The Uninsured: Top 3 Best States, Worst States

Sept. 10, 2009— -- As lawmakers in Washington debate how to overhaul America's health care system, Americans are becoming poorer and more of them lack any health insurance at all.

The U.S. Census Bureau's annual report on income, poverty and health insurance coverage, out Thursday, showed that in 2008, median household income fell 3.6 percent, 2.5 million more Americans fell below the poverty line, and the ranks of the uninsured grew from 45.7 million in 2007 to 46.3 million.

The overall percentage of people without health coverage held steady at 15.4 percent, according to the 2009 Current Population Survey.

"The situation's grown worse over the last 12 months," said President Obama, discussing the nation's uninsured population at the White House Thursday.

Obama noted the effect of rising unemployment on insurance coverage is not fully reflected in the latest figures.

"It's estimated that the ranks of the uninsured have swelled by at least 6 million," he said.

Some researchers estimate the current number of uninsured is closer to 50 million -- the number now used by the Congressional Budget Office -- because the Census Bureau does not count as "uninsured" any person who has had insurance coverage for any time during the year.

The states with the highest average rate of uninsured people from 2006 to 2008 are Texas (24.9 percent), New Mexico (23.0 percent) and Florida (20.5 percent).

The states with the lowest uninsured rates are Massachusetts (7.1 percent), Hawaii (8.1 percent) and Minnesota (8.7 percent).

The U.S. average uninsured rate for the same period is 15.5 percent.

The disparity in uninsured rates between states reflects a combination of factors, including differences in population demographics, the predominant types of employers and the relative generosity of eligibility requirements for Medicaid, said David Rousseau of the Kaiser Family Foundation.

Impoverished adults without children, for example, are eligible for Medicaid in Massachusetts, Minnesota and Hawaii but are not eligible in Texas, New Mexico or Florida.

Sara Collins, an analyst with The Commonwealth Fund, added that Massachusetts residents are required to have health insurance, Hawaii employers are mandated to offer coverage, and Minnesota traditionally has been a leader in broadening Medicaid eligibility.

"The steady drop in employer-provided coverage and increase in government-provided health coverage is significant," said Collins.

The Census report showed fewer people were covered by employer-based insurance policies in 2008 while more people received government health insurance coverage from programs like Medicare and Medicaid.

Experts say the increase in number covered by government plans is likely a result of a combination of factors: an aging population, reauthorization and expansion of the State Children's Health Insurance Program (SCHIP), and a growing number of Americans in poverty.

In 2008, the nation's poverty rate rose to 13.2 percent, up from 12.5 percent in 2007. It is the first statistically significant increase since 2004 and represents the highest poverty rate since 1997.

You can access the full Census Bureau report on Income, Poverty and Health Insurance Coverage here.