For other versions of this document, see http://wikileaks.org/wiki/CRS-97-310 ------------------------------------------------------------------------------ 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) Public health insurance Private health insurance (including military) Uninsured Total Percent Percent Percent State population Number Value Rank Number Value Rank Number Value Rank United States 78,256 50,884 65.0% NA 23,173 29.6% NA 9,016 11.5% NA NA Massachusetts 1,565 1,183 75.6% 4 378 24.2% 43 76 4.8% - 1 Iowa 743 563 75.8% 3 200 26.9% 33 41 5.5% - 2 Michigan 2,611 1,894 72.5% 11 750 28.7% 27 148 5.7% - 3 Hawaii 312 221 70.8% 16 110 35.3% 11 18 5.8% - 4 Wisconsin 1,390 1,045 75.2% 5 364 26.2% 36 81 5.8% - 5 Maine 302 203 67.3% 28 109 36.0% 10 19 6.4% - 6 New Hampshire 317 258 81.4% 1 57 18.1% 49 21 6.6% - 7 Alabama 1,175 780 66.4% 31 394 33.5% 15 78 6.7% - 8 Connecticut 873 655 75.1% 6 203 23.3% 45 60 6.9% - 9 Minnesota 1,320 1,036 78.5% 2 263 19.9% 47 91 6.9% - 10 West Virginia 418 252 60.3% 41 170 40.6% 4 29 7.0% - 11 Rhode Island 256 180 70.3% 21 81 31.5% 21 18 7.0% - 12 Kansas 736 516 70.1% 23 223 30.3% 25 53 7.2% - 13 District of Columbia 119 63 53.0% 48 54 46.0% 1 9 7.3% - 14 Pennsylvania 2,944 2,132 72.4% 12 771 26.2% 35 222 7.6% - 15 Ohio 2,922 2,063 70.6% 17 826 28.3% 30 224 7.7% - 16 Vermont 140 91 64.8% 33 56 39.7% 6 11 7.7% - 17 Washington 1,617 1,124 69.5% 25 492 30.5% 24 126 7.8% - 18 Indiana 1,682 1,183 70.3% 20 454 27.0% 32 132 7.9% - 19 Tennessee 1,537 970 63.1% 36 557 36.2% 9 130 8.5% - 20 Kentucky 1,061 679 64.0% 34 366 34.5% 14 92 8.7% - 21 New York 4,770 3,101 65.0% 32 1,561 32.7% 16 415 8.7% - 22 Nebraska 467 347 74.2% 7 117 25.1% 41 41 8.7% - 23 South Dakota 205 144 70.4% 19 58 28.4% 29 18 8.8% - 24 Illinois 3,395 2,395 70.6% 18 871 25.6% 40 305 9.0% - 25 North Dakota 155 114 73.6% 8 38 24.2% 42 14 9.1% - 26 Missouri 1,483 991 66.8% 30 453 30.5% 23 138 9.3% - 27 Arkansas 732 405 55.3% 47 322 44.0% 2 69 9.5% - 28 Maryland 1,455 1,068 73.4% 9 348 23.9% 44 141 9.7% - 29 Wyoming 130 91 70.2% 22 37 28.1% 31 13 9.7% x 30 Virginia 1,933 1,341 69.4% 26 569 29.4% 26 194 10.0% x 31 Alaska 193 122 63.0% 37 76 39.2% 7 20 10.3% x 32 Delaware 216 150 69.6% 24 56 26.1% 37 23 10.6% x 33 Idaho 427 293 68.6% 27 111 25.9% 38 51 12.0% x 34 Oregon 920 619 67.2% 29 237 25.8% 39 111 12.1% x 35 Georgia 2,568 1,543 60.1% 42 907 35.3% 12 313 12.2% x 36 South Carolina 1,094 677 61.8% 38 356 32.5% 18 134 12.2% x 37 New Jersey 2,237 1,639 73.3% 10 387 17.3% 50 279 12.5% x 38 Oklahoma 948 539 56.9% 46 368 38.9% 8 119 12.6% x 39 Louisiana 1,140 668 58.7% 44 398 34.9% 13 145 12.7% x 40 California 10,089 6,032 59.8% 43 3,259 32.3% 20 1,294 12.8% + 41 North Carolina 2,333 1,409 60.4% 40 757 32.5% 19 303 13.0% x 42 Utah 841 607 72.2% 13 173 20.5% 46 109 13.0% x 43 Colorado 1,254 896 71.4% 14 245 19.6% 48 172 13.7% x 44 Montana 230 145 63.2% 35 66 28.6% 28 32 13.9% x 45 Mississippi 820 421 51.3% 50 344 41.9% 3 122 14.9% + 46 Nevada 686 486 70.9% 15 113 16.5% 51 111 16.2% + 47 Arizona 1,747 1,013 58.0% 45 571 32.7% 17 286 16.4% + 48 New Mexico 535 272 50.8% 51 215 40.1% 5 96 17.9% + 49 Florida 4,295 2,612 60.8% 39 1,151 26.8% 34 822 19.1% + 50 Texas 6,917 3,654 52.8% 49 2,131 30.8% 22 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) Public health insurance (including Private health insurance military) Uninsured State Number Percent Number Percent Number Percent United States 50,884 +/- 414 65.0% +/-0.4% 23,173 +/- 318 29.6% +/-0.4% 9,016 +/- 204 11.5% +/- 0.2% Alabama 780 +/- 53 66.4% +/- 3.1% 394 +/- 42 33.5% +/- 3.1% 78 +/- 19 6.7% +/- 1.6% Alaska 122 +/- 9 63.0% +/- 3.2% 76 +/- 8 39.2% +/- 3.2% 20 +/- 4 10.3% +/- 2.0% Arizona 1,013 +/- 65 58.0% +/- 2.9% 571 +/- 55 32.7% +/- 2.7% 286 +/- 40 16.4% +/- 2.1% Arkansas 405 +/- 31 55.3% +/- 3.3% 322 +/- 30 44.0% +/- 3.3% 69 +/- 15 9.5% +/- 2.0% California 6,032 +/- 160 59.8% +/- 1.2% 3,259 +/- 133 32.3% +/- 1.1% 1,294 +/- 86 12.8% +/- 0.8% Colorado 896 +/- 60 71.4% +/- 3.0% 245 +/- 36 19.6% +/- 2.7% 172 +/- 31 13.7% +/- 2.3% Connecticut 655 +/- 44 75.1% +/- 3.0% 203 +/- 28 23.3% +/- 2.9% 60 +/- 16 6.9% +/- 1.8% Delaware 150 +/- 11 69.6% +/- 3.2% 56 +/- 7 26.1% +/- 3.1% 23 +/- 5 10.6% +/- 2.2% District of Columbia 63 +/- 6 53.0% +/- 4.2% 54 +/- 6 46.0% +/- 4.2% 9 +/- 3 7.3% +/- 2.2% Florida 2,612 +/- 101 60.8% +/- 1.7% 1,151 +/- 76 26.8% +/- 1.6% 822 +/- 65 19.1% +/- 1.4% Georgia 1,543 +/- 75 60.1% +/- 2.2% 907 +/- 65 35.3% +/- 2.1% 313 +/- 39 12.2% +/- 1.5% Hawaii 221 +/- 15 70.8% +/- 3.0% 110 +/- 12 35.3% +/- 3.2% 18 +/- 5 5.8% +/- 1.6% Idaho 293 +/- 19 68.6% +/- 2.9% 111 +/- 13 25.9% +/- 2.8% 51 +/- 9 12.0% +/- 2.1% Illinois 2,395 +/- 95 70.6% +/- 1.8% 871 +/- 66 25.6% +/- 1.7% 305 +/- 40 9.0% +/- 1.1% Indiana 1,183 +/- 65 70.3% +/- 2.5% 454 +/- 47 27.0% +/- 2.4% 132 +/- 26 7.9% +/- 1.5% Iowa 563 +/- 38 75.8% +/- 3.0% 200 +/- 26 26.9% +/- 3.1% 41 +/- 12 5.5% +/- 1.6% Kansas 516 +/- 35 70.1% +/- 3.1% 223 +/- 27 30.3% +/- 3.1% 53 +/- 13 7.2% +/- 1.8% Kentucky 679 +/- 49 64.0% +/- 3.3% 366 +/- 41 34.5% +/- 3.3% 92 +/- 21 8.7% +/- 1.9% Louisiana 668 +/- 49 58.7% +/- 3.2% 398 +/- 42 34.9% +/- 3.1% 145 +/- 26 12.7% +/- 2.2% Maine 203 +/- 16 67.3% +/- 3.7% 109 +/- 14 36.0% +/- 3.8% 19 +/- 6 6.4% +/- 1.9% Maryland 1,068 +/- 63 73.4% +/- 2.7% 348 +/- 42 23.9% +/- 2.6% 141 +/- 27 9.7% +/- 1.8% Massachusetts 1,183 +/- 64 75.6% +/- 2.4% 378 +/- 42 24.2% +/- 2.4% 76 +/- 19 4.8% +/- 1.2% Michigan 1,894 +/- 83 72.5% +/- 2.0% 750 +/- 60 28.7% +/- 2.0% 148 +/- 27 5.7% +/- 1.0% Minnesota 1,036 +/- 60 78.5% +/- 2.5% 263 +/- 35 19.9% +/- 2.5% 91 +/- 21 6.9% +/- 1.6% Mississippi 421 +/- 32 51.3% +/- 3.2% 344 +/- 32 41.9% +/- 3.2% 122 +/- 20 14.9% +/- 2.3% Missouri 991 +/- 61 66.8% +/- 2.8% 453 +/- 47 30.5% +/- 2.7% 138 +/- 27 9.3% +/- 1.7% Montana 145 +/- 11 63.2% +/- 3.4% 66 +/- 8 28.6% +/- 3.2% 32 +/- 6 13.9% +/- 2.4% Nebraska 347 +/- 23 74.2% +/- 3.0% 117 +/- 15 25.1% +/- 3.0% 41 +/- 9 8.7% +/- 1.9% Nevada 486 +/- 33 70.9% +/- 3.1% 113 +/- 19 16.5% +/- 2.5% 111 +/- 18 16.2% +/- 2.5% New Hampshire 258 +/- 17 81.4% +/- 2.8% 57 +/- 9 18.1% +/- 2.7% 21 +/- 6 6.6% +/- 1.8% New Jersey 1,639 +/- 78 73.3% +/- 2.2% 387 +/- 44 17.3% +/- 1.8% 279 +/- 38 12.5% +/- 1.6% New Mexico 272 +/- 23 50.8% +/- 3.6% 215 +/- 23 40.1% +/- 3.5% 96 +/- 16 17.9% +/- 2.8% New York 3,101 +/- 111 65.0% +/- 1.6% 1,561 +/- 89 32.7% +/- 1.6% 415 +/- 47 8.7% +/- 1.0% North Carolina 1,409 +/- 73 60.4% +/- 2.3% 757 +/- 60 32.5% +/- 2.2% 303 +/- 39 13.0% +/- 1.6% North Dakota 114 +/- 8 73.6% +/- 3.1% 38 +/- 5 24.2% +/- 3.0% 14 +/- 3 9.1% +/- 2.0% Ohio 2,063 +/- 87 70.6% +/- 1.9% 826 +/- 63 28.3% +/- 1.9% 224 +/- 34 7.7% +/- 1.1% Oklahoma 539 +/- 41 56.9% +/- 3.4% 368 +/- 38 38.9% +/- 3.3% 119 +/- 22 12.6% +/- 2.2% Oregon 619 +/- 46 67.2% +/- 3.4% 237 +/- 33 25.8% +/- 3.2% 111 +/- 23 12.1% +/- 2.3% Pennsylvania 2,132 +/- 89 72.4% +/- 1.9% 771 +/- 61 26.2% +/- 1.8% 222 +/- 34 7.6% +/- 1.1% Rhode Island 180 +/- 13 70.3% +/- 3.4% 81 +/- 10 31.5% +/- 3.5% 18 +/- 5 7.0% +/- 1.9% South Carolina 677 +/- 50 61.8% +/- 3.3% 356 +/- 41 32.5% +/- 3.2% 134 +/- 25 12.2% +/- 2.2% South Dakota 144 +/- 9 70.4% +/- 2.9% 58 +/- 7 28.4% +/- 2.8% 18 +/- 4 8.8% +/- 1.8% Tennessee 970 +/- 60 63.1% +/- 2.8% 557 +/- 51 36.2% +/- 2.8% 130 +/- 26 8.5% +/- 1.6% Texas 3,654 +/- 127 52.8% +/- 1.5% 2,131 +/- 109 30.8% +/- 1.4% 1,447 +/- 90 20.9% +/- 1.2% Utah 607 +/- 32 72.2% +/- 2.5% 173 +/- 20 20.5% +/- 2.2% 109 +/- 16 13.0% +/- 1.9% Vermont 91 +/- 8 64.8% +/- 3.7% 56 +/- 7 39.7% +/- 3.8% 11 +/- 3 7.7% +/- 2.1% Virginia 1,341 +/- 70 69.4% +/- 2.4% 569 +/- 52 29.4% +/- 2.3% 194 +/- 31 10.0% +/- 1.5% Washington 1,124 +/- 66 69.5% +/- 2.7% 492 +/- 50 30.5% +/- 2.7% 126 +/- 26 7.8% +/- 1.6% West Virginia 252 +/- 19 60.3% +/- 3.3% 170 +/- 17 40.6% +/- 3.3% 29 +/- 7 7.0% +/- 1.7% Wisconsin 1,045 +/- 62 75.2% +/- 2.6% 364 +/- 42 26.2% +/- 2.7% 81 +/- 21 5.8% +/- 1.4% Wyoming 91 +/- 7 70.2% +/- 3.4% 37 +/- 5 28.1% +/- 3.3% 13 +/- 3 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. ------------------------------------------------------------------------------ For other versions of this document, see http://wikileaks.org/wiki/CRS-97-310