Health Insurance: Uninsured by State, 2005-2007

Order Code 96-979 Updated September 5, 2008 Health Insurance: Uninsured by State, 2005-2007 Chris L. Peterson and April Grady Domestic Social Policy Division Summary Based on data from the Census Bureau’s Current Population Survey (CPS), an estimated 45.7 million people lacked health insurance coverage in 2007, representing 15.3% of the civilian noninstitutionalized U.S. population. When comparing state-level health insurance estimates, a three-year average is used to increase their reliability. During 2005-2007, the estimated average percentage uninsured was 15.5% nationally, ranging from a low of 8.3% in Massachusetts to a high of 24.5% in Texas. States in the Midwest and Northeast generally had lower uninsured rates than those in the South and West. These state-level estimates must be interpreted with caution because they are based on a sample of the population. When sampling variation is taken into account, the uninsured rate in nine states is not statistically different from the national rate. The uninsured rate in 28 states and the District of Columbia is statistically lower than the national rate, and statistically higher in the remaining 13 states. Estimates of Health Insurance Coverage, by State During 2005-2007, the estimated average percentage uninsured was 15.5% nationally. Table 1 shows that 2005-2007 average uninsured rates ranged from 8.3% in Massachusetts to 24.5% in Texas. Eight states (Massachusetts, Hawaii, Minnesota, Wisconsin, Iowa, Maine, Pennsylvania, and Connecticut) had three-year average uninsured rates of less than 10.0%. Three states (Florida, New Mexico, and Texas) had average uninsured rates of 20.0% or more. Generally, states with the lowest uninsured rates were located in the Midwest and Northeast; states with the highest rates were in the South and West (Figure 1). CRS-2 Table 1 provides private health insurance,1 public health insurance,2 and uninsured estimates with percentage rankings by state. The right side of the table indicates whether a state’s three-year average uninsured rate is statistically lower (shown with a “-”), statistically higher (shown with a “+”), or not statistically different (shown with a “x”) than the national rate of 15.5%.3 Both private and public health insurance affect a state’s uninsured rate. For example, as shown in Table 1, Minnesota and Maine have similarly low uninsured rates.4 However, Minnesota has the highest three-year average private coverage rate in the country (79.7%) and a relatively low public coverage rate (24.0%). On the other hand, Maine has a lower three-year average private coverage rate (69.5%) and the highest public coverage rate (35.9%). Thus, even though there are differences regarding whether people in Maine and Minnesota obtain private or public health insurance, the impact is that both have similarly low uninsured rates. States with the highest rankings for average percentage uninsured during 2005-2007, led by Texas with nearly a quarter of its population, have some of the lowest rankings for private coverage. All but two of the 10 states with the highest uninsured rates (shown in the last 10 rows of Table 1) rank in the lowest 10 states for private coverage. Estimates with 95% Confidence Intervals. The estimates in this report are based on data from the March 2008 supplement to the Current Population Survey (CPS).5 The CPS is representative of the civilian noninstitutionalized population and is designed to produce reliable estimates at the national, regional, and state levels. The small sample sizes available from the CPS for many states make it prudent to use a three-year average when comparing state-level estimates and to consider the estimates in terms of a range of values. Like Table 1, Table 2 shows the best point estimates, or single values, for the average number and percentage of people covered and not covered by health insurance. It also reports a range of values — the 95% confidence interval — for these estimates. The larger the confidence interval in relation to the size of the estimate, the less reliable the estimate. The size of the range depends primarily on the sample size. A 95% confidence interval means that if repeated samples were collected under essentially the same conditions and their confidence intervals calculated, in the long 1 Coverage through an employer or union, all coverage from outside the home, and coverage purchased directly from a private insurer. 2 Medicare, Medicaid, the State Children’s Health Insurance Program (SCHIP), and other government-provided health insurance, as well as coverage related to employment in the military. 3 Statistical significance was tested at the 95% confidence level (also referred to as the 5% significance level). This means that one can be 95% certain that the difference between a state’s uninsured rate and the national rate is not zero (i.e., the state’s rate is statistically higher or lower) or could be zero (i.e., the state’s rate is not statistically different). 4 Their uninsured rates are statistically lower than the national rate and are not statistically different from each other. 5 Because the supplement is now fielded from February through April, it has been officially renamed the Annual Social and Economic supplement (ASEC) to the CPS, though many analysts continue to refer to it by its traditional name. CRS-3 run about 95% of those intervals would contain the true number of people with (or without) health insurance. Reasons for Differences in the Percentage Uninsured Figure 1 indicates that people in the South and West are more likely to lack health insurance, and that residents of the Midwest and Northeast are more likely to be covered. Various characteristics of a state’s population may account for these differences. Nationwide, the uninsured rate is related to age, race and ethnicity, employment, and a number of other factors.6 The prevalence of particular population and employer characteristics may account for some of the regional or state variation in uninsured rates. The percentage of a state’s population that is uninsured may also be affected by state policies, such as eligibility criteria for the state’s Medicaid program or its State Children’s Health Insurance Program (SCHIP). 6 For more information, see CRS Report 96-891, Health Insurance Coverage: Characteristics of the Insured and Uninsured Populations in 2007, by Chris L. Peterson and April Grady. CRS-4 Table 1. Health Insurance Coverage Estimates with Rankings, by State, 2005-2007 Average (sorted by percentage uninsured ranking, numbers in thousands) State Total population 296,588 United States Massachusetts 6,334 Hawaii 1,267 Minnesota 5,156 Wisconsin 5,465 Iowa 2,933 Maine 1,316 Pennsylvania 12,313 Connecticut 3,475 Rhode Island 1,051 New Hampshire 1,308 Michigan 9,960 Vermont 619 Ohio 11,318 North Dakota 619 South Dakota 776 District of Columbia 564 Kansas 2,713 Delaware 856 Nebraska 1,762 Washington 6,359 Indiana 6,247 Missouri 5,767 New York 19,041 Virginia 7,559 Maryland 5,582 Illinois 12,647 Kentucky 4,122 Tennessee 5,979 Alabama 4,542 Wyoming 515 Idaho 1,473 West Virginia 1,803 New Jersey 8,647 Utah 2,573 Montana 933 South Carolina 4,264 North Carolina 8,865 Colorado 4,773 Oregon 3,702 Alaska 664 Arkansas 2,774 Georgia 9,295 Nevada 2,517 Oklahoma 3,516 California 36,148 Mississippi 2,883 Louisiana 4,166 Arizona 6,228 Florida 18,007 New Mexico 1,943 Texas 23,253 Public health insurance Private health insurance (including military) Uninsured Percent Percent Percent Number Value Rank Number Value Rank Number Value Rank 201,616 68.0% NA 81,171 27.4% NA 45,822 15.5% NA NA 4,731 74.7% 9 1,768 27.9% 25 527 8.3% 1 945 74.6% 12 404 31.9% 10 105 8.3% 2 4,110 79.7% 1 1,238 24.0% 45 438 8.5% 3 4,218 77.2% 5 1,413 25.9% 36 480 8.8% 4 2,290 78.1% 3 778 26.5% 35 274 9.4% 5 915 69.5% 29 472 35.9% 1 125 9.5% 6 9,356 76.0% 7 3,380 27.5% 29 1,203 9.8% 7 2,657 76.4% 6 892 25.7% 38 344 9.9% 8 761 72.4% 21 321 30.6% 15 108 10.3% 9 1,040 79.5% 2 279 21.4% 48 138 10.5% 10 7,418 74.5% 13 2,738 27.5% 28 1,075 10.8% 11 435 70.4% 28 204 33.0% 5 68 11.0% 12 8,307 73.4% 15 3,076 27.2% 31 1,249 11.0% 13 482 77.9% 4 152 24.5% 42 68 11.1% 14 579 74.6% 11 221 28.5% 22 87 11.2% 15 373 66.2% 36 180 32.0% 8 64 11.4% 16 2,026 74.7% 10 739 27.3% 30 320 11.8% 17 625 73.0% 19 239 27.9% 26 101 11.8% 18 1,326 75.2% 8 438 24.8% 41 212 12.0% 19 4,604 72.4% 22 1,796 28.2% 23 770 12.1% 20 4,584 73.4% 16 1,522 24.4% 43 766 12.3% 21 4,093 71.0% 26 1,617 28.0% 24 723 12.5% 22 12,649 66.4% 35 5,893 30.9% 13 2,551 13.4% 23 5,414 71.6% 24 2,091 27.7% 27 1,031 13.6% 24 4,158 74.5% 14 1,339 24.0% 46 761 13.6% 25 9,182 72.6% 20 3,056 24.2% 44 1,735 13.7% 26 2,750 66.7% 34 1,282 31.1% 11 569 13.8% 27 3,859 64.5% 40 1,985 33.2% 4 830 13.9% 28 3,113 68.5% 32 1,391 30.6% 14 632 13.9% 29 370 71.9% 23 139 27.0% 32 73 14.3% x 30 1,039 70.5% 27 375 25.5% 39 216 14.7% x 31 1,155 64.1% 41 623 34.6% 2 268 14.8% x 32 6,337 73.3% 17 1,785 20.6% 49 1,318 15.2% x 33 1,880 73.1% 18 510 19.8% 51 399 15.5% x 34 631 67.7% 33 273 29.3% 20 150 16.1% x 35 2,759 64.7% 39 1,278 30.0% 17 705 16.5% x 36 5,776 65.2% 37 2,603 29.4% 19 1,469 16.6% + 37 3,406 71.3% 25 980 20.5% 50 799 16.7% x 38 2,554 69.0% 30 953 25.7% 37 621 16.8% x 39 421 63.3% 42 206 31.1% 12 115 17.3% + 40 1,699 61.2% 46 888 32.0% 9 485 17.5% + 41 6,031 64.9% 38 2,469 26.6% 34 1,658 17.8% + 42 1,726 68.6% 31 549 21.8% 47 452 18.0% + 43 2,177 61.9% 45 1,131 32.2% 7 640 18.2% + 44 22,650 62.7% 44 9,651 26.7% 33 6,720 18.6% + 45 1,660 57.6% 50 971 33.7% 3 543 18.8% + 46 2,538 60.9% 47 1,240 29.8% 18 807 19.4% + 47 3,768 60.5% 48 1,876 30.1% 16 1,219 19.6% + 48 11,355 63.1% 43 5,216 29.0% 21 3,698 20.5% + 49 1,095 56.4% 51 637 32.8% 6 425 21.9% + 50 13,590 58.4% 49 5,911 25.4% 40 5,687 24.5% + 51 Source: CRS analysis of data from the March 2008 Current Population Survey (CPS). Notes: People may have both private and public coverage. On the right side of the table, “-” indicates that a state’s uninsured rate is statistically lower than the national rate, “+” indicates that it is statistically higher, and “x” indicates that it is not statistically different. Statistical significance was tested at the 95% confidence level (see text for more information). CRS-5 Table 2. Health Insurance Coverage Estimates with 95% Confidence Intervals, by State, 2005-2007 Average (numbers in thousands) State United States Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia 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 Private health insurance Number Percent 201,616 +/- 509 68.0% +/3,113 +/- 65 68.5% +/421 +/- 10 63.3% +/3,768 +/- 86 60.5% +/1,699 +/- 43 61.2% +/22,650 +/- 207 62.7% +/3,406 +/- 68 71.3% +/2,657 +/- 47 76.4% +/625 +/- 12 73.0% +/373 +/- 10 66.2% +/11,355 +/- 138 63.1% +/6,031 +/- 96 64.9% +/945 +/- 17 74.6% +/1,039 +/- 21 70.5% +/9,182 +/- 108 72.6% +/4,584 +/- 73 73.4% +/2,290 +/- 40 78.1% +/2,026 +/- 39 74.7% +/2,750 +/- 63 66.7% +/2,538 +/- 65 60.9% +/915 +/- 21 69.5% +/4,158 +/- 69 74.5% +/4,731 +/- 72 74.7% +/7,418 +/- 92 74.5% +/4,110 +/- 59 79.7% +/1,660 +/- 45 57.6% +/4,093 +/- 73 71.0% +/631 +/- 14 67.7% +/1,326 +/- 24 75.2% +/1,726 +/- 38 68.6% +/1,040 +/- 17 79.5% +/6,337 +/- 87 73.3% +/1,095 +/- 34 56.4% +/12,649 +/- 142 66.4% +/5,776 +/- 94 65.2% +/482 +/- 8 77.9% +/8,307 +/- 99 73.4% +/2,177 +/- 55 61.9% +/2,554 +/- 57 69.0% +/9,356 +/- 99 76.0% +/761 +/- 16 72.4% +/2,759 +/- 65 64.7% +/579 +/- 10 74.6% +/3,859 +/- 78 64.5% +/13,590 +/- 172 58.4% +/1,880 +/- 33 73.1% +/435 +/- 10 70.4% +/5,414 +/- 81 71.6% +/4,604 +/- 77 72.4% +/1,155 +/- 26 64.1% +/4,218 +/- 66 77.2% +/370 +/- 8 71.9% +/- 0.2% 1.5% 1.7% 1.5% 1.7% 0.6% 1.6% 1.5% 1.6% 1.8% 0.8% 1.1% 1.4% 1.6% 0.9% 1.3% 1.5% 1.5% 1.6% 1.7% 1.7% 1.4% 1.2% 1.0% 1.3% 1.7% 1.4% 1.6% 1.5% 1.7% 1.4% 1.1% 1.9% 0.8% 1.2% 1.5% 0.9% 1.7% 1.7% 0.9% 1.6% 1.6% 1.4% 1.4% 0.8% 1.4% 1.7% 1.2% 1.3% 1.5% 1.3% 1.7% Public health insurance (including military) Number Percent 81,171 +/- 529 27.4% +/1,391 +/- 69 30.6% +/206 +/- 11 31.1% +/1,876 +/- 87 30.1% +/888 +/- 44 32.0% +/9,651 +/- 205 26.7% +/980 +/- 67 20.5% +/892 +/- 53 25.7% +/239 +/- 13 27.9% +/180 +/- 10 32.0% +/5,216 +/- 140 29.0% +/2,469 +/- 96 26.6% +/404 +/- 19 31.9% +/375 +/- 22 25.5% +/3,056 +/- 112 24.2% +/1,522 +/- 77 24.4% +/778 +/- 46 26.5% +/739 +/- 43 27.3% +/1,282 +/- 66 31.1% +/1,240 +/- 66 29.8% +/472 +/- 24 35.9% +/1,339 +/- 74 24.0% +/1,768 +/- 80 27.9% +/2,738 +/- 101 27.5% +/1,238 +/- 69 24.0% +/971 +/- 46 33.7% +/1,617 +/- 78 28.0% +/273 +/- 15 29.3% +/438 +/- 27 24.8% +/549 +/- 37 21.8% +/279 +/- 19 21.4% +/1,785 +/- 87 20.6% +/637 +/- 34 32.8% +/5,893 +/- 150 30.9% +/2,603 +/- 98 29.4% +/152 +/9 24.5% +/3,076 +/- 108 27.2% +/1,131 +/- 58 32.2% +/953 +/- 58 25.7% +/3,380 +/- 113 27.5% +/321 +/- 18 30.6% +/1,278 +/- 67 30.0% +/221 +/- 11 28.5% +/1,985 +/- 83 33.2% +/5,911 +/- 164 25.4% +/510 +/- 32 19.8% +/204 +/- 11 33.0% +/2,091 +/- 88 27.7% +/1,796 +/- 84 28.2% +/623 +/- 27 34.6% +/1,413 +/- 74 25.9% +/139 +/8 27.0% +/- 0.2% 1.5% 1.7% 1.4% 1.6% 0.6% 1.4% 1.5% 1.6% 1.8% 0.8% 1.0% 1.5% 1.5% 0.9% 1.2% 1.6% 1.6% 1.6% 1.6% 1.8% 1.3% 1.3% 1.0% 1.3% 1.6% 1.4% 1.6% 1.5% 1.5% 1.4% 1.0% 1.8% 0.8% 1.1% 1.5% 1.0% 1.6% 1.6% 0.9% 1.7% 1.6% 1.5% 1.4% 0.7% 1.3% 1.7% 1.2% 1.3% 1.5% 1.4% 1.7% Uninsured Number Percent 45,822 +/- 429 15.5% +/- 0.1% 632 +/- 52 13.9% +/- 1.1% 115 +/9 17.3% +/- 1.4% 1,219 +/- 76 19.6% +/- 1.2% 485 +/- 36 17.5% +/- 1.3% 6,720 +/- 180 18.6% +/- 0.5% 799 +/- 61 16.7% +/- 1.3% 344 +/- 36 9.9% +/- 1.0% 101 +/- 10 11.8% +/- 1.1% 64 +/7 11.4% +/- 1.2% 3,698 +/- 125 20.5% +/- 0.7% 1,658 +/- 84 17.8% +/- 0.9% 105 +/- 12 8.3% +/- 0.9% 216 +/- 18 14.7% +/- 1.2% 1,735 +/- 90 13.7% +/- 0.7% 766 +/- 59 12.3% +/- 0.9% 274 +/- 30 9.4% +/- 1.0% 320 +/- 31 11.8% +/- 1.1% 569 +/- 49 13.8% +/- 1.2% 807 +/- 57 19.4% +/- 1.4% 125 +/- 14 9.5% +/- 1.1% 761 +/- 59 13.6% +/- 1.1% 527 +/- 49 8.3% +/- 0.8% 1,075 +/- 70 10.8% +/- 0.7% 438 +/- 45 8.5% +/- 0.9% 543 +/- 38 18.8% +/- 1.3% 723 +/- 58 12.5% +/- 1.0% 150 +/- 12 16.1% +/- 1.3% 212 +/- 20 12.0% +/- 1.1% 452 +/- 34 18.0% +/- 1.4% 138 +/- 14 10.5% +/- 1.1% 1,318 +/- 77 15.2% +/- 0.9% 425 +/- 30 21.9% +/- 1.6% 2,551 +/- 111 13.4% +/- 0.6% 1,469 +/- 80 16.6% +/- 0.9% 68 +/7 11.1% +/- 1.1% 1,249 +/- 76 11.0% +/- 0.7% 640 +/- 48 18.2% +/- 1.4% 621 +/- 50 16.8% +/- 1.3% 1,203 +/- 75 9.8% +/- 0.6% 108 +/- 12 10.3% +/- 1.1% 705 +/- 54 16.5% +/- 1.3% 87 +/8 11.2% +/- 1.0% 830 +/- 61 13.9% +/- 1.0% 5,687 +/- 161 24.5% +/- 0.7% 399 +/- 29 15.5% +/- 1.1% 68 +/7 11.0% +/- 1.2% 1,031 +/- 67 13.6% +/- 0.9% 770 +/- 61 12.1% +/- 1.0% 268 +/- 21 14.8% +/- 1.1% 480 +/- 48 8.8% +/- 0.9% 73 +/7 14.3% +/- 1.3% Source: CRS analysis of data from the March 2008 Current Population Survey (CPS). Notes: People may have both private and public coverage. The 95% confidence interval is a measure of an estimate’s variability (see text for more information). CRS-6 Figure 1. Percentage Uninsured, by State, 2005-2007 Average Source: CRS analysis of data from the March 2008 Current Population Survey (CPS). Note: States in the 14.3%-16.8% category are not statistically different from the national rate, except for North Carolina (which is statistically higher). Others are statistically higher (more than 16.8% category) or lower (less than 14.3% category)