Report: States with the worst health coverage

Alexander E.M. Hess, Michael B. Sauter and Thomas C. Frohlich | 24/7 Wall St.

Last year, just under 15% of the U.S. population did not have health insurance coverage. But as different stages of the Affordable Care Act roll out over the next few years — and more Americans become insured — this rate is likely to fall.

For now though, health insurance remains out of reach for many Americans. In states

such as Florida and Alaska, more than one in five residents are without insurance. And an

estimated 22.5% of Texans didn't have health insurance in 2012.

Based on data recently released by the Census Bureau, 24/7 Wall St. reviewed the states with the lowest rates of health insurance coverage in the U.S. in 2012. People 65 and older are automatically eligible for Medicare. Nationally, 15.5% of the population is covered by this program. Several of the states with lower overall coverage rates have disproportionately fewer residents over 65, and as a result they have lower rates of Medicare coverage.

The opposite is also true. In Florida, where 20.1% of the population is without health

insurance, it has the the second-highest proportion of residents covered by Medicare. The other large public health insurance program, Medicaid, covers Americans who cannot afford coverage. Roughly 18% of the population is covered under the program.

Many of the states with the lowest health insurance coverage have relatively low median household income and high poverty rates. But, like Medicare, there does not appear to be a strong relationship between high Medicaid coverage and lower overall rates of uninsured residents.

In an interview with 24/7 Wall St., Peter Cunningham, senior fellow at Center for

Studying Health System Change, explained that Medicare and Medicaid can

impact a state's health insurance coverage rate. Where Medicaid plays a small role, "it's really the variation in the rates of employer-provided private insurance coverage that drives the variation in uninsured rates," Cunningham said.

In fact, more than 65% of the U.S. population is covered through private health insurance, and the vast majority of that is through employers. All of the states with the lowest overall health insurance coverage rates had among the lowest rates of employer-provided insurance.

These states have low rates of employer-provided insurance, Cunningham explained,

because of the industries that are common to these states. Most of these states have

lower proportions of higher-paying jobs or unionized manufacturing jobs, in which

employers tend to provide insurance. In fact, all but one of the 10 worst states had below the national average manufacturing employment. "We all talk about the decline of American manufacturing, but it's still the case that in a lot of states, the traditional manufacturing jobs still play a pretty big role."

Cunningham also explained that states with high uninsurance rates are typically poorer because lower-wage jobs are much less likely to provide health insurance coverage. Cunningham gave the example of Florida. "The economy in Florida is based on tourism. A lot of the service and hospitality sector jobs don't pay a lot and don't offer health benefits. It's a very different economy than states that have much lower uninsured rates." Florida had the lowest rate of employer-provided health insurance in the country.

Based on the Census Bureau's 2012 American Community Survey, 24/7 Wall St.

reviewed the 10 states with the lowest percentage of the population covered by a health

insurance plan. We also reviewed a variety of additional data from the ACS for 2012,

including age distribution, poverty, income, and the proportion of residents covered by

private insurance, Medicaid and Medicare. We also reviewed 2012 average unemployment rates from the U.S. Bureau of Labor Statistics. These are the 5 states with the worst health coverage.

5. Georgia

• Pct. without health insurance (2012): 18.4% (tied-5th highest)• Unemployment rate (2012): 9.0% (9th highest)

• Poverty rate: 19.2% (6th highest)

• Pct. aged 65 and over: 11.5% (4th lowest)

Last year 43.8% of unemployed workers in the U.S. did not have health insurance, while in Georgia, 53.6% of the unemployed were uninsured. However, Gov. Nathan Deal, an outspoken opponent of the Affordable Care Act, has elected not to expand Medicaid or set up a state-controlled insurance exchange. The state's Insurance Commissioner Ralph Hudgens drew scrutiny last month when he stated that Georgia was doing "everything in [its] power to be an obstructionist."

4. Florida

• Pct. without health insurance (2012): 20.1%

• Unemployment rate (2012): 8.6% (12th highest)

• Poverty rate: 17.1% (17th highest)

• Pct. aged 65 and over: 18.2% (the highest)

Florida is one of just four states where at least a fifth of the population didn't have

health insurance in 2012. While the state's relatively large elderly population means

that a disproportionately high percentage of Floridians were covered under Medicare,

the younger adult population were much more likely to be without insurance than other

states. As many as 28.8% of those between the ages of 18 and 64 didn't have health

coverage compared to just over 20% nationally. The New York Times reported that, in

defiance of the Affordable Care Act, Florida's government has been reluctant to offer

its residents information on the the federal insurance exchanges that will allow

residents to shop for the most affordable plan.

3. Alaska

• Pct. without health insurance (2012): 20.5%

• Unemployment rate (2012): 7% (22nd lowest)

• Poverty rate: 10.1% (2nd lowest)

• Pct. aged 65 and over: 8.5% (the lowest)

Although Alaska is one of the nation's wealthiest states, with a median income of

$67,712 in 2012, it also has a relatively large number of residents who were uninsured.

This may be due in part to the seasonal nature of much of Alaska's workforce — such

workers often either do not receive insurance from their employers or do not keep their

insurance after their work has ended. Last year, 21.4% of workers who were employed

did not have health insurance, one of the highest rates in the nation. But for Alaskans

hoping to obtain health insurance under the Affordable Care Act, premiums in the state

will be higher than anywhere else in the nation, exempting for Wyoming.

2. Nevada

• Pct. without health insurance (2012): 22.2%

• Unemployment rate (2012): 11.1% (the highest)

• Poverty rate: 16.4% (19th highest)

• Pct. aged 65 and over: 13.0% (11th lowest)

Nevada minors were the most likely in the country to lack health insurance. An

estimated 16.6% were not covered, more than double the national rate. In general, the

likelihood of not having health insurance is much higher for those without a high school

diploma. In Nevada, due to a poor graduation rate, the chances of this happening are

significantly worse. Nevada also has the largest portion in the nation of households

earning under $25,000 per year without health insurance. Under the Affordable Care

Act in Nevada, those earning under 400% of the national poverty rate will be eligible

for tax credits. Nevada will likely be one state relying on this provision the most. The

state also has the highest proportion of residents employed in service jobs, which are

less likely than many jobs to provide health benefits.

1. Texas

• Pct. without health insurance (2012): 22.5%

• Unemployment rate (2012): 6.8% (17th lowest)

• Poverty rate: 17.9% (11th highest)

• Pct. aged 65 and over: 10.9% (3rd lowest)

Not only did Texas have the highest rate of uninsured people in 2012, but the state also

had among the highest portion of uninsured children, elderly, and unemployed people. Additionally, over 30% of adults under 65 were uninsured in the state. Lawmakers have been opposed to the Affordable Care Act, with Texas Sen. Ted Cruz speaking for over 20 hours in an attempt to block the law from taking effect.

MORE: Five more of top 10 states with worst health coverage

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