Health Insurance: Uninsured Children, by State, 2005-2007

Order Code 97-310 Updated August 29, 2008 Health Insurance: Uninsured Children, 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 8.9 million children under age 191 were uninsured in 2007, representing 11.3% of all children in the United States. When examining health insurance coverage among children at the state level, a three-year average is used to provide more reliable estimates. During 2005-2007, the estimated average percentage of children without health insurance nationally was 11.5%, ranging from 4.8% in Massachusetts to 20.9% in Texas. The proportion of uninsured children tended to be lower in the Midwest and New England, and higher in the South and West. In 28 states and the District of Columbia, the 2005-2007 average uninsured rate for children was significantly below the national rate; in seven states, it was significantly higher. The 2005-2007 average uninsured rate among children in Texas (20.9%) was significantly higher than any other state, including Florida, which had the second-highest rate of uninsured children (19.1%). Estimates of Health Insurance Coverage by State During 2005-2007, the estimated average percentage of children under age 19 who lacked health insurance coverage was 11.5%. Table 1 shows that 2005-2007 average uninsured rates for children ranged from 4.8% in Massachusetts to 20.9% in Texas. Twenty-nine states and the District of Columbia had average uninsured rates for children of less than 10.0%. Six states (Arizona, Florida, Mississippi, Nevada, New Mexico, and Texas) had rates of 15% or more. Generally, states with the lowest average uninsured rates for children were located in the Midwest and Northeast; states with the highest rates were in South and West (Figure 1). 1 Census Bureau estimates for children generally refer to individuals under age 18. Estimates in this report refer to individuals under age 19, which corresponds with the cutoff used for Medicaid poverty-related child eligibility and the State Children’s Health Insurance Program (SCHIP) allotment formula. CRS-2 Table 1 provides private health insurance,2 public health insurance,3 and uninsured estimates with percentage rankings for children by state. The right side of the table indicates whether a state’s three-year average uninsured rate for children is statistically lower (shown with a “-”), statistically higher (shown with a “+”), or not statistically different (shown with a “x”) than the national rate of 11.5%.4 Both private and public health insurance affect a state’s uninsured rate. For example, as shown in Table 1, Maine and New Hampshire have similarly low uninsured rates.5 However, New Hampshire has the highest three-year average private coverage rate for children in the country (81.4%) and the third-lowest public coverage rate (18.1%). On the other hand, Maine has a much lower three-year average private coverage rate for children (67.3%), and a public coverage rate (36.0%) that is roughly double that of New Hampshire. Thus, even though there are differences regarding whether children in Maine and New Hampshire obtain private or public health insurance, the impact is that both have similarly low three-year average uninsured rates. Estimates with 95% Confidence Intervals. The estimates in this report are based on data from the March 2006, 2007, and 2008 supplements to the Current Population Survey (CPS).6 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, especially when examining a subset of the sample such as children under the age of 19, make it prudent to use a three-year average and consider state-level 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 children covered and not covered by health insurance. The table 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 run about 95% of those intervals would contain the true number of children with (or without) health insurance. 2 Coverage through an employer or union, all coverage from outside the home, and coverage purchased directly from a private insurer. 3 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. 4 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). 5 Their uninsured rates are statistically lower than the national rate and are not statistically different from each other. 6 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 Reasons for Differences in the Percentage Uninsured Figure 1 indicates that children under age 19 in the South and West are more likely to lack health insurance, and that those in the Midwest and New England are more likely to be covered. Various characteristics of a state’s population may account for these differences. Nationwide, the uninsured rate for children is related to race and ethnicity, family structure, and family members’ employment. The prevalence of particular population and employer characteristics may account for some of the regional or state variation in uninsured rates for children. The percentage of a state’s child 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). CRS-4 Table 1. Health Insurance Coverage Estimates with Rankings by State for Children Under Age 19, 2005-2007 Average (sorted by percentage uninsured ranking, numbers in thousands) State United States Massachusetts Iowa Michigan Hawaii Wisconsin Maine New Hampshire Alabama Connecticut Minnesota West Virginia Rhode Island Kansas District of Columbia Pennsylvania Ohio Vermont Washington Indiana Tennessee Kentucky New York Nebraska South Dakota Illinois North Dakota Missouri Arkansas Maryland Wyoming Virginia Alaska Delaware Idaho Oregon Georgia South Carolina New Jersey Oklahoma Louisiana California North Carolina Utah Colorado Montana Mississippi Nevada Arizona New Mexico Florida Texas Total population 78,256 1,565 743 2,611 312 1,390 302 317 1,175 873 1,320 418 256 736 119 2,944 2,922 140 1,617 1,682 1,537 1,061 4,770 467 205 3,395 155 1,483 732 1,455 130 1,933 193 216 427 920 2,568 1,094 2,237 948 1,140 10,089 2,333 841 1,254 230 820 686 1,747 535 4,295 6,917 Private health insurance Percent Number Value Rank 50,884 65.0% NA 1,183 75.6% 4 563 75.8% 3 1,894 72.5% 11 221 70.8% 16 1,045 75.2% 5 203 67.3% 28 258 81.4% 1 780 66.4% 31 655 75.1% 6 1,036 78.5% 2 252 60.3% 41 180 70.3% 21 516 70.1% 23 63 53.0% 48 2,132 72.4% 12 2,063 70.6% 17 91 64.8% 33 1,124 69.5% 25 1,183 70.3% 20 970 63.1% 36 679 64.0% 34 3,101 65.0% 32 347 74.2% 7 144 70.4% 19 2,395 70.6% 18 114 73.6% 8 991 66.8% 30 405 55.3% 47 1,068 73.4% 9 91 70.2% 22 1,341 69.4% 26 122 63.0% 37 150 69.6% 24 293 68.6% 27 619 67.2% 29 1,543 60.1% 42 677 61.8% 38 1,639 73.3% 10 539 56.9% 46 668 58.7% 44 6,032 59.8% 43 1,409 60.4% 40 607 72.2% 13 896 71.4% 14 145 63.2% 35 421 51.3% 50 486 70.9% 15 1,013 58.0% 45 272 50.8% 51 2,612 60.8% 39 3,654 52.8% 49 Public health insurance (including military) Percent Number Value Rank 23,173 29.6% NA 378 24.2% 43 200 26.9% 33 750 28.7% 27 110 35.3% 11 364 26.2% 36 109 36.0% 10 57 18.1% 49 394 33.5% 15 203 23.3% 45 263 19.9% 47 170 40.6% 4 81 31.5% 21 223 30.3% 25 54 46.0% 1 771 26.2% 35 826 28.3% 30 56 39.7% 6 492 30.5% 24 454 27.0% 32 557 36.2% 9 366 34.5% 14 1,561 32.7% 16 117 25.1% 41 58 28.4% 29 871 25.6% 40 38 24.2% 42 453 30.5% 23 322 44.0% 2 348 23.9% 44 37 28.1% 31 569 29.4% 26 76 39.2% 7 56 26.1% 37 111 25.9% 38 237 25.8% 39 907 35.3% 12 356 32.5% 18 387 17.3% 50 368 38.9% 8 398 34.9% 13 3,259 32.3% 20 757 32.5% 19 173 20.5% 46 245 19.6% 48 66 28.6% 28 344 41.9% 3 113 16.5% 51 571 32.7% 17 215 40.1% 5 1,151 26.8% 34 2,131 30.8% 22 Number 9,016 76 41 148 18 81 19 21 78 60 91 29 18 53 9 222 224 11 126 132 130 92 415 41 18 305 14 138 69 141 13 194 20 23 51 111 313 134 279 119 145 1,294 303 109 172 32 122 111 286 96 822 Uninsured Percent Value Rank 11.5% NA NA 4.8% 1 5.5% 2 5.7% 3 5.8% 4 5.8% 5 6.4% 6 6.6% 7 6.7% 8 6.9% 9 6.9% 10 7.0% 11 7.0% 12 7.2% 13 7.3% 14 7.6% 15 7.7% 16 7.7% 17 7.8% 18 7.9% 19 8.5% 20 8.7% 21 8.7% 22 8.7% 23 8.8% 24 9.0% 25 9.1% 26 9.3% 27 9.5% 28 9.7% 29 9.7% x 30 10.0% x 31 10.3% x 32 10.6% x 33 12.0% x 34 12.1% x 35 12.2% x 36 12.2% x 37 12.5% x 38 12.6% x 39 12.7% x 40 12.8% + 41 13.0% x 42 13.0% x 43 13.7% x 44 13.9% x 45 14.9% + 46 16.2% + 47 16.4% + 48 17.9% + 49 19.1% + 50 1,447 20.9% + 51 Source: Congressional Research Service analysis of data from the March 2006-2008 Current Population Survey. Note: People may have both private and public coverage. The symbol “-” 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. CRS-5 Table 2. Health Insurance Coverage Estimates with 95% Confidence Intervals by State for Children Under Age 19, 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 50,884 +/- 414 65.0% +/-0.4% 780 +/- 53 66.4% +/- 3.1% 122 +/- 9 63.0% +/- 3.2% 1,013 +/- 65 58.0% +/- 2.9% 405 +/- 31 55.3% +/- 3.3% 6,032 +/- 160 59.8% +/- 1.2% 896 +/- 60 71.4% +/- 3.0% 655 +/- 44 75.1% +/- 3.0% 150 +/- 11 69.6% +/- 3.2% 63 +/- 6 53.0% +/- 4.2% 2,612 +/- 101 60.8% +/- 1.7% 1,543 +/- 75 60.1% +/- 2.2% 221 +/- 15 70.8% +/- 3.0% 293 +/- 19 68.6% +/- 2.9% 2,395 +/- 95 70.6% +/- 1.8% 1,183 +/- 65 70.3% +/- 2.5% 563 +/- 38 75.8% +/- 3.0% 516 +/- 35 70.1% +/- 3.1% 679 +/- 49 64.0% +/- 3.3% 668 +/- 49 58.7% +/- 3.2% 203 +/- 16 67.3% +/- 3.7% 1,068 +/- 63 73.4% +/- 2.7% 1,183 +/- 64 75.6% +/- 2.4% 1,894 +/- 83 72.5% +/- 2.0% 1,036 +/- 60 78.5% +/- 2.5% 421 +/- 32 51.3% +/- 3.2% 991 +/- 61 66.8% +/- 2.8% 145 +/- 11 63.2% +/- 3.4% 347 +/- 23 74.2% +/- 3.0% 486 +/- 33 70.9% +/- 3.1% 258 +/- 17 81.4% +/- 2.8% 1,639 +/- 78 73.3% +/- 2.2% 272 +/- 23 50.8% +/- 3.6% 3,101 +/- 111 65.0% +/- 1.6% 1,409 +/- 73 60.4% +/- 2.3% 114 +/- 8 73.6% +/- 3.1% 2,063 +/- 87 70.6% +/- 1.9% 539 +/- 41 56.9% +/- 3.4% 619 +/- 46 67.2% +/- 3.4% 2,132 +/- 89 72.4% +/- 1.9% 180 +/- 13 70.3% +/- 3.4% 677 +/- 50 61.8% +/- 3.3% 144 +/- 9 70.4% +/- 2.9% 970 +/- 60 63.1% +/- 2.8% 3,654 +/- 127 52.8% +/- 1.5% 607 +/- 32 72.2% +/- 2.5% 91 +/- 8 64.8% +/- 3.7% 1,341 +/- 70 69.4% +/- 2.4% 1,124 +/- 66 69.5% +/- 2.7% 252 +/- 19 60.3% +/- 3.3% 1,045 +/- 62 75.2% +/- 2.6% 91 +/- 7 70.2% +/- 3.4% Public health insurance (including military) Number Percent 23,173 +/- 318 29.6% +/-0.4% 394 +/- 42 33.5% +/- 3.1% 76 +/- 8 39.2% +/- 3.2% 571 +/- 55 32.7% +/- 2.7% 322 +/- 30 44.0% +/- 3.3% 3,259 +/- 133 32.3% +/- 1.1% 245 +/- 36 19.6% +/- 2.7% 203 +/- 28 23.3% +/- 2.9% 56 +/- 7 26.1% +/- 3.1% 54 +/- 6 46.0% +/- 4.2% 1,151 +/- 76 26.8% +/- 1.6% 907 +/- 65 35.3% +/- 2.1% 110 +/- 12 35.3% +/- 3.2% 111 +/- 13 25.9% +/- 2.8% 871 +/- 66 25.6% +/- 1.7% 454 +/- 47 27.0% +/- 2.4% 200 +/- 26 26.9% +/- 3.1% 223 +/- 27 30.3% +/- 3.1% 366 +/- 41 34.5% +/- 3.3% 398 +/- 42 34.9% +/- 3.1% 109 +/- 14 36.0% +/- 3.8% 348 +/- 42 23.9% +/- 2.6% 378 +/- 42 24.2% +/- 2.4% 750 +/- 60 28.7% +/- 2.0% 263 +/- 35 19.9% +/- 2.5% 344 +/- 32 41.9% +/- 3.2% 453 +/- 47 30.5% +/- 2.7% 66 +/- 8 28.6% +/- 3.2% 117 +/- 15 25.1% +/- 3.0% 113 +/- 19 16.5% +/- 2.5% 57 +/- 9 18.1% +/- 2.7% 387 +/- 44 17.3% +/- 1.8% 215 +/- 23 40.1% +/- 3.5% 1,561 +/- 89 32.7% +/- 1.6% 757 +/- 60 32.5% +/- 2.2% 38 +/- 5 24.2% +/- 3.0% 826 +/- 63 28.3% +/- 1.9% 368 +/- 38 38.9% +/- 3.3% 237 +/- 33 25.8% +/- 3.2% 771 +/- 61 26.2% +/- 1.8% 81 +/- 10 31.5% +/- 3.5% 356 +/- 41 32.5% +/- 3.2% 58 +/- 7 28.4% +/- 2.8% 557 +/- 51 36.2% +/- 2.8% 2,131 +/- 109 30.8% +/- 1.4% 173 +/- 20 20.5% +/- 2.2% 56 +/- 7 39.7% +/- 3.8% 569 +/- 52 29.4% +/- 2.3% 492 +/- 50 30.5% +/- 2.7% 170 +/- 17 40.6% +/- 3.3% 364 +/- 42 26.2% +/- 2.7% 37 +/- 5 28.1% +/- 3.3% Uninsured Number 9,016 +/78 +/20 +/286 +/69 +/1,294 +/172 +/60 +/23 +/9 +/822 +/313 +/18 +/51 +/305 +/132 +/41 +/53 +/92 +/145 +/19 +/141 +/76 +/148 +/91 +/122 +/138 +/32 +/41 +/111 +/21 +/279 +/96 +/415 +/303 +/14 +/224 +/119 +/111 +/222 +/18 +/134 +/18 +/130 +/1,447 +/109 +/11 +/194 +/126 +/29 +/81 +/13 +/- 204 19 4 40 15 86 31 16 5 3 65 39 5 9 40 26 12 13 21 26 6 27 19 27 21 20 27 6 9 18 6 38 16 47 39 3 34 22 23 34 5 25 4 26 90 16 3 31 26 7 21 3 Percent 11.5% +/- 0.2% 6.7% +/- 1.6% 10.3% +/- 2.0% 16.4% +/- 2.1% 9.5% +/- 2.0% 12.8% +/- 0.8% 13.7% +/- 2.3% 6.9% +/- 1.8% 10.6% +/- 2.2% 7.3% +/- 2.2% 19.1% +/- 1.4% 12.2% +/- 1.5% 5.8% +/- 1.6% 12.0% +/- 2.1% 9.0% +/- 1.1% 7.9% +/- 1.5% 5.5% +/- 1.6% 7.2% +/- 1.8% 8.7% +/- 1.9% 12.7% +/- 2.2% 6.4% +/- 1.9% 9.7% +/- 1.8% 4.8% +/- 1.2% 5.7% +/- 1.0% 6.9% +/- 1.6% 14.9% +/- 2.3% 9.3% +/- 1.7% 13.9% +/- 2.4% 8.7% +/- 1.9% 16.2% +/- 2.5% 6.6% +/- 1.8% 12.5% +/- 1.6% 17.9% +/- 2.8% 8.7% +/- 1.0% 13.0% +/- 1.6% 9.1% +/- 2.0% 7.7% +/- 1.1% 12.6% +/- 2.2% 12.1% +/- 2.3% 7.6% +/- 1.1% 7.0% +/- 1.9% 12.2% +/- 2.2% 8.8% +/- 1.8% 8.5% +/- 1.6% 20.9% +/- 1.2% 13.0% +/- 1.9% 7.7% +/- 2.1% 10.0% +/- 1.5% 7.8% +/- 1.6% 7.0% +/- 1.7% 5.8% +/- 1.4% 9.7% +/- 2.2% Source: Congressional Research Service analysis of data from the March 2006-2008 Current Population Survey. Note: 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 of Children Under Age 19 Uninsured, by State, 2005-2007 Average Source: Congressional Research Service analysis of data from the March 2006-2008 Current Population Survey. Note: States in the 10.0%-12.7% category are not statistically different from the national rate.