Health Insurance and States Overview


Health Insurance and States: NCSL Overview


Featured NCSL Links

Updated: April  2013


For most Americans, market-based health insurance remains the predominant form of health coverage, although 2009 marked the lowest rate of private coverage since 1987. 

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.

Latest Information

According to the most recent detailed census report (2011, published September 2012), of 312,250,315 total Americans:

  • The number of people with health insurance increased to 260.2 million in 2011 from 256.6 million in 2010, as did the percentage of people with health insurance (84.3 percent in 2011, 83.7 percent in 2010).
  • The percentage of people covered by private health insurance in 2011 was not statistically different from 2010, at 63.9 percent. This was the first time in the last 10 years that the rate of private health insurance coverage has not decreased. The percentage covered by employment-based health insurance in 2011 was not statistically different from 2010, at 55.1 percent.
  • The percentage of people covered by government health insurance increased from 31.2 percent to 32.2 percent. The percentage covered by Medicaid increased from 15.8 percent in 2010 to 16.5 percent in 2011. The percentage covered by Medicare also rose over the period, from 14.6 percent to 15.2 percent. The percentage covered by Medicaid in 2011 was higher than the percentage covered by Medicare.
  • In 2011, 9.7 percent of children under 19 (7.6 million) were without health insurance. Neither estimate is significantly different from the corresponding 2010 estimate. The uninsured rate also remained statistically unchanged for those age 26 to 34 and people age 45 to 64. It declined, however, for people age 19 to 25, age 35 to 44 and those age 65 and older. The uninsured rate for children in poverty (13.8 percent) was higher than the rate for all children (9.4 percent).
  • In 2011, the uninsured rates decreased as household income increased from 25.4 percent for those in households with annual income less than $25,000 to 7.8 percent in households with income of $75,000 or more.

Source: Income, Poverty, and Health Insurance Coverage in the United States: 2011; ; also 2010, September 2011;

  • NEW -  “State-Level Trends in Employer-Sponsored Health Insurance: A State-by-State Analysis  (2009-2011), examines recent trends in employer-sponsored insurance (ESI) at the national and state level, and it expands and updates a previous analysis.  Most nonelderly Americans who have health insurance coverage obtain it through an employer, whether through their own employer or through the employer of a family member to whom they are related as a dependent.  However, ESI coverage eroded substantially during the time period of this study (1999-/2011). It includes a full page on each states  Published by SHADAC of Minnesota, April 11, 2013. [download full report.  78 pages, PDF]
  • 2012 Employer Health Benefits Survey -Kaiser/HRET survey, published 9/2012. || Summary of Findings || Full report
  • 2011 Average Annual Premiums for Family Health Benefits Top $15,000 in 2011, Up 9 Percent - - Kaiser/HRET survey, published 9/27/2011.
    Full Report (225 pages, pdf)  ||  Summary of Findings (.pdf) ||  Chart Pack
  • 2010 Family Health Premiums Rise 3 Percent to $13,770 in 2010, But Workers' Share Jumps 14 Percent as Firms Shift Cost Burden - Kiaser/HRET survey, published 9/2/2010
    These links allow you to download the full original report materials – Summary of Findings (8 pages, PDF) || Full Report (226 pages, PDF) ||  Chart Pack (PDF) || Slides (PDF)
  • 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.

Federal Health Reform: Major Effects on State Health Insurance

The 2010 federal health ereform laws make major changes in the way private health insurance is handled and regulated.  Several of these changes will be implemented in 2010 and 2011.  These include:

  • Access to insurance for people with preexisting conditions through federally-funded high risk pools.(July 1, 2010) 
  • No preexisting condition restrictions for children;
  • Restrictions on certain insurance practices;
  • Reporting requirements;
  • A small-business tax credit;
  • Expanded dependent coverage;
  • Coverage and access provisions;
  • Expanding access to information on health insurance;
  • Retirees’ access to health insurance; and
  • Access to long-term care insurance. 

NCSL Resources

Examples of reports with State Laws and Recent Legislation:

Archive of NCSL Meetings

  • Health Care Costs & Spending: Latest State Strategies- Presentation by Richard Cauchi for the Iowa Legislative Commission on Affordable Health Care Plans for Small Businesses and Families, 9/19/07. [36 pages, PDF]

  • Covering High-Cost, High-Risk People:  Whose Responsibility?- NCSL Spring Forum, Sponsored by the NCSL Health Committee, 4/25/08.
    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.

    Karen L. Pollitz, Project Director, Health Policy Institute, Georgetown University, Washington, DC-  Presentation
    Karen Ignagni, President and Chief Executive Officer, America’s Health Insurance Plans (AHIP), Washington, DC-Presentation
    Facilitator: Representative Susan King, Texas House of Representatives
  • State Health Care Reform: 10+ years of laws, debates and innovation- Presentation NCSL by Richard Cauchi for the 340B Drug Pricing Program Coalition Winter, 2/2/2010.

State Health Insurance Mandates and Requirements

Non- NCSL Reports and Resources


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