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Tuesday, February 8, 2011

The Uninsured by State and Congressional District

David Newman
Specialist in Health Care Financing

The total U.S. civilian non-institutionalized population in 2009 was estimated to be slightly more than 301 million of whom 15.1%, or 45.5 million, were estimated by the American Community Survey to be without health insurance or uninsured. The uninsured are far more likely than those with health insurance to report problems getting needed medical care, less likely to follow recommended treatments because of costs, have less access to care, receive less preventive care, and are more likely to be hospitalized for avoidable health problems. Moreover, it is widely believed that the uninsured, when they need care, are less able to pay for their care since they do not have health insurance and therefore it is further assumed that other payers take on the financial burden of their care through higher prices.

Many Americans obtain their health insurance through employers. Local factors such as local labor market conditions, the mix of firms and firm sizes, and demographic factors such as age, play a role in the proportion of uninsured among those of working age. The Medicare program has effectively provided health insurance to almost all elderly Americans while the Medicaid program and the State Children’s Health Insurance Program have expanded health insurance coverage to both the poor and to children. State policies to expand coverage, including implementing Medicaid waivers to expand coverage, account for some of the differences across states in the proportion of uninsureds. Similarly, state policies to expand coverage such as employer or personal mandates to purchase insurance in Hawaii and Massachusetts further explain some of the differences in the number of uninsureds across states.

The Patient Protection and Affordable Care Act (PPACA, P.L. 111-148, as amended), through an expansion of Medicaid and the creation of state health insurance exchanges, is projected by the Congressional Budget Office to reduce the share of legal non-elderly residents without health insurance to 6% of the population by 2019.

This report, using the U.S. Census Bureau’s 2009 American Community Survey, details differences in the number and proportion of uninsured across states, within states, and across demographic groups.

Date of Report: January 24, 2011
Number of Pages: 141
Order Number: R41621
Price: $29.95

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