Health Insurance and the States
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Updated: November 6, 2009
For most Americans, market-based health insurance remains the predominant form of health coverage. According to the most recent detailed census report (2007, published August 2008), of 299,106,000 total Americans:
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- The number of people with health insurance increased to 253.4 million in 2007 up from 249.8 million in 2006.
- 201,897,000 people (67.5%) were covered by private market health insurance.
- 177,367,000 people (59.3%) were enrolled in employer based insurance.
- 26,620,000 people (8.9%) were enrolled in "individual market" or direct purchase health insurance.
- By comparison, 83,151,000 people (27.8%) were covered by some form of government insurance.
- 39,481,000 were counted in Medicaid in 2007. In 2003, 6,419,000 of Medicaid recipients also had some type of private insurance according the the Census Bureau. [NOTE: Medicaid agencies provided services to over 50 million individuals in 2006; see NCSL's Medicaid Overview for resources and updates]
- 41,276,000 were enrolled in Medicare in 2007. According the Census Bureau, in 2003, 21,777,000 of Medicare enrollees also had some type of private insurance, such as "Medi-Gap" supplemental policies or retiree benefits from a former employer.
- 10,767,000 were enrolled in military health care.
- 45,657,000 were counted as "not covered at any time during the year."
- Source: For a complete national and state breakdown see the Income, Poverty, and Health Insurance Coverage in the United States: 2007 report; The Census Bureau's 2006 Report is found here. Pertinent Statistics of those with health insurance for 2006 is found in Appendix 1 below.
- 2010 Health Insurance Premiums Include Major Increases: A fall 2009 survey of state insurance regulators by the National Association of Insurance Commissioners found that average insurance policies will increase between 11% to 16%—and as high as 25% to 30%—annually in most states.
- AVERAGE ANNUAL CHANGES IN PREMIUMS to 2009
In general terms, all 50 states regulate and initiate policies affecting health insurance. These statutes, and the Insurance Departments and other agencies that administer them, play a significant role in virtually every state.
The National Conference of State Legislatures (NCSL) has tracked and evaluated activities in several project areas in health care, and has collaborated with or relied on a number of outside experts in this field.
The list in the right-hand column includes links to several current NCSL projects and publications. In addition, the internal and external resources listed below provide further details.
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‘Cafeteria plans’ to provide health insurance, States use of- NCSL report, published 2009.
High Risk Pools for Health Coverage, State - NCSL report on programs in 35 states. updated 2/09.
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Insurance and Fiscal Incentives for Wellness and Prevention- Sample of 2006 through 2008 State Legislation
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Covering High-Cost, High-Risk People: Whose Responsibility?
Health Committee Session- April 25, 2008 |
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State interest in both health "reform" and health cost savings creates special challenges for covering patients considered "high risk" and high cost. The sickest 10 percent of our population often cost tens of thousands of dollars annually, accounting for over 60 percent of U.S. health spending. Yet a cancer survivor may have low annual costs but be uninsurable. How should these people be treated by insurance market underwriting practices? What are the roles of state-sponsored high-risk pools, the health insurance industry, government, providers and the high-cost individuals themselves in providing and paying for care? Two national experts share facts and recent thinking.
Presenters: SESSION PODCAST - Listen here.
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2007-08 Comprehensive Health Care Reforms: Side-by-Side Comparisons
Small Business Health Insurance: An Overview - NCSL reports, updated 2009
State Insurance Mandated Coverage - Updated 2009
More Churches Start Paying For Health-Care Services, Leaving States To Confront The Question: Are These Groups Insurers? - State Health Notes-5/23/08
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Additional Reports and Resources (Non-NCSL):
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Recent:
2009 Employer Health Benefits Survey was released by the Kaiser Family Foundation and the Health Research & Educational Trust (HRET). It shows employer-sponsored health insurance rose to $13,375 annually for family coverage this year -- with employees on average paying $3,515 and employers paying $9,860. Over 10 Years, Premiums Jumped 131 Percent, More Than Three Times Worker Wages And Four Times General Inflation. This report provides an important annual "benchmark" and is widely used by policymakers in evaluating health insurance regulation, expansion and reforms. The full report is a massive 238 pages; however the 8 page Summary of Findings including web links to several formats - article, full text and powerpoint.
"How Many Are Underinsured? Trends Among U.S. Adults, 2003 and 2007" - The number of underinsured U.S. adults—that is, people who have health coverage that does not adequately protect them from high medical expenses—has risen dramatically, a Commonwealth Fund study finds. As of 2007, there were an estimated 25 million underinsured adults in the United States, up 60 percent from 2003. Health Affairs Web report, 6/10/08. [11 pages  PDF]
> Charts, PowerPoint by Commonwealth Fund, 6/10/08.
Large Firms That 'Self-Insure' Are Resisting New Regulations -Article by Associated Press, http://www.kaiserhealthnews.org/Daily-Reports/2009/October/22/Large-Employers.aspx 10/22/09.
"Out-of-Network Fee Schedules Will Soon Need to Change" Analysis of the recent New York state AG settlement. Published by Segal/Sibson, March 2009 Bulletin.
New York Health Plans Continue to Lead the Nation in Performance and Consumer Satisfaction About half of all New Yorkers get their medical care through a health maintenance organization – an HMO – and a new report from the State Department of Health shows they are getting excellent care. Report by NY Dept of Health, 10/9/09.
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U.S. Supreme Court Allows Employers To Continue Reducing Health Care Benefits for Medicare-Eligible Retirees - On March 24 the Court "gave employers a green light to reduce health benefits for millions of retirees who turn 65 and become eligible for Medicare. The justices turned away a legal challenge from AARP, the nation's leading senior citizens lobby, which had contended these lower benefits for older retirees violated the federal law against age discrimination." Article by Los Angeles Times/Kaiser Network 3/25/08.
Improving the value and cost of US health benefits: Could shifts in the employer role provide the solution? - An overview from Mercer, the commercial benefits advisory company. 1/25/08.
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Employers Tap Incentives to Encourage Wellness Program Participation, Survey Suggests. A survey presented at a national health insurance industry meeting suggests that U.S. employers are using more sophisticated strategies to encourage employee participation in health and wellness programs, Healthcare IT News reports.
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The Impact of Guaranteed Issue and Community Rating Reforms on Individual Insurance Markets - by AHIP, 9/07.
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Increasing Numbers of Insured Workers Required to Meet a Deductible - The number of workers with plans that require that a deductible be met increased from 48% in 2002 to 64% in 2005. Medscape Business of Medicine, 1/08.
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Women Buying Health Policies Pay a Penalty - Article by New York Times, October 29, 2008.Health Insurance Coverage Status and Type of Coverage by Selected Characteristics: 2005 & 2006. (US Census Bureau; updated as published 3/07)
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.Security: What Americans Want from a Job A new poll shows that health insurance and security are at the top of Americans’ list of desirables in a job, while pay ranked much lower. The national poll, conducted by Princeton Survey Research Associates for the Center for State and Local Government Excellence, surveyed 1,200 adults age 18 and older. Participants were given a list of 15 benefits and characteristics that may be important in choosing a job. 1/3/08.
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Mass. panel approves changes to subsidized residents health plan - Coverage costs rising. - Boston Globe, 12/14/07California Employer Health Benefits Survey, 2007, online survey results, a joint project of the California HealthCare Foundation and the National Opinion Research Center. 12/17/07. Projected declines reflect 5th year of lower medical trends. "Surprisingly, trends for prescription drug coverage are projected to decelerate most - to levels similar to trends for medical coverage for the second consecutive year. Prescription drug projected trends have declined dramatically, by nearly nine percentage points, since their high of 19.5 percent in 2003." Published 10/07. PDF
- Tracy Cassidy Watts [PowerPoint download / slides], Principal, Healthcare and Group Benefits, Mercer Co.
- Simmi Singh [PowerPoint download / slides], VP, Cognizant Technology Solutions, Chicago, IL
Federal Rule for Nondiscrimination and Wellness Programs in Health Coverage in the Group Market - NCSL Federal Affairs update, effective 7/1/07.Health Care Costs & Spending: Latest State Strategies for ReformConsumer Driven Health Insurance: New State Solutions in 2006?" NCSL session at Spring Forum, April 6, 2006. Funded in part by the Robert Wood Johnson Foundation & the NCSL Critical Health Areas Project CHAP) Speakers: PowerPoint download / slides]Individual Coverage, a State Health Lawmakers' Digest - published 7/05. Health Care Reform and Finance by Professor Uwe Reinhardt - Plenary Session speech at NCSL Annual Meeting, August 19, 2005 in Seattle (80 slides in PDF | Audio Link | Video Link.Disclosure of Employers of Medicaid Enrollees: How Private Coverage Works: A Primer, 2008 Update" It discusses the fundamental aims of private health coverage and sorts out the complicated web of state and federal regulations that govern it. Published by Kaiser Family Foundation, 4/21/08. [27 pages ]State Health Care Reform: Key Questions and Answers" - A free-market rebuttal and analysis by the National Center for Policy Analysis, 4/08. [43 pages ] Health Savings Accounts: Participation Increased and Was More Common among Individuals with Higher Incomes" - General Accountability Office (GAO), Released 4/30/08.Health Care Costs 101, 2008 Edition" - a user friendly set of graphs and charts based on CMS data and estimates in 2008. It "shows that while health care spending growth has slowed, if left unchecked, it will represent 19.5% of the U.S. GDP by 2017." Released by the California HealthCare Foundation, 4/08. [27 pages ]Health Spending Projections Through 2017: The Baby-Boom Generation Is Coming To Medicare" - CMS staff analysis as published in Health Affairs web article, 2/26/08. State Insurance Departments - web sites and contacts. Compiled by NAIC, 2007.Health Insurance Coverage Status and Type of Coverage by Selected Characteristics: 2006 & 2007 (US Census Bureau; updated as published 3/08.)
Changing Definition of 'Dependent': Who is insured and for how long? - NCSL tracking report on bills and laws. Updated 2008.
Health Insurance: Overview and Economic Impact in the States | PDF full report, 64 pp. - A compendium of reference information on health insurance in the states. Published by America's Health Insurance Plans (AHIP), 12/06.
Abstract of 2007 Segal Health Plan Cost Trend Survey - by Segal & Co, 12/06.
"The Illusion of Coverage: How Health Insurance Fails People When They Get Sick" - report by The Access Project, 5/14/07.
"Workers With Employment-Based Health Benefits Steady Over Time" Release;
Employment-Based Health Benefits: Access and Coverage, 1988-2005
Research from EBRI, 3/07.
www.healthinsuranceinfo.net - Consumer Guides for Getting and Keeping Health Insurance
Changes in Employees’ Health Insurance Coverage, 2001-2005, examines the underlying reasons behind the decline in employer-sponsored coverage among employees. Almost half of the decline was due to a loss of employer sponsorship with another quarter of the decline due to lost eligibility for benefits or lost access as a dependent of another employee. The remaining quarter of the decline was due to an increase in employees not participating in the offer of coverage. The paper also finds that two-thirds of newly uninsured employees between 2001 and 2005 were from low-income families. Kaiser, 10/19/06. [16 pages PDF]
Milliman Survey Foresees 2007 Lowest Health Insurance Rate Increase in 7 Years - The 2007 estimated January renewal increase of 9.7% for Health Maintenance Organizations (HMOs) is 0.9% lower than last year’s survey result of 10.6%, and down 7% from four years ago. Preliminary results for Preferred Provider Organizations (PPOs) show an anticipated 2007 renewal rate increase of 10.7%, or 1.0% lower than last year but 1.0% higher than HMOs. News release, 7/18/06. [2 pages PDF].
Health benefit cost growth will slow again in 2007 according to preliminary survey findings released by Mercer Health. After changing plans or making plan design changes, employers so far project an average increase of 5.6%. Released 9/11/06. [2 pages]
"Employers Willing to Do More to Cover Workers" - Despite fast-rising health care costs, employers that offer health benefits to their workers say they are committed to the current employer-based health insurance system. Commonwealth Fund report, 11/06
Wisconsin Managed Care Review 2006 finds: Hospitals and HMOs Enjoy Strong Profits; Exodus of Employers from HMOs Continues (summary) - released by Allan Baumgarten, 12/06
Michigan's Managed Care Review 2006 (summary) - released by Allan Baumgarten, 8/06
Insurance Coverage Of Biopharmaceuticals -"breakthrough biopharmaceuticals pose a difficult challenge to existing arrangements for financing care because of their high costs, the small patient populations they often serve, and problems in measuring their incremental therapeutic value..." Health Affairs, Sept/Oct 2006.
Workers' Health Insurance: Trends, Issues, and Options to Expand Coverage by
Paul Fronstin, Employee Benefit Research Institute, 2/06
Competition in Health Insurance: A Comprehensive Study of U.S. Markets - an American Medical Association (AMA) report finds a steep decline in competition in the nation's health insurance markets. Summary; full text. 4/17/06
Recent Growth in Health Expenditures report by the Health Policy Center of the Urban Institute, 3/06
Employers Expect Rate of Increase in Health Benefit Costs to Slow in 2006 report by Watson Wyatt, National Business Group on Health Survey results, 2/15/06. [Full survey released 3/06]
Employer Health Benefits 2006 Annual Survey - [For comparison to 2007] Last year's survey of employers provides a detailed look at trends in employer-sponsored health coverage, including changes in premiums, employee contributions, cost-sharing policies, and other relevant information. This year the survey also documented the prevalence of high-deductible health plans associated with a savings option. Versions: News Release | Summary of Findings | Chart Pack | Cost of Health Insurance (Sec. 1) | Health Affairs article: Health Benefits In 2006. [10 pages PDF].
Researchers at the Kaiser Family Foundation, The Center for Studying Health System Change and Health Research and Educational Trust designed and analyzed the survey. Published 9/26/06.
Proposed NCQA Measures Hold Promise for Bringing Health Care Quality, Satisfaction Data to as Many as 130 Million - report by NCQA 6/13/06.
Private Health Insurance: Number and Market Share of Carriers in the Small Group Health Insurance Market in 2004 U.S. General Accountability Office GAO-06-155R 10/13/05.
Health Insurance Coverage: Estimates from the National Health Interview Survey, 2004 | News Release - published by the Centers for Disease Control and Prevention, 6/2005 - [19 pages, PDF].
Health Insurance Coverage by Age: 1987 to 2004—Tables on pages 59-78 Published by US Census Bureau, August 2005.
"Choice" in Health Care: What Do People Really Want? examines Consumer-Directed and HSA options. By Jeanne M. Lambrew, Ph.D., The Commonwealth Fund, 9/19/05 - | Press Release | (printer-friendly version).
America's Health Insurance Plans (AHIP) - the trade association for insurers has a comprehensive web site, updated regularly.
Reinsurance: How States Can Make Health Coverage More Affordable for Employers and Workers, Commonwealth Fund report, 7/05.
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Compiled by NCSL's Health Costs, Finance and Insurance Project - Denver
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