Virginia Performs

Health & Family

Health Insurance

Without health insurance, citizens often are unable to pay for the medical care they need, and frequently forego preventive measures that would make that care unnecessary. Virginia works to reach this population through a variety of federal and state programs designed to serve different needs. Despite these efforts, an unacceptable percentage of the state's population remains uninsured.

Why is This Important?

Health insurance is defined as insurance against loss by illness or bodily injury. Health insurance generally provides coverage for medicine, visits to the doctor or emergency room, hospital stays, and other medical expenses. Policies differ in what they cover, the size of the deductible and/or co-payment, limits of coverage, and the options for treatment available to the policyholder. The uninsured by population is measured by the percentage of population not covered by private or public health insurance. Research has shown individuals without health insurance have great difficulty accessing the health care system and frequently do not participate in preventive care programs.

How is Virginia Doing?

Estimates of uninsurance in Virginia over the past several years have ranged from 10 percent to 16 percent of the total population, due to differences in survey methodology, changes in policies and demographics, and fluctuations in the economy. Based on U.S. Census Bureau estimates, the national average of uninsured was 15.8 percent in 2006. In the same year, Virginia's rate was 13.3 percent, lower than the national average, but 22nd among all states. In comparison with its peers, Virginia had a lower percentage of uninsured individuals than Tennessee (13.7 percent), North Carolina (17.9 percent) and Maryland (13.8 percent). Rhode Island had the lowest uninsured rate (8.6 percent) among the states.

Within Virginia, the estimated percent of uninsured in the Eastern (15.7 percent), Hampton Roads (13.7 percent), Southside (13.8 percent) and Southwest (13.1 percent) regions exceeded the statewide average for 2000, which was 12.2. The Valley and West Central regions had the lowest rates at 10.6.

• The private sector, which insures about 66 percent of the population, provides insurance for families of workers and their dependents but does not cover the cost of long-term care.
• The public sector, through Medicare at the federal level and Medicaid at the state level, provides insurance for about 19 percent of the population, with services targeted to vulnerable persons including the poor, elderly and disabled. In FY 2007 the average monthly enrollment in Medicaid and in FAMIS was 656,000 and 80,000, respectively. The rate of Virginians dependent on Medicaid has remained stable at around 7 to 8 percent over the past five years.
• About 4 percent of the population covers medical insurance out of their own pocketbooks. The remaining 11 percent of the population is uninsured.

What Influences the Health Insurance Rate?

Income Level: People with income at or below 200 percent of poverty (2007: $20,420 for an individual) are nearly twice as likely to be uninsured as people at higher income levels.

Race and Ethnicity:  Racial and ethnic minority groups are less likely to be insured than white Virginians.

Age: Young adults are at greater risk for being uninsured than children and older adults.

Employment Status: Unemployed individuals, part-time workers, and homemakers are at greater risk of being uninsured.

Firm Size: Employees of very small firms are typically at greater risk of being uninsured.

What is the State's Role?

Medicaid and FAMIS assist eligible Virginians. Teaching hospitals, state facilities, community health centers and free clinics offer health care services either free or at a reduced rate. Considerable attention is still needed to achieve:

• Improved access to health care services for the uninsured.
• Population-based strategies that encourage healthier living for all segments of the population.
• Strategies for improving the quality of care delivered by various health care providers.
• Policies that are geared towards a more cost-effective delivery of services for aged and disabled Medicaid recipients.