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, over one million Virginians lack health insurance.

Why is This Important?

Health insurance generally provides coverage for preventive care, 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.

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 that help deter the development of physical ailments and chronic diseases. When the uninsured do seek treatment, it is often through public hospitals and emergency room care, increasing the financial burden on state and federal coffers.

How is Virginia Doing?

The uninsured population is measured by the percentage of population under age 65 not covered by private or public health insurance. Often these are working people who do not get health insurance from their employers but whose income is too high to qualify for public assistance via Medicaid.

Based on the latest U.S. Census Bureau estimates, the national average for uninsured people under age 65 was 17.9 percent in 2011. In the same year, Virginia's rate was 15.3 percent, ranking it 21st among all the states. In comparison with its peers, Virginia had a lower percentage of uninsured individuals than North Carolina (18.8%) and Maryland (15.6%), but higher than Tennessee (15.0%). Massachusetts, which in 2006-07 began mandating that every state resident acquire healthcare coverage, had the lowest uninsured rate -- 3.8 percent -- in the nation.

The most recent regional data available is for 2010. The Southside (18.6 percent), Eastern (18.1 percent), and Southwest (17.3) regions had the highest uninsured percentages. The Northern region had the lowest rate at 13.0 percent uninsured. The statewide average for uninsured persons under the age of 65 is 13.6 percent.

• The private sector currently insures about 58 percent of the population (a drop of nearly 10 percentage points since 2001). This insurance covers 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 17 percent of the population, with services targeted to vulnerable persons including the poor, elderly and disabled. From FY 2007 to FY 2011, enrollment in Virginia's FAMIS/SCHIP program increased from 80,024 children to 103,590 children. Medicaid enrollment increased from 649,903 to 804,186 during the same period. The rate of Virginians dependent on Medicaid has increased from 8 to 10 percent over the past five years.
• About 7 percent of the population pays for medical insurance out of their own pockets. Nearly 18 percent of the population is uninsured.

What Influences the Health Insurance Rate?

Income Level: People with income at or below 200 percent of poverty -- in 2012 that equates to $22,340 for an individual -- are more than 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 more cost-effective delivery of services for aged and disabled Medicaid recipients.