Providing context for state health care spending

State spending for health care services varies widely by state. But the relationship between the services delivered and residents' health status—how "healthy" people are—is complex. The amount a state spends on such services is not necessarily correlated with better or worse health status. A resident's well-being is only partially influenced by the health care services received; behavioral patterns, genetics, social circumstances, and environmental exposures also play a large role.

States need to invest wisely in health care as well as in the other related factors that contribute to health. High-value health care is as much about how dollars are spent as it is about how many dollars are spent.

Uninsured Rate Among Adults - Percentage of Americans ages 18–64 without health insurance, 2011

For state-by-state data please see the tables below.

Uninsured rate among adults

Health insurance coverage is an important measure of access to care, which plays a significant role in overall health.

In 2011, over 41.6 million adults were uninsured. Rates of uninsured adults varied greatly across the nation. Massachusetts had the lowest rate (3.6 percent), and Texas had the highest rate (26.9 percent). Texas and California had the largest number of uninsured adults, accounting for a combined 27 percent of the total nationally.4

Uninsured rates are highest among blacks and Hispanics, and disproportionately include adults between ages 19 and 34.5 A high correlation exists between states’ rates for uninsured adults and children. States that have low rates of uninsured adults also tend to have high rates of employer-sponsored coverage.

The consequences to an adult of not having insurance can be significant. Uninsured adults are more likely to die or have extremely poor health outcomes than insured adults for many acute conditions, including heart attacks, strokes, and trauma. They also are likely to have less-timely diagnoses and treatments for chronic conditions such as cancer, diabetes, and hypertension.6

State policymakers can directly affect their uninsured rates by expanding the eligibility of their Medicaid programs.

Demographics and the uninsured

Uninsured Rate Among Children - Percentage of children ages 0–17 without health insurance, 2011

For state-by-state data please see the tables below.

Uninsured rate among children

Health insurance coverage is an important measure of potential access to health care, which plays a significant role in overall health.

Almost 7 million children were uninsured in 2011.7 Rates varied dramatically among states. Massachusetts had the lowest rate (2.5 percent) and Nevada the highest (21.0 percent). Nationally, Texas and California account for nearly 30 percent of children without health insurance.8 Uninsured rates among children tend to be highest among Hispanics, American Indians, and those over the age of 6.9 Kids with health insurance are more likely to receive well-child care, immunizations, and dental care; have fewer avoidable hospitalizations; have better asthma outcomes; and less truancy.10 A high correlation exists between states’ rates for uninsured adults and children.

One way for state policymakers to directly affect their uninsured rate is to expand the eligibility of their Medicaid program and Children’s Health Insurance Program to above the federal eligibility minimums.

Demographics and the uninsured

Rate of Poverty - Percentage of people with incomes of up to 138% of the federal poverty level, 2010-11

For state-by-state data please see the tables below.

Poverty rate

Living in poverty can significantly influence health by limiting access to safe housing, food and water, and health care services.

Nationally, more than 86 million people live in the range of up to 138 percent of the federal poverty level, the eligibility guidelines for Medicaid established by the Affordable Care Act.*,11 New Hampshire had the lowest poverty rate (15 percent) and New Mexico the highest (36 percent). Poverty rates are highest among blacks and Hispanics.12

  • * As of Jan. 1, 2014, the eligibility level for Medicaid was 138 percent of the federal poverty level, or $22,350 for a family of four in 2011, in states that expanded Medicaid.
  • 11 Kaiser Family Foundation's State Health Facts, "Distribution of Total Population by Federal Poverty Level," Data source: Census Bureau's March 2012 and 2013 Current Population Survey, accessed Nov. 8, 2013, http://kff.org/other/state-indicator/distribution-by-fpl/.
  • 12 National Center for Health Statistics, Health, United States, 2012: With Special Feature on Emergency Care (Hyattsville, MD: 2013), Table 2, accessed Jan. 13, 2014, http://www.cdc.gov/nchs/data/hus/hus12.pdf.

Demographics and the uninsured

Rate of Americans Over Age 65, 2010

For state-by-state data please see the tables below.

Population over age 65

People 65 years or older tend to use more health care services, compared with younger people.

Older Americans are a quickly growing segment of state populations, with more than 40 million people nationally over the age of 65 in 2010.13 Alaska had the lowest rate of elderly people (7.7 percent) and Florida the highest (17.3 percent). The health care needs of older Americans are generally more complex than the rest of the population because they tend to live with at least one chronic disease.

Demographics and the uninsured