Health Insurance and States Overview


Health Insurance and States: NCSL Overview


Featured NCSL Links

Updated: September 2014


For most Americans, market-based health insurance remains the predominant form of health coverage. 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 by the Numbers

According to the most recent detailed U.S. census report (2013, published September 2014), these are latest official numbers on health insurance:

  • The Current Population Survey shows that the percentage of people with health insurance for all or part of 2013 was 86.6 percent, and 13.4 percent did not have health insurance for the entire year.
  • Full-time, year-round workers were more likely to be covered by health insurance (86.1 percent) than those who worked less than full-time, year round (76.0 percent) or non-workers (77.6 percent).
  • Among adults age 18 to 64 with a disability, 39.3 percent had private health insurance, compared with 70.7 percent of their counterparts with no disability in 2013. More than half (56.6 percent) of people with a disability had government-provided health insurance. The percentage of working-age adults with a disability who had any type of health insurance coverage was higher than the comparable population with no disability (86.2 percent, compared with 81.1 percent.)
  • In 2013, the majority of individuals (64.2 percent) were covered by private health insurance. The largest single type of health insurance in 2013 was employment-based health insurance, which covered 53.9 percent of the population.
  • In 2013, 34.3 percent of the population was covered by government health insurance. The percentage of people covered by Medicaid in 2013 was 17.3 percent and the percentage covered by Medicare was 15.6 percent.
  • In 2013, the uninsured rate for children younger than 19 in poverty (9.8 percent) was higher than the uninsured rate for children not in poverty (7.0 percent)
  • In 2013, 9.8 percent of non-Hispanic whites were uninsured, compared with 15.9 percent of blacks and 24.3 percent of Hispanics.

Source: U.S. Census Bureau:Health Insurance Coverage in the United States: 2013
also Income, Poverty, and Health Insurance Coverage in the United States: 2012; ; also 2010, September 2011;

  •  “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]
  • Health Insurance Overview - A CDC hosted slide presentation, by Deloitte, August 2013 [46 pp, PDF]
  • -NEW-  2014 Employer Health Benefits Survey.
    Annual premiums for employer-sponsored family health coverage reached $16,834 this year, up 3 percent from last year, with workers on average paying $4,823 towards the cost of their coverage|| Summary of Findings || Full report. - Kaiser/HRET survey, published 9/2014.
  • 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

  • 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
  • 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.
  • 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]

Non- NCSL Reports and Resources


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