Uninsured in the United States
Encyclopedia
The number of persons without health insurance
coverage in the United States
is one of the primary concerns raised by advocates of health care reform
. According to the United States Census Bureau
, in 2009 there were 50.7 million people in the US (16.7% of the population) who were without health insurance. The percentage of the non-elderly population who are uninsured has been generally increasing since the year 2000.
The causes of this rate of uninsurance remain a matter of political debate. Rising insurance costs have contributed to a trend in which fewer employers are offering health insurance, and many employers are managing costs by requiring higher employee contributions. Many of the uninsured are the working poor
or are unemployed
. Others are healthy and choose to go without it. Some have been rejected by insurance companies and are considered "uninsurable". Some are without health insurance only temporarily. Some choose faith-based alternatives to health insurance.
annually reports statistics on the uninsured. The current Census Bureau report states that the number of Americans living uninsured has climbed to 49.9 million in 2010 from 49 million in 2009. The increase of those uninsured is not considered to be statistically different from 2009. The number of persons insured in 2010 increased to 256.2 million from 255.3 million in 2009. According to its most recent figures, in 2009 there were 50.7 million people in the US (16.7% of the population) who were without health insurance. This is up from 2008, when there were 46.3 million people in the US (15.4% of the population) who were without health insurance. The percentage of the non-elderly population who are uninsured has been generally increasing since the year 2000. However, the 2007 figures were down slightly from the Census Bureau reports for the previous year, because 3 million more people received coverage under government programs.
A study published in 2009 by the journal Health Affairs found that the Census Bureau estimates, which are based on the Current Population Survey
, under count Medicaid
enrollment. As a result, it likely overstates the number of uninsured individuals.
The number of people who lack insurance at some time during a multi-year period is greater than the number currently uninsured. A study published by Families USA
in 2009 estimated that approximately 86.7 million people were uninsured at some point during the two-year period 2007-2008. This represented about 29% of the total US population or about one-in-three under 65 years of age.
However, this rate decreased slightly from 2006 to 2007, from 15.3 to 14.8 million, a decrease of 2 percentage points (34.1% to 32.1%).
The state with the highest percentage of uninsured was Texas
(24.1% average for three years, 2004–2006). New Mexico
has the second highest percentage of residents without health insurance at 22%.
It has been estimated that nearly one-fifth of the uninsured population is able to afford insurance, almost one quarter is eligible for public coverage, and the remaining 56% need financial assistance (8.9% of all Americans). An estimated 5 million of those without health insurance are considered "uninsurable" because of pre-existing condition
s. A recent study concluded that 15% of people shopping online for health insurance are considered "uninsurable" because of a pre-existing condition, or for being overweight. This label does not necessarily mean they can never get health insurance, but that they will not qualify for standard individual coverage. People with similar health status can be covered via employer-provided health insurance, Medicare, or Medicaid.
According to the Congressional Budget Office the plan the way it is now would have to cover unmarried dependents under their parents' insurance up to age 26. These changes also affect large employers, including self-insured firms, so that the firm bears the financial responsibility of providing coverage. The only exception to this is policies that were maintained continuously before the enactment of this legislation. Those policies would be grandfathered in.http://www.cbo.gov
, October 2008 (Supplemental data tables) The longer a non-citizen immigrant has been in the country, the less likely they are to be uninsured. In 2006, roughly 27% of immigrants entering the country before 1970 were uninsured, compared to 45% of immigrants entering the country in the 1980s and 49% of those entering between 2000 and 2006.
Most uninsured non-citizens are recent immigrants; almost half entered the country between 2000 and 2006, and 36% entered during the 1990s. Foreign-born non-citizens accounted for over 40% of the increase in the uninsured between 1990 and 1998, and over 90% of the increase between 1998 and 2003. One reason for the acceleration after 1998 may be restrictions imposed by the Personal Responsibility and Work Opportunity Reconciliation Act
(PRWORA) of 1996. Almost seven out of ten (68%) of uninsured non-citizens live in California, Texas, Florida, or New York.
in April 2008 found that US economic downturns place a significant strain on state Medicaid
and SCHIP
programs. The authors estimated that a 1% increase in the unemployment rate increase Medicaid and SCHIP enrollment by 1 million, and increase the number uninsured by 1.1 million. State spending on Medicaid and SCHIP would increase by $1.4 billion (total spending on these programs would increase by $3.4 billion). This increased spending would occur while state government revenues were declining. During the last downturn, the Jobs and Growth Tax Relief Reconciliation Act of 2003
(JGTRRA) included federal assistance to states, which helped states avoid tightening their Medicaid and SCHIP eligibility rules. The authors conclude that Congress
should consider similar relief for the current economic downturn.
Low-income workers are less likely than higher income individuals to be offered coverage by their employer (or by their spouse's employer), and less able to afford buying it on their own. Beginning with wage and price controls during World War II
, and cemented by an income tax exemption ruling in 1954, most working Americans have received their health insurance from their employers. However, recent trends have shown an ongoing decline in employer-sponsored health insurance benefits. In 2000, 68% of small companies with 3 to 199 workers offered health benefits. Since that time, that number has continued to drop to 2007, when 59% offered health benefits. For large firms with 200 or more workers, in 2000, 99% of employers offered health benefits, and in 2007, that number stayed the same at 99%. On average, considering firms of all numbers of employees, in 2000, 69% offered health insurance, and that number has fallen nearly every year since, to 2007, when 60% of employers offered health insurance.
One study published in 2008 found that people of average health are least likely to become uninsured if they have large group health coverage, more likely to become uninsured if they have small group coverage, and most likely to become uninsured if they have individual health insurance. But, "for people in poor or fair health, the chances of losing coverage are much greater for people who had small-group insurance than for those who had individual insurance." The authors attribute these results to the combination in the individual market of high costs and guaranteed renewability of coverage. Individual coverage costs more if it is purchased after a person becomes unhealthy, but "provides better protection (compared to group insurance) against high premiums for already individually insured people who become high risk." Healthy individuals are more likely to drop individual coverage than less-expensive, subsidized employment-based coverage, but group coverage leaves them "more vulnerable to dropping or losing any and all coverage than does individual insurance" if they become seriously ill.
Roughly a quarter of the uninsured are eligible for public coverage, but are not enrolled. Possible reasons include a lack of awareness of the programs or of how to enroll, reluctance due to a perceived stigma associated with public coverage, poor retention of enrollees, and burdensome administrative procedures. In addition, some state programs have enrollment caps.
A study by the Kaiser Family Foundation
published in June 2009 found that 45% of low-income adults under age 65 lack health insurance. Almost a third of non-elderly adults are low income, with family incomes below 200% of the federal poverty level. Low-income adults are generally younger, less well educated, and less likely to live in a household with a full time worker than are higher income adults; these factors contribute to the likelihood of being uninsured. In addition, the chances of being healthy decline with lower income; 19% of adults with incomes below the federal poverty level describe their health as fair or poor.
professor Vicente Navarro stated, more broadly, in 2003, "the problem does not end here, with the uninsured. An even larger problem is the underinsured
" and "The most credible estimate of the number of people in the United States who have died because of lack of medical care was provided by a study carried out by Harvard Medical School
Professors David Himmelstein and Steffie Woolhandler (New England Journal of Medicine 336, no. 11 [1997]). They concluded that almost 100,000 people died in the United States each year because of lack of needed care—three times the number of people who died of AIDS."
Offsetting that, a Hearst Newspapers investigation called medical error
"far more deadly than inadequate medical insurance." The number of Americans with access to care who are killed by medical errors is estimated from 44,000 to hundreds of thousands each year, and the New England Journal of Medicine
published a study finding that American hospitals injured around 20% of all patients every year from 2002-2007. Notably, Representative John Murtha
, who had voted for the House healthcare reform bill in 2009, died from a surgical error in 2010. Moreover, the best predictor of longevity is education; in study after study, money and health insurance "pale in comparison."
A survey released in 2008 found that being uninsured impacts American consumers' health in the following ways:
The costs of treating the uninsured must often be absorbed by providers as charity care
, passed on to the insured via cost-shifting
and higher health insurance premiums, or paid by taxpayers through higher taxes. On the other hand, the uninsured often subsidize the insured because the uninsured use fewer services and are billed unfairly. 60 Minutes
reported, "Hospitals charge uninsured patients two, three, four or more times what an insurance company would pay for the same treatment." On average, per capita health care spending on behalf of the uninsured is a bit more than half that for the insured.
A study published in August 2008 in Health Affairs
found that covering all of the uninsured in the US would increase national spending on health care by $122.6 billion, which would represent a 5% increase in health care spending and 0.8% of GDP. The impact on government spending could be higher, depending on the details of the plan used to increase coverage and the extent to which new public coverage crowded out existing private coverage. Massachusetts' law requiring everyone to buy insurance has reportedly caused costs there to increase faster than in the rest of the country.
A study published in the American Journal of Public Health
in 2009 found that "[u]ninsurance is associated with mortality. The strength of that association appears similar to that from a study that evaluated data from the mid-1980s, despite changes in medical therapeutics and the demography of the uninsured since that time." The study estimated that lack of insurance is associated with 45,000 deaths annually. This is two and a half times higher than an estimate produced by the Institute of Medicine in 2002. One of the authors characterized the results as "now one dies every 12 minutes."
, between 1993 and 2003, emergency room visits in the U.S. grew by 26%, while in the same period, the number of emergency departments declined by 425. Hospitals bill uninsured patients directly under the fee-for-service
model, often charging much more than insurers would pay, and patients may become bankrupt when hospitals file lawsuits to collect.
Mentally ill patients present a unique challenge for emergency departments and hospitals. In accordance with EMTALA, mentally ill patients who enter emergency rooms are evaluated for emergency medical conditions. Once mentally ill patients are medically stable, regional mental health agencies are contacted to evaluate them. Patients are evaluated as to whether they are a danger to themselves or others. Those meeting this criterion are admitted to a mental health facility to be further evaluated by a psychiatrist. Typically, mentally ill patients can be held for up to 72 hours, after which a court order is required.
regularly conducts the Current Population Survey
(CPS), which includes estimates on health insurance coverage in the United States. The data is published annually in the Annual Social and Economic Supplement (ASEC). The data from 1999 to 2009 are reproduced below.The Census Bureau's algorithm was revised in 2000 and again in 2005. The data for 2004 was revised after its initial publishing. See the Health Insurance Historical Tables for more information. , the five states with the highest estimated percentage of uninsured are, in order, Texas
, Florida
, New Mexico
, Nevada
, and Georgia
. The five states with the lowest estimated percentage of uninsured for the same year are, in order, Massachusetts
, Hawaii
, Minnesota
, Wisconsin
, and Vermont
. These rankings for each year are highlighted below.
.
Health insurance in the United States
The term health insurance is commonly used in the United States to describe any program that helps pay for medical expenses, whether through privately purchased insurance, social insurance or a non-insurance social welfare program funded by the government...
coverage in the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
is one of the primary concerns raised by advocates of health care reform
Health care reform in the United States
Health care reform in the United States has a long history, of which the most recent results were two federal statutes enacted in 2010: the Patient Protection and Affordable Care Act , signed March 23, 2010, and the Health Care and Education Reconciliation Act of 2010 , which amended the PPACA and...
. According to the United States Census Bureau
United States Census Bureau
The United States Census Bureau is the government agency that is responsible for the United States Census. It also gathers other national demographic and economic data...
, in 2009 there were 50.7 million people in the US (16.7% of the population) who were without health insurance. The percentage of the non-elderly population who are uninsured has been generally increasing since the year 2000.
The causes of this rate of uninsurance remain a matter of political debate. Rising insurance costs have contributed to a trend in which fewer employers are offering health insurance, and many employers are managing costs by requiring higher employee contributions. Many of the uninsured are the working poor
Working poor
- Definition in the United States :There are several popular definitions of "working poor" in the United States. According to the US Department of Labor, the working poor "are persons who spent at least 27 weeks [in the past year] in the labor force , but whose incomes fell below the official...
or are unemployed
Unemployment
Unemployment , as defined by the International Labour Organization, occurs when people are without jobs and they have actively sought work within the past four weeks...
. Others are healthy and choose to go without it. Some have been rejected by insurance companies and are considered "uninsurable". Some are without health insurance only temporarily. Some choose faith-based alternatives to health insurance.
Estimates of the number uninsured
The United States Census BureauUnited States Census Bureau
The United States Census Bureau is the government agency that is responsible for the United States Census. It also gathers other national demographic and economic data...
annually reports statistics on the uninsured. The current Census Bureau report states that the number of Americans living uninsured has climbed to 49.9 million in 2010 from 49 million in 2009. The increase of those uninsured is not considered to be statistically different from 2009. The number of persons insured in 2010 increased to 256.2 million from 255.3 million in 2009. According to its most recent figures, in 2009 there were 50.7 million people in the US (16.7% of the population) who were without health insurance. This is up from 2008, when there were 46.3 million people in the US (15.4% of the population) who were without health insurance. The percentage of the non-elderly population who are uninsured has been generally increasing since the year 2000. However, the 2007 figures were down slightly from the Census Bureau reports for the previous year, because 3 million more people received coverage under government programs.
A study published in 2009 by the journal Health Affairs found that the Census Bureau estimates, which are based on the Current Population Survey
Current Population Survey
The Current Population Survey is a statistical survey conducted by the United States Census Bureau for the Bureau of Labor Statistics . The BLS uses the data to provide a monthly report on the Employment Situation. This report provides estimates of the number of unemployed people in the United...
, under count Medicaid
Medicaid
Medicaid is the United States health program for certain people and families with low incomes and resources. It is a means-tested program that is jointly funded by the state and federal governments, and is managed by the states. People served by Medicaid are U.S. citizens or legal permanent...
enrollment. As a result, it likely overstates the number of uninsured individuals.
The number of people who lack insurance at some time during a multi-year period is greater than the number currently uninsured. A study published by Families USA
Families USA
Families USA is an American non-profit consumer health-care advocacy organization. It was co-founded by attorney Ronald Pollack, its current executive director, and Philippe Villers, the organization's current President....
in 2009 estimated that approximately 86.7 million people were uninsured at some point during the two-year period 2007-2008. This represented about 29% of the total US population or about one-in-three under 65 years of age.
Uninsured Demographic
The Census Bureau reports that in 2007 nearly 37 million of the uninsured were employment-age adults (ages 18 to 64) and more than 27 million worked at least part time. Approximately 61% of the roughly 45 million uninsured live in households with incomes under $50,000 (13.5 million below $25,000 and 14.5 million at $25,000 to $49,000). And 38% live in households with incomes of $50,000 or more (8.5 million at $50,000 to $74,999 and 9.1 million at $75,000 or more). As stated by the Census Bureau, people of Hispanic origin were the most affected by being uninsured; nearly a third of Hispanics lack health insurance. In 2004, about 33% of Latinos were uninsured as opposed to 10% of white, non-LatinosHowever, this rate decreased slightly from 2006 to 2007, from 15.3 to 14.8 million, a decrease of 2 percentage points (34.1% to 32.1%).
The state with the highest percentage of uninsured was Texas
Texas
Texas is the second largest U.S. state by both area and population, and the largest state by area in the contiguous United States.The name, based on the Caddo word "Tejas" meaning "friends" or "allies", was applied by the Spanish to the Caddo themselves and to the region of their settlement in...
(24.1% average for three years, 2004–2006). New Mexico
New Mexico
New Mexico is a state located in the southwest and western regions of the United States. New Mexico is also usually considered one of the Mountain States. With a population density of 16 per square mile, New Mexico is the sixth-most sparsely inhabited U.S...
has the second highest percentage of residents without health insurance at 22%.
It has been estimated that nearly one-fifth of the uninsured population is able to afford insurance, almost one quarter is eligible for public coverage, and the remaining 56% need financial assistance (8.9% of all Americans). An estimated 5 million of those without health insurance are considered "uninsurable" because of pre-existing condition
Pre-existing condition
A pre-existing condition is a risk with extant causes that is not readily compensated by standard, affordable insurance premiums. Pre-existing condition exclusions by the insurance industry are meant to cope with adverse selection by potential customers. Such exclusions have become a topic in the...
s. A recent study concluded that 15% of people shopping online for health insurance are considered "uninsurable" because of a pre-existing condition, or for being overweight. This label does not necessarily mean they can never get health insurance, but that they will not qualify for standard individual coverage. People with similar health status can be covered via employer-provided health insurance, Medicare, or Medicaid.
Uninsured children and young adults
The current estimate for uninsured children does not greatly differ from past estimates. In 2009 the Census Bureau states that 10.0 percent or 7.5 million children under the age of 18 were medically uninsured. Children living in poverty are 15.1 percent greater than other children to be uninsured. The lower the income of a household the more likely it is they are uninsured. In 2009, a household with an annual income of 25,000 or less was only 26.6 percent likely not to have medical insurance and those with an annual income of 75,000 or more were only 9.1 percent unlikely to be insured. According to the Census Bureau, in 2007, there were 8.1 million uninsured children in the US. Nearly 8 million young adults (those aged 18–24), were uninsured, representing 28.1% of their population. Young adults make up the largest age segment of the uninsured, are the most likely to be uninsured, and are one of the fastest growing segments of the uninsured population. They often lose coverage under their parents' health insurance policies or public programs when they reach age 19. Others lose coverage when they graduate from college. Many young adults do not have the kind of stable employment that would provide ongoing access to health insurance.According to the Congressional Budget Office the plan the way it is now would have to cover unmarried dependents under their parents' insurance up to age 26. These changes also affect large employers, including self-insured firms, so that the firm bears the financial responsibility of providing coverage. The only exception to this is policies that were maintained continuously before the enactment of this legislation. Those policies would be grandfathered in.http://www.cbo.gov
Non-citizens
Non-citizens are more likely to be uninsured than citizens, with a 43.8% uninsured rate. This is attributable to a higher likelihood of working in a low-wage job that does not offer health benefits, and restrictions on eligibility for public programs. However, most of the uninsured in the US are citizens (78%).Catherine Hoffman,Karyn Schwartz, Jennifer Tolbert, Allison Cook and Aimee Williams, "The Uninsured: A Primer", Kaiser Family FoundationKaiser Family Foundation
The Henry J. Kaiser Family Foundation , or just Kaiser Family Foundation, is a U.S.-based non-profit, private operating foundation headquartered in Menlo Park, California. It focuses on the major health care issues facing the nation, as well as the U.S. role in global health policy...
, October 2008 (Supplemental data tables) The longer a non-citizen immigrant has been in the country, the less likely they are to be uninsured. In 2006, roughly 27% of immigrants entering the country before 1970 were uninsured, compared to 45% of immigrants entering the country in the 1980s and 49% of those entering between 2000 and 2006.
Most uninsured non-citizens are recent immigrants; almost half entered the country between 2000 and 2006, and 36% entered during the 1990s. Foreign-born non-citizens accounted for over 40% of the increase in the uninsured between 1990 and 1998, and over 90% of the increase between 1998 and 2003. One reason for the acceleration after 1998 may be restrictions imposed by the Personal Responsibility and Work Opportunity Reconciliation Act
Personal Responsibility and Work Opportunity Act
The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 is a United States federal law considered to be a fundamental shift in both the method and goal of federal cash assistance to the poor. The bill added a workforce development component to welfare legislation, encouraging...
(PRWORA) of 1996. Almost seven out of ten (68%) of uninsured non-citizens live in California, Texas, Florida, or New York.
Downturn effects
A report by the Kaiser Family FoundationKaiser Family Foundation
The Henry J. Kaiser Family Foundation , or just Kaiser Family Foundation, is a U.S.-based non-profit, private operating foundation headquartered in Menlo Park, California. It focuses on the major health care issues facing the nation, as well as the U.S. role in global health policy...
in April 2008 found that US economic downturns place a significant strain on state Medicaid
Medicaid
Medicaid is the United States health program for certain people and families with low incomes and resources. It is a means-tested program that is jointly funded by the state and federal governments, and is managed by the states. People served by Medicaid are U.S. citizens or legal permanent...
and SCHIP
State Children's Health Insurance Program
The State Children's Health Insurance Program – later known more simply as the Children's Health Insurance Program – is a program administered by the United States Department of Health and Human Services that provides matching funds to states for health insurance to families with children...
programs. The authors estimated that a 1% increase in the unemployment rate increase Medicaid and SCHIP enrollment by 1 million, and increase the number uninsured by 1.1 million. State spending on Medicaid and SCHIP would increase by $1.4 billion (total spending on these programs would increase by $3.4 billion). This increased spending would occur while state government revenues were declining. During the last downturn, the Jobs and Growth Tax Relief Reconciliation Act of 2003
Jobs and Growth Tax Relief Reconciliation Act of 2003
The Jobs and Growth Tax Relief Reconciliation Act of 2003 , was passed by the United States Congress on May 23, 2003 and signed into law by President George W. Bush on May 28, 2003...
(JGTRRA) included federal assistance to states, which helped states avoid tightening their Medicaid and SCHIP eligibility rules. The authors conclude that Congress
United States Congress
The United States Congress is the bicameral legislature of the federal government of the United States, consisting of the Senate and the House of Representatives. The Congress meets in the United States Capitol in Washington, D.C....
should consider similar relief for the current economic downturn.
Types of Insurance
American's are accessing their medical insurance through employment-based programs, private health insurance companies, and Medicaid. The Census Bureau reports that in 2010 persons covered by private health insurance decreased to 64 percent. This was not a dramatic decrease from those being covered by private insurance companies in 2009, at 195.9 million, but private health coverage has continued to decline since 2001. Those persons being covered by government sponsored health insurance programs have increased. During 2010 persons insured through government programs increased slightly from 30.6 percent to 93.2 million durning 2009 covered 31.0 percent or 95.0 million. Persons covered by employment-based health insurance have also declined. The decrease in employment-based health insurance to 55.3 percent in 2010 from 56.1 percent in 2009.Causes
Americans who are uninsured may be so because: their job does not offer insurance; they are unemployed and cannot pay for insurance; or they may be financially able to buy insurance but consider the high cost prohibitive. During 2009 the continued low employment rate has negativly affect those who had previously been enrolled in employment-based insurance policies. Census Bureau states a 55 percent drop.Other uninsured Americans have chosen to join a health care sharing ministry as an alternative to insurance.Low-income workers are less likely than higher income individuals to be offered coverage by their employer (or by their spouse's employer), and less able to afford buying it on their own. Beginning with wage and price controls during World War II
World War II
World War II, or the Second World War , was a global conflict lasting from 1939 to 1945, involving most of the world's nations—including all of the great powers—eventually forming two opposing military alliances: the Allies and the Axis...
, and cemented by an income tax exemption ruling in 1954, most working Americans have received their health insurance from their employers. However, recent trends have shown an ongoing decline in employer-sponsored health insurance benefits. In 2000, 68% of small companies with 3 to 199 workers offered health benefits. Since that time, that number has continued to drop to 2007, when 59% offered health benefits. For large firms with 200 or more workers, in 2000, 99% of employers offered health benefits, and in 2007, that number stayed the same at 99%. On average, considering firms of all numbers of employees, in 2000, 69% offered health insurance, and that number has fallen nearly every year since, to 2007, when 60% of employers offered health insurance.
One study published in 2008 found that people of average health are least likely to become uninsured if they have large group health coverage, more likely to become uninsured if they have small group coverage, and most likely to become uninsured if they have individual health insurance. But, "for people in poor or fair health, the chances of losing coverage are much greater for people who had small-group insurance than for those who had individual insurance." The authors attribute these results to the combination in the individual market of high costs and guaranteed renewability of coverage. Individual coverage costs more if it is purchased after a person becomes unhealthy, but "provides better protection (compared to group insurance) against high premiums for already individually insured people who become high risk." Healthy individuals are more likely to drop individual coverage than less-expensive, subsidized employment-based coverage, but group coverage leaves them "more vulnerable to dropping or losing any and all coverage than does individual insurance" if they become seriously ill.
Roughly a quarter of the uninsured are eligible for public coverage, but are not enrolled. Possible reasons include a lack of awareness of the programs or of how to enroll, reluctance due to a perceived stigma associated with public coverage, poor retention of enrollees, and burdensome administrative procedures. In addition, some state programs have enrollment caps.
A study by the Kaiser Family Foundation
Kaiser Family Foundation
The Henry J. Kaiser Family Foundation , or just Kaiser Family Foundation, is a U.S.-based non-profit, private operating foundation headquartered in Menlo Park, California. It focuses on the major health care issues facing the nation, as well as the U.S. role in global health policy...
published in June 2009 found that 45% of low-income adults under age 65 lack health insurance. Almost a third of non-elderly adults are low income, with family incomes below 200% of the federal poverty level. Low-income adults are generally younger, less well educated, and less likely to live in a household with a full time worker than are higher income adults; these factors contribute to the likelihood of being uninsured. In addition, the chances of being healthy decline with lower income; 19% of adults with incomes below the federal poverty level describe their health as fair or poor.
Consequences
A report from the Institute of Medicine of the National Academies states: "Lack of health insurance causes roughly 18,000 unnecessary deaths every year in the United States." A 2009 Harvard study published in the American Journal of Public Health found more than 44,800 excess deaths annually in the United States associated with uninsurance. Johns Hopkins UniversityJohns Hopkins University
The Johns Hopkins University, commonly referred to as Johns Hopkins, JHU, or simply Hopkins, is a private research university based in Baltimore, Maryland, United States...
professor Vicente Navarro stated, more broadly, in 2003, "the problem does not end here, with the uninsured. An even larger problem is the underinsured
Underinsured
Underinsured refers to various degrees of being insured for some real risks and uninsured for others, at the same time.-Health care:Johns Hopkins University professor Vicente Navarro stated in 2003, "the problem does not end here, with the uninsured...
" and "The most credible estimate of the number of people in the United States who have died because of lack of medical care was provided by a study carried out by Harvard Medical School
Harvard Medical School
Harvard Medical School is the graduate medical school of Harvard University. It is located in the Longwood Medical Area of the Mission Hill neighborhood of Boston, Massachusetts....
Professors David Himmelstein and Steffie Woolhandler (New England Journal of Medicine 336, no. 11 [1997]). They concluded that almost 100,000 people died in the United States each year because of lack of needed care—three times the number of people who died of AIDS."
Offsetting that, a Hearst Newspapers investigation called medical error
Medical error
A medical error may be defined as a preventable adverse effect of care, whether or not it is evident or harmful to the patient. This might include an inaccurate or incomplete diagnosis or treatment of a disease, injury, syndrome, behavior, infection, or other ailment.-Definitions:As a general...
"far more deadly than inadequate medical insurance." The number of Americans with access to care who are killed by medical errors is estimated from 44,000 to hundreds of thousands each year, and the New England Journal of Medicine
New England Journal of Medicine
The New England Journal of Medicine is an English-language peer-reviewed medical journal published by the Massachusetts Medical Society. It describes itself as the oldest continuously published medical journal in the world.-History:...
published a study finding that American hospitals injured around 20% of all patients every year from 2002-2007. Notably, Representative John Murtha
John Murtha
John Patrick "Jack" Murtha, Jr. was an American politician from the U.S. state of Pennsylvania. Murtha, a Democrat, represented Pennsylvania's 12th congressional district in the United States House of Representatives from 1974 until his death in 2010....
, who had voted for the House healthcare reform bill in 2009, died from a surgical error in 2010. Moreover, the best predictor of longevity is education; in study after study, money and health insurance "pale in comparison."
A survey released in 2008 found that being uninsured impacts American consumers' health in the following ways:
- More of the uninsured chose not to see a doctor when were sick or hurt (53%) vs 46% of the insured.
- Fewer of the uninsured (28%) report currently undergoing treatment or participating in a program to help them manage a chronic condition; 37% of the insured are receiving such treatment.
- 21% of the uninsured, vs. 16% of the insured, believe their overall health is below average for people in their age group.
The costs of treating the uninsured must often be absorbed by providers as charity care
Charity care
In the United States, charity care is health care provided for free or at reduced prices to low income patients. The percentage of doctors providing charity care dropped from 76% in 1996-97 to 68% in 2004-2005. Potential reasons for the decline include changes in physician practice patterns and...
, passed on to the insured via cost-shifting
Cost-shifting
Cost-shifting is either an economic situation where one group underpays for a service resulting another group overpaying for a service or where one group pays a smaller share of costs than before resulting in another group paying a larger share of costs than before...
and higher health insurance premiums, or paid by taxpayers through higher taxes. On the other hand, the uninsured often subsidize the insured because the uninsured use fewer services and are billed unfairly. 60 Minutes
60 Minutes
60 Minutes is an American television news magazine, which has run on CBS since 1968. The program was created by producer Don Hewitt who set it apart by using a unique style of reporter-centered investigation....
reported, "Hospitals charge uninsured patients two, three, four or more times what an insurance company would pay for the same treatment." On average, per capita health care spending on behalf of the uninsured is a bit more than half that for the insured.
A study published in August 2008 in Health Affairs
Health Affairs
Health Affairs is a peer-reviewed healthcare journal established in 1981 by John K. Iglehart. It was described by The Washington Post as "the bible of health policy". Health Affairs is indexed and/or abstracted in PubMed, MEDLINE, EBSCO databases, ProQuest, LexisNexis, Current Contents/Health...
found that covering all of the uninsured in the US would increase national spending on health care by $122.6 billion, which would represent a 5% increase in health care spending and 0.8% of GDP. The impact on government spending could be higher, depending on the details of the plan used to increase coverage and the extent to which new public coverage crowded out existing private coverage. Massachusetts' law requiring everyone to buy insurance has reportedly caused costs there to increase faster than in the rest of the country.
A study published in the American Journal of Public Health
American Journal of Public Health
The American Journal of Public Health is a monthly peer-reviewed medical journal published by the American Public Health Association covering health policy and public health. The journal was established in 1911 and its stated mission is "to advance public health research, policy, practice, and...
in 2009 found that "[u]ninsurance is associated with mortality. The strength of that association appears similar to that from a study that evaluated data from the mid-1980s, despite changes in medical therapeutics and the demography of the uninsured since that time." The study estimated that lack of insurance is associated with 45,000 deaths annually. This is two and a half times higher than an estimate produced by the Institute of Medicine in 2002. One of the authors characterized the results as "now one dies every 12 minutes."
Emergency Medical Treatment and Active Labor Act (EMTALA)
EMTALA, enacted by the federal government in 1986, requires that hospital emergency departments treat emergency conditions of all patients regardless of their ability to pay and is considered a critical element in the "safety net" for the uninsured. However, the federal law established no direct payment mechanism for such care. Indirect payments and reimbursements through federal and state government programs have never fully compensated public and private hospitals for the full cost of care mandated by EMTALA. In fact, more than half of all emergency care in the U.S. now goes uncompensated. According to some analyses, EMTALA is an unfunded mandate that has contributed to financial pressures on hospitals in the last 20 years, causing them to consolidate and close facilities, and contributing to emergency room overcrowding. According to the Institute of MedicineInstitute of Medicine
The Institute of Medicine is a not-for-profit, non-governmental American organization founded in 1970, under the congressional charter of the National Academy of Sciences...
, between 1993 and 2003, emergency room visits in the U.S. grew by 26%, while in the same period, the number of emergency departments declined by 425. Hospitals bill uninsured patients directly under the fee-for-service
Fee-for-service
Fee-for-service is a payment model where services are unbundled and paid for separately. In health care, it gives an incentive for physicians to provide more treatments because payment is dependent on the quantity of care, rather than quality of care...
model, often charging much more than insurers would pay, and patients may become bankrupt when hospitals file lawsuits to collect.
Mentally ill patients present a unique challenge for emergency departments and hospitals. In accordance with EMTALA, mentally ill patients who enter emergency rooms are evaluated for emergency medical conditions. Once mentally ill patients are medically stable, regional mental health agencies are contacted to evaluate them. Patients are evaluated as to whether they are a danger to themselves or others. Those meeting this criterion are admitted to a mental health facility to be further evaluated by a psychiatrist. Typically, mentally ill patients can be held for up to 72 hours, after which a court order is required.
Uninsured rates by state
The United States Census BureauUnited States Census Bureau
The United States Census Bureau is the government agency that is responsible for the United States Census. It also gathers other national demographic and economic data...
regularly conducts the Current Population Survey
Current Population Survey
The Current Population Survey is a statistical survey conducted by the United States Census Bureau for the Bureau of Labor Statistics . The BLS uses the data to provide a monthly report on the Employment Situation. This report provides estimates of the number of unemployed people in the United...
(CPS), which includes estimates on health insurance coverage in the United States. The data is published annually in the Annual Social and Economic Supplement (ASEC). The data from 1999 to 2009 are reproduced below.The Census Bureau's algorithm was revised in 2000 and again in 2005. The data for 2004 was revised after its initial publishing. See the Health Insurance Historical Tables for more information. , the five states with the highest estimated percentage of uninsured are, in order, Texas
Texas
Texas is the second largest U.S. state by both area and population, and the largest state by area in the contiguous United States.The name, based on the Caddo word "Tejas" meaning "friends" or "allies", was applied by the Spanish to the Caddo themselves and to the region of their settlement in...
, Florida
Florida
Florida is a state in the southeastern United States, located on the nation's Atlantic and Gulf coasts. It is bordered to the west by the Gulf of Mexico, to the north by Alabama and Georgia and to the east by the Atlantic Ocean. With a population of 18,801,310 as measured by the 2010 census, it...
, New Mexico
New Mexico
New Mexico is a state located in the southwest and western regions of the United States. New Mexico is also usually considered one of the Mountain States. With a population density of 16 per square mile, New Mexico is the sixth-most sparsely inhabited U.S...
, Nevada
Nevada
Nevada is a state in the western, mountain west, and southwestern regions of the United States. With an area of and a population of about 2.7 million, it is the 7th-largest and 35th-most populous state. Over two-thirds of Nevada's people live in the Las Vegas metropolitan area, which contains its...
, and Georgia
Georgia (U.S. state)
Georgia is a state located in the southeastern United States. It was established in 1732, the last of the original Thirteen Colonies. The state is named after King George II of Great Britain. Georgia was the fourth state to ratify the United States Constitution, on January 2, 1788...
. The five states with the lowest estimated percentage of uninsured for the same year are, in order, Massachusetts
Massachusetts
The Commonwealth of Massachusetts is a state in the New England region of the northeastern United States of America. It is bordered by Rhode Island and Connecticut to the south, New York to the west, and Vermont and New Hampshire to the north; at its east lies the Atlantic Ocean. As of the 2010...
, Hawaii
Hawaii
Hawaii is the newest of the 50 U.S. states , and is the only U.S. state made up entirely of islands. It is the northernmost island group in Polynesia, occupying most of an archipelago in the central Pacific Ocean, southwest of the continental United States, southeast of Japan, and northeast of...
, Minnesota
Minnesota
Minnesota is a U.S. state located in the Midwestern United States. The twelfth largest state of the U.S., it is the twenty-first most populous, with 5.3 million residents. Minnesota was carved out of the eastern half of the Minnesota Territory and admitted to the Union as the thirty-second state...
, Wisconsin
Wisconsin
Wisconsin is a U.S. state located in the north-central United States and is part of the Midwest. It is bordered by Minnesota to the west, Iowa to the southwest, Illinois to the south, Lake Michigan to the east, Michigan to the northeast, and Lake Superior to the north. Wisconsin's capital is...
, and Vermont
Vermont
Vermont is a state in the New England region of the northeastern United States of America. The state ranks 43rd in land area, , and 45th in total area. Its population according to the 2010 census, 630,337, is the second smallest in the country, larger only than Wyoming. It is the only New England...
. These rankings for each year are highlighted below.
| Division | 1999 | 2000 | 2001 | 2002 | 2003 | 2004 | 2005 | 2006 | 2007 | 2008 | 2009 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| United States United States The United States of America is a federal constitutional republic comprising fifty states and a federal district... |
14.0 | 13.7 | 14.1 | 14.7 | 15.1 | 14.9 | 15.3 | 15.8 | 15.3 | 15.4 | 16.7 |
| Alabama Alabama Alabama is a state located in the southeastern region of the United States. It is bordered by Tennessee to the north, Georgia to the east, Florida and the Gulf of Mexico to the south, and Mississippi to the west. Alabama ranks 30th in total land area and ranks second in the size of its inland... |
13.0 | 12.7 | 12.5 | 12.2 | 13.2 | 12.5 | 14.5 | 15.2 | 12.0 | 11.9 | 16.9 |
| Alaska Alaska Alaska is the largest state in the United States by area. It is situated in the northwest extremity of the North American continent, with Canada to the east, the Arctic Ocean to the north, and the Pacific Ocean to the west and south, with Russia further west across the Bering Strait... |
18.3 | 18.3 | 15.5 | 18.5 | 18.7 | 16.5 | 17.2 | 16.5 | 18.2 | 19.8 | 17.7 |
| Arizona Arizona Arizona ; is a state located in the southwestern region of the United States. It is also part of the western United States and the mountain west. The capital and largest city is Phoenix... |
19.6 | 16.0 | 17.5 | 16.3 | 16.7 | 16.7 | 19.6 | 20.9 | 18.3 | 19.5 | 19.6 |
| Arkansas Arkansas Arkansas is a state located in the southern region of the United States. Its name is an Algonquian name of the Quapaw Indians. Arkansas shares borders with six states , and its eastern border is largely defined by the Mississippi River... |
13.6 | 13.8 | 15.8 | 16.0 | 17.1 | 16.2 | 17.5 | 18.9 | 16.1 | 17.8 | 19.2 |
| California California California is a state located on the West Coast of the United States. It is by far the most populous U.S. state, and the third-largest by land area... |
19.1 | 18.1 | 19.1 | 17.7 | 17.9 | 18.0 | 18.8 | 18.8 | 18.2 | 18.6 | 20.0 |
| Colorado Colorado Colorado is a U.S. state that encompasses much of the Rocky Mountains as well as the northeastern portion of the Colorado Plateau and the western edge of the Great Plains... |
15.3 | 13.8 | 14.9 | 15.1 | 16.6 | 15.9 | 16.6 | 17.2 | 16.4 | 15.9 | 15.3 |
| Connecticut Connecticut Connecticut is a state in the New England region of the northeastern United States. It is bordered by Rhode Island to the east, Massachusetts to the north, and the state of New York to the west and the south .Connecticut is named for the Connecticut River, the major U.S. river that approximately... |
8.5 | 9.3 | 9.5 | 9.8 | 10.1 | 10.9 | 10.9 | 9.4 | 9.4 | 10.0 | 12.0 |
| Delaware Delaware Delaware is a U.S. state located on the Atlantic Coast in the Mid-Atlantic region of the United States. It is bordered to the south and west by Maryland, and to the north by Pennsylvania... |
9.4 | 8.9 | 8.9 | 9.4 | 10.4 | 13.3 | 12.2 | 12.1 | 11.2 | 10.8 | 13.4 |
| District of Columbia Washington, D.C. Washington, D.C., formally the District of Columbia and commonly referred to as Washington, "the District", or simply D.C., is the capital of the United States. On July 16, 1790, the United States Congress approved the creation of a permanent national capital as permitted by the U.S. Constitution.... |
14.0 | 13.6 | 12.1 | 12.5 | 13.7 | 12.3 | 13.2 | 11.6 | 9.5 | 10.0 | 12.4 |
| Florida Florida Florida is a state in the southeastern United States, located on the nation's Atlantic and Gulf coasts. It is bordered to the west by the Gulf of Mexico, to the north by Alabama and Georgia and to the east by the Atlantic Ocean. With a population of 18,801,310 as measured by the 2010 census, it... |
17.8 | 17.0 | 17.0 | 16.7 | 17.5 | 19.4 | 20.2 | 21.2 | 20.2 | 20.0 | 22.4 |
| Georgia Georgia (U.S. state) Georgia is a state located in the southeastern United States. It was established in 1732, the last of the original Thirteen Colonies. The state is named after King George II of Great Britain. Georgia was the fourth state to ratify the United States Constitution, on January 2, 1788... |
14.5 | 14.1 | 15.8 | 15.7 | 16.0 | 16.9 | 18.3 | 17.7 | 17.5 | 17.8 | 20.5 |
| Hawaii Hawaii Hawaii is the newest of the 50 U.S. states , and is the only U.S. state made up entirely of islands. It is the northernmost island group in Polynesia, occupying most of an archipelago in the central Pacific Ocean, southwest of the continental United States, southeast of Japan, and northeast of... |
9.9 | 9.1 | 9.2 | 9.8 | 9.5 | 8.3 | 8.6 | 8.8 | 7.5 | 7.8 | 8.2 |
| Idaho Idaho Idaho is a state in the Rocky Mountain area of the United States. The state's largest city and capital is Boise. Residents are called "Idahoans". Idaho was admitted to the Union on July 3, 1890, as the 43rd state.... |
18.0 | 15.0 | 15.6 | 17.3 | 18.1 | 14.5 | 14.8 | 15.4 | 13.9 | 15.6 | 15.2 |
| Illinois Illinois Illinois is the fifth-most populous state of the United States of America, and is often noted for being a microcosm of the entire country. With Chicago in the northeast, small industrial cities and great agricultural productivity in central and northern Illinois, and natural resources like coal,... |
12.8 | 13.3 | 13.1 | 13.5 | 13.9 | 13.0 | 13.7 | 14.0 | 13.4 | 12.9 | 14.8 |
| Indiana Indiana Indiana is a US state, admitted to the United States as the 19th on December 11, 1816. It is located in the Midwestern United States and Great Lakes Region. With 6,483,802 residents, the state is ranked 15th in population and 16th in population density. Indiana is ranked 38th in land area and is... |
9.0 | 10.8 | 11.2 | 12.3 | 12.9 | 13.8 | 13.6 | 11.8 | 11.4 | 12.3 | 14.2 |
| Iowa Iowa Iowa is a state located in the Midwestern United States, an area often referred to as the "American Heartland". It derives its name from the Ioway people, one of the many American Indian tribes that occupied the state at the time of European exploration. Iowa was a part of the French colony of New... |
6.9 | 8.4 | 7.4 | 9.0 | 10.9 | 9.2 | 8.3 | 10.5 | 9.3 | 9.5 | 11.4 |
| Kansas Kansas Kansas is a US state located in the Midwestern United States. It is named after the Kansas River which flows through it, which in turn was named after the Kansa Native American tribe, which inhabited the area. The tribe's name is often said to mean "people of the wind" or "people of the south... |
11.4 | 10.3 | 10.9 | 9.9 | 10.3 | 10.7 | 10.3 | 12.3 | 12.7 | 12.1 | 13.3 |
| Kentucky Kentucky The Commonwealth of Kentucky is a state located in the East Central United States of America. As classified by the United States Census Bureau, Kentucky is a Southern state, more specifically in the East South Central region. Kentucky is one of four U.S. states constituted as a commonwealth... |
12.3 | 13.0 | 11.5 | 13.1 | 13.1 | 13.6 | 12.3 | 15.6 | 13.6 | 16.0 | 16.2 |
| Louisiana Louisiana Louisiana is a state located in the southern region of the United States of America. Its capital is Baton Rouge and largest city is New Orleans. Louisiana is the only state in the U.S. with political subdivisions termed parishes, which are local governments equivalent to counties... |
21.1 | 17.3 | 18.2 | 17.8 | 19.5 | 16.0 | 17.7 | 21.9 | 18.5 | 20.1 | 16.0 |
| Maine Maine Maine is a state in the New England region of the northeastern United States, bordered by the Atlantic Ocean to the east and south, New Hampshire to the west, and the Canadian provinces of Quebec to the northwest and New Brunswick to the northeast. Maine is both the northernmost and easternmost... |
10.8 | 10.6 | 10.1 | 11.0 | 10.0 | 8.9 | 10.3 | 9.3 | 8.8 | 10.4 | 10.2 |
| Maryland Maryland Maryland is a U.S. state located in the Mid Atlantic region of the United States, bordering Virginia, West Virginia, and the District of Columbia to its south and west; Pennsylvania to its north; and Delaware to its east... |
10.4 | 9.7 | 11.7 | 12.3 | 13.3 | 13.4 | 13.4 | 13.8 | 13.7 | 12.1 | 14.0 |
| Massachusetts Massachusetts The Commonwealth of Massachusetts is a state in the New England region of the northeastern United States of America. It is bordered by Rhode Island and Connecticut to the south, New York to the west, and Vermont and New Hampshire to the north; at its east lies the Atlantic Ocean. As of the 2010... |
8.9 | 8.4 | 7.6 | 9.5 | 10.2 | 11.3 | 9.2 | 10.4 | 5.4 | 5.5 | 4.4 |
| Michigan Michigan Michigan is a U.S. state located in the Great Lakes Region of the United States of America. The name Michigan is the French form of the Ojibwa word mishigamaa, meaning "large water" or "large lake".... |
9.7 | 8.5 | 9.8 | 10.9 | 10.2 | 11.1 | 10.3 | 10.5 | 11.6 | 11.7 | 13.8 |
| Minnesota Minnesota Minnesota is a U.S. state located in the Midwestern United States. The twelfth largest state of the U.S., it is the twenty-first most populous, with 5.3 million residents. Minnesota was carved out of the eastern half of the Minnesota Territory and admitted to the Union as the thirty-second state... |
6.7 | 7.5 | 7.5 | 7.4 | 8.3 | 8.5 | 7.9 | 9.2 | 8.3 | 8.7 | 8.8 |
| Mississippi Mississippi Mississippi is a U.S. state located in the Southern United States. Jackson is the state capital and largest city. The name of the state derives from the Mississippi River, which flows along its western boundary, whose name comes from the Ojibwe word misi-ziibi... |
15.2 | 12.9 | 16.0 | 16.1 | 17.6 | 16.7 | 16.9 | 20.8 | 18.8 | 17.9 | 17.6 |
| Missouri Missouri Missouri is a US state located in the Midwestern United States, bordered by Iowa, Illinois, Kentucky, Tennessee, Arkansas, Oklahoma, Kansas and Nebraska. With a 2010 population of 5,988,927, Missouri is the 18th most populous state in the nation and the fifth most populous in the Midwest. It... |
6.2 | 9.3 | 9.5 | 11.1 | 10.8 | 11.9 | 11.7 | 13.3 | 12.6 | 12.6 | 15.3 |
| Montana Montana Montana is a state in the Western United States. The western third of Montana contains numerous mountain ranges. Smaller, "island ranges" are found in the central third of the state, for a total of 77 named ranges of the Rocky Mountains. This geographical fact is reflected in the state's name,... |
17.5 | 16.4 | 13.3 | 14.6 | 18.9 | 18.2 | 15.6 | 17.1 | 15.6 | 16.1 | 15.4 |
| Nebraska Nebraska Nebraska is a state on the Great Plains of the Midwestern United States. The state's capital is Lincoln and its largest city is Omaha, on the Missouri River.... |
9.2 | 8.3 | 8.7 | 9.5 | 10.5 | 10.4 | 10.5 | 12.3 | 13.2 | 11.9 | 11.5 |
| Nevada Nevada Nevada is a state in the western, mountain west, and southwestern regions of the United States. With an area of and a population of about 2.7 million, it is the 7th-largest and 35th-most populous state. Over two-thirds of Nevada's people live in the Las Vegas metropolitan area, which contains its... |
18.3 | 16.4 | 15.4 | 19.4 | 18.2 | 18.4 | 17.1 | 19.6 | 17.2 | 18.8 | 20.8 |
| New Hampshire New Hampshire New Hampshire is a state in the New England region of the northeastern United States of America. The state was named after the southern English county of Hampshire. It is bordered by Massachusetts to the south, Vermont to the west, Maine and the Atlantic Ocean to the east, and the Canadian... |
8.6 | 8.0 | 9.0 | 9.5 | 9.7 | 10.1 | 9.7 | 11.5 | 10.5 | 10.2 | 10.5 |
| New Jersey New Jersey New Jersey is a state in the Northeastern and Middle Atlantic regions of the United States. , its population was 8,791,894. It is bordered on the north and east by the state of New York, on the southeast and south by the Atlantic Ocean, on the west by Pennsylvania and on the southwest by Delaware... |
11.7 | 11.7 | 12.7 | 13.4 | 13.4 | 13.9 | 14.5 | 15.5 | 15.8 | 14.1 | 15.8 |
| New Mexico New Mexico New Mexico is a state located in the southwest and western regions of the United States. New Mexico is also usually considered one of the Mountain States. With a population density of 16 per square mile, New Mexico is the sixth-most sparsely inhabited U.S... |
24.1 | 23.7 | 20.2 | 20.6 | 21.9 | 19.8 | 20.3 | 22.9 | 22.5 | 23.7 | 21.7 |
| New York New York New York is a state in the Northeastern region of the United States. It is the nation's third most populous state. New York is bordered by New Jersey and Pennsylvania to the south, and by Connecticut, Massachusetts and Vermont to the east... |
15.1 | 16.0 | 15.0 | 15.3 | 14.7 | 12.6 | 13.0 | 14.0 | 13.2 | 14.1 | 14.8 |
| North Carolina North Carolina North Carolina is a state located in the southeastern United States. The state borders South Carolina and Georgia to the south, Tennessee to the west and Virginia to the north. North Carolina contains 100 counties. Its capital is Raleigh, and its largest city is Charlotte... |
13.5 | 13.1 | 13.7 | 16.4 | 16.9 | 14.8 | 15.3 | 17.9 | 16.4 | 15.4 | 18.0 |
| North Dakota North Dakota North Dakota is a state located in the Midwestern region of the United States of America, along the Canadian border. The state is bordered by Canada to the north, Minnesota to the east, South Dakota to the south and Montana to the west. North Dakota is the 19th-largest state by area in the U.S.... |
10.8 | 10.7 | 8.8 | 10.0 | 9.7 | 10.1 | 11.0 | 12.2 | 10.0 | 11.8 | 10.7 |
| Ohio Ohio Ohio is a Midwestern state in the United States. The 34th largest state by area in the U.S.,it is the 7th‑most populous with over 11.5 million residents, containing several major American cities and seven metropolitan areas with populations of 500,000 or more.The state's capital is Columbus... |
9.7 | 10.7 | 10.7 | 11.1 | 11.5 | 10.6 | 11.4 | 10.1 | 11.7 | 11.5 | 14.3 |
| Oklahoma Oklahoma Oklahoma is a state located in the South Central region of the United States of America. With an estimated 3,751,351 residents as of the 2010 census and a land area of 68,667 square miles , Oklahoma is the 28th most populous and 20th-largest state... |
15.5 | 18.4 | 17.6 | 17.0 | 20.0 | 19.2 | 17.9 | 18.9 | 17.8 | 14.0 | 18.1 |
| Oregon Oregon Oregon is a state in the Pacific Northwest region of the United States. It is located on the Pacific coast, with Washington to the north, California to the south, Nevada on the southeast and Idaho to the east. The Columbia and Snake rivers delineate much of Oregon's northern and eastern... |
13.3 | 12.2 | 12.5 | 14.1 | 16.5 | 16.3 | 15.6 | 17.9 | 16.8 | 16.3 | 17.7 |
| Pennsylvania Pennsylvania The Commonwealth of Pennsylvania is a U.S. state that is located in the Northeastern and Mid-Atlantic regions of the United States. The state borders Delaware and Maryland to the south, West Virginia to the southwest, Ohio to the west, New York and Ontario, Canada, to the north, and New Jersey to... |
7.7 | 8.0 | 8.7 | 10.5 | 10.7 | 10.9 | 9.7 | 10.0 | 9.5 | 9.9 | 11.4 |
| Rhode Island Rhode Island The state of Rhode Island and Providence Plantations, more commonly referred to as Rhode Island , is a state in the New England region of the United States. It is the smallest U.S. state by area... |
6.2 | 7.1 | 7.4 | 9.4 | 9.9 | 10.3 | 11.5 | 8.6 | 10.8 | 11.8 | 12.3 |
| South Carolina South Carolina South Carolina is a state in the Deep South of the United States that borders Georgia to the south, North Carolina to the north, and the Atlantic Ocean to the east. Originally part of the Province of Carolina, the Province of South Carolina was one of the 13 colonies that declared independence... |
14.8 | 11.9 | 11.8 | 12.1 | 13.7 | 14.8 | 17.3 | 15.9 | 16.4 | 15.8 | 17.0 |
| South Dakota South Dakota South Dakota is a state located in the Midwestern region of the United States. It is named after the Lakota and Dakota Sioux American Indian tribes. Once a part of Dakota Territory, South Dakota became a state on November 2, 1889. The state has an area of and an estimated population of just over... |
10.1 | 10.5 | 8.7 | 10.9 | 11.4 | 11.2 | 11.7 | 11.8 | 10.1 | 12.5 | 13.5 |
| Tennessee Tennessee Tennessee is a U.S. state located in the Southeastern United States. It has a population of 6,346,105, making it the nation's 17th-largest state by population, and covers , making it the 36th-largest by total land area... |
9.5 | 10.4 | 10.5 | 10.4 | 12.7 | 13.1 | 13.6 | 13.7 | 14.4 | 15.1 | 15.4 |
| Texas Texas Texas is the second largest U.S. state by both area and population, and the largest state by area in the contiguous United States.The name, based on the Caddo word "Tejas" meaning "friends" or "allies", was applied by the Spanish to the Caddo themselves and to the region of their settlement in... |
22.1 | 22.4 | 23.2 | 25.4 | 24.0 | 24.2 | 23.6 | 24.5 | 25.2 | 25.1 | 26.1 |
| Utah Utah Utah is a state in the Western United States. It was the 45th state to join the Union, on January 4, 1896. Approximately 80% of Utah's 2,763,885 people live along the Wasatch Front, centering on Salt Lake City. This leaves vast expanses of the state nearly uninhabited, making the population the... |
12.9 | 11.5 | 14.2 | 12.7 | 12.3 | 13.3 | 16.4 | 17.4 | 12.8 | 13.2 | 14.8 |
| Vermont Vermont Vermont is a state in the New England region of the northeastern United States of America. The state ranks 43rd in land area, , and 45th in total area. Its population according to the 2010 census, 630,337, is the second smallest in the country, larger only than Wyoming. It is the only New England... |
10.3 | 8.3 | 9.1 | 10.3 | 9.2 | 10.5 | 11.5 | 10.2 | 11.2 | 9.2 | 9.9 |
| Virginia Virginia The Commonwealth of Virginia , is a U.S. state on the Atlantic Coast of the Southern United States. Virginia is nicknamed the "Old Dominion" and sometimes the "Mother of Presidents" after the eight U.S. presidents born there... |
12.1 | 10.7 | 9.9 | 12.7 | 12.5 | 13.4 | 12.8 | 13.3 | 14.8 | 12.4 | 13.0 |
| Washington | 13.3 | 13.2 | 13.0 | 13.9 | 15.3 | 12.4 | 13.3 | 11.8 | 11.3 | 12.4 | 12.9 |
| West Virginia West Virginia West Virginia is a state in the Appalachian and Southeastern regions of the United States, bordered by Virginia to the southeast, Kentucky to the southwest, Ohio to the northwest, Pennsylvania to the northeast and Maryland to the east... |
15.1 | 13.9 | 12.8 | 14.3 | 16.4 | 16.1 | 16.9 | 13.5 | 14.1 | 15.0 | 14.0 |
| Wisconsin Wisconsin Wisconsin is a U.S. state located in the north-central United States and is part of the Midwest. It is bordered by Minnesota to the west, Iowa to the southwest, Illinois to the south, Lake Michigan to the east, Michigan to the northeast, and Lake Superior to the north. Wisconsin's capital is... |
9.5 | 7.5 | 7.3 | 9.4 | 10.5 | 10.1 | 9.3 | 8.8 | 8.2 | 9.6 | 9.5 |
| Wyoming Wyoming Wyoming is a state in the mountain region of the Western United States. The western two thirds of the state is covered mostly with the mountain ranges and rangelands in the foothills of the Eastern Rocky Mountains, while the eastern third of the state is high elevation prairie known as the High... |
14.4 | 15.3 | 14.9 | 16.8 | 15.1 | 12.8 | 14.6 | 14.6 | 13.6 | 13.6 | 15.8 |
Assisting programs for uninsured
People without health insurance in the United States may receive benefits from patient-assistance programs such as Partnership for Prescription AssistancePartnership for Prescription Assistance
The Partnership for Prescription Assistance is a United States patient-assistance program clearinghouse that designed to help low-income patients apply for free or reduced-priced prescription drugs.-History:...
.
See also
- Health care reform in the United StatesHealth care reform in the United StatesHealth care reform in the United States has a long history, of which the most recent results were two federal statutes enacted in 2010: the Patient Protection and Affordable Care Act , signed March 23, 2010, and the Health Care and Education Reconciliation Act of 2010 , which amended the PPACA and...
- Health insuranceHealth insuranceHealth insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...
- Health insurance in the United StatesHealth insurance in the United StatesThe term health insurance is commonly used in the United States to describe any program that helps pay for medical expenses, whether through privately purchased insurance, social insurance or a non-insurance social welfare program funded by the government...
- List of healthcare reform advocacy groups in the United States
- Single-payer health careSingle-payer health careSingle-payer health care is medical care funded from a single insurance pool, run by the state. Under a single-payer system, universal health care for an entire population can be financed from a pool to which many parties employees, employers, and the state have contributed...
- Universal health careUniversal health careUniversal health care is a term referring to organized health care systems built around the principle of universal coverage for all members of society, combining mechanisms for health financing and service provision.-History:...
- Patient Protection and Affordable Care ActPatient Protection and Affordable Care ActThe Patient Protection and Affordable Care Act is a United States federal statute signed into law by President Barack Obama on March 23, 2010. The law is the principal health care reform legislation of the 111th United States Congress...
External links
- America's Uninsured Crisis: Consequences for Health and Health Care Institute of Medicine, National Academy of Sciences, 2009.
- FamiliesUSA contains links to numerous studies and literature about health-care-related issues such as the uninsured.
- SHADAC Data Center is a web-based tool that allows users to create customized tables and graphs showing health insurance coverage estimates using U.S. Census surveys between 1987-2009.