0% 10,655 10,471 10,839 1,676 1,602 1,750 13.6% * 13.1% 14.1% 771 748 794 121 111 131 13.6% 12.6% 14.6% 6,932 6,782 7,082 1,167 1,104 1,230 14.4% 13.7% 15.1% 1,927 1,876 1,978 335 314 356 14.8% 14.0% 15.6% 15,911 15,696 16,126 2,916 2,822 3,010 15.5% ** 15.0% 16.0% 3,723 3,636 3,810 687 649 725 15.6% ** 14.8% 16.4% 534 521 547 100 93 107 15.7% ** 14.9% 16.5% 411 399 423 78 73 83 15.9% ** 14.9% 16.9% 1,105 1,074 1,136 210 197 223 16.0% ** 15.0% 17.0% 2,229 2,165 2,293 428 400 456 16.1% ** 15.1% 17.1% 1,791 1,747 1,835 344 324 364 16.1% ** 15.3% 16.9% 2,341 2,270 2,412 459 428 490 16.4% ** 15.4% 17.4% 6,912 6,729 7,095 1,376 1,294 1,458 16.6% ** 15.6% 17.6% 13,491 13,279 13,703 2,856 2,757 2,955 17.5% ** 17.0% 18.0% 4,365 4,238 4,492 950 891 1,009 17.9% ** 16.9% 18.9% 2,762 2,686 2,838 620 584 656 18.3% ** 17.3% 19.3% 3,544 3,440 3,648 845 794 896 19.3% ** 18.3% 20.3% 27,770 27,420 28,120 6,718 6,539 6,897 19.5% ** 19.0% 20.0% 1,431 1,383 1,479 373 348 398 20.7% ** 19.5% 21.9% 16,105 15,843 16,367 4,960 4,812 5,108 23.5% ** 22.8% 24.2% 240,875 n/a n/a 41,207 40,881 41,533 14.6% 14.4% 14.8% Source: Bureau of the Census, based on the March 2002 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, 2001 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 Percent not covered Point Range Point Range Point Range estimate Low High estimate Low High estimate Low High 3,815 3,715 3,915 573 534 612 13.1% * 12.3% 13.9% 534 521 547 100 93 107 15.7% ** 14.9% 16.5% 4,365 4,238 4,492 950 891 1,009 17.9% ** 16.9% 18.9% 2,229 2,165 2,293 428 400 456 16.1% ** 15.1% 17.1% 27,770 27,420 28,120 6,718 6,539 6,897 19.5% ** 19.0% 20.0% 3,723 3,636 3,810 687 649 725 15.6% ** 14.8% 16.4% 3,047 2,976 3,118 346 323 369 10.2% * 9.5% 10.9% 719 699 739 73 66 80 9.2% * 8.5% 9.9% 484 469 499 70 65 75 12.7% * 11.7% 13.7% 13,491 13,279 13,703 2,856 2,757 2,955 17.5% ** 17.0% 18.0% 6,912 6,729 7,095 1,376 1,294 1,458 16.6% ** 15.6% 17.6% 1,096 1,068 1,124 117 107 127 9.6% * 8.9% 10.3% 1,105 1,074 1,136 210 197 223 16.0% ** 15.0% 17.0% 10,655 10,471 10,839 1,676 1,602 1,750 13.6% * 13.1% 14.1% 5,322 5,204 5,440 714 670 758 11.8% * 11.1% 12.5% 2,645 2,581 2,709 216 198 234 7.5% * 6.8% 8.2% 2,341 2,283 2,399 301 280 322 11.4% * 10.6% 12.2% 3,505 3,413 3,597 492 457 527 12.3% * 11.5% 13.1% 3,544 3,440 3,648 845 794 896 19.3% ** 18.3% 20.3% 1,147 1,121 1,173 132 124 140 10.3% * 9.6% 11.0% 4,673 4,561 4,785 653 610 696 12.3% * 11.5% 13.1% 5,802 5,677 5,927 520 482 558 8.2% * 7.7% 8.7% 8,864 8,703 9,025 1,028 972 1,084 10.4% * 9.9% 10.9% 4,530 4,426 4,634 392 361 423 8.0% * 7.3% 8.7% 2,341 2,270 2,412 459 428 490 16.4% ** 15.4% 17.4% 4,960 4,842 5,078 565 524 606 10.2% * 9.5% 10.9% 771 748 794 121 111 131 13.6% 12.6% 14.6% 1,523 1,484 1,562 160 147 173 9.5% * 8.8% 10.2% 1,791 1,747 1,835 344 324 364 16.1% ** 15.3% 16.9% 1,139 1,113 1,165 119 111 127 9.4% * 8.7% 10.1% 7,361 7,221 7,501 1,109 1,055 1,163 13.1% * 12.4% 13.8% 1,431 1,383 1,479 373 348 398 20.7% ** 19.5% 21.9% 15,911 15,696 16,126 2,916 2,822 3,010 15.5% ** 15.0% 16.0% 6,932 6,782 7,082 1,167 1,104 1,230 14.4% 13.7% 15.1% 561 546 576 60 55 65 9.6% * 8.9% 10.3% 9,943 9,767 10,119 1,248 1,184 1,312 11.2% * 10.7% 11.7% 2,762 2,686 2,838 620 584 656 18.3% ** 17.3% 19.3% 3,018 2,939 3,097 443 413 473 12.8% * 12.0% 13.6% 10,983 10,805 11,161 1,119 1,061 1,177 9.2% * 8.7% 9.7% 963 942 984 80 73 87 7.7% * 7.2% 8.2% 3,517 3,427 3,607 493 458 528 12.3% * 11.5% 13.1% 670 654 686 69 64 74 9.3% * 8.6% 10.0% 5,042 4,904 5,180 640 591 689 11.3% * 10.5% 12.1% 16,105 15,843 16,367 4,960 4,812 5,108 23.5% ** 22.8% 24.2% 1,927 1,876 1,978 335 314 356 14.8% 14.0% 15.6% 549 536 562 58 53 63 9.6% * 8.9% 10.3% 6,331 6,176 6,486 774 720 828 10.9% * 10.2% 11.6% 5,151 5,018 5,284 780 727 833 13.1% * 12.3% 13.9% 1,539 1,501 1,577 234 219 249 13.2% * 12.4% 14.0% 4,927 4,817 5,037 409 378 440 7.7% * 7.0% 8.4% 411 399 423 78 73 83 15.9% ** 14.9% 16.9% 240,875 n/a n/a 41,207 40,881 41,533 14.6% 14.4% 14.8% Source: Bureau of the Census, based on the March 2002 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, 2001 US average is 14.6% Percent uninsured 20% or more (2) 15.0 to 19.9% (14) 10.0 to 14.9% (22) Less than 10.0% (13) Figure 2. Percent Uninsured by State, 2001 Accounting for Statistical Variation in Estimates Percent uninsured Greater than US average (16) Same as US average (3) Less than US average (32)