Health and Family

Health Insurance

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 the uninsured through a variety of federal and state programs designed to serve different needs. Despite these efforts, an unacceptable percentage of the state's population lacks health insurance.

Why is This Important?

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 population is measured by the percentage of population not covered by private or public health insurance. Research has consistently shown that 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; the range is 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 15.3 percent in 2007. In the same year, Virginia's rate was 14.8 percent, lower than the national average, but 32nd among all states. In comparison with its peers, Virginia had a lower percentage of uninsured individuals than North Carolina (16.4%) but a higher one than Maryland (13.7%) and Tennessee (14.4%).  Massachusetts had the lowest uninsured rate -- 5.4 percent -- among the states.

The estimated percentage of uninsured persons under the age of 65 within Virginia was 14.5 in 2005.  The Eastern (19.1 percent), Valley (15.5), West Central (15.3), and Northern regions exceeded the statewide average. The Hampton Roads region had the lowest rate at 13.3.

• The private sector, which insures about 62 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 22 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 8 percent of the population covers medical insurance out of their own pocketbooks. The remaining 15 percent of the population is uninsured.

What Influences the Health Insurance Rate?

Income Level: People with income at or below 200 percent of poverty (2008: $20,800 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.