SPG synthesis report - State Coverage Initiatives

one-third with incomes below poverty were uninsured. And Latino children comprised a
significant portion of those eligible but not enrolled in public programs. The analysis also
found that non-citizens experienced high rates of uninsurance.
Overall, states found that the subpopulations of greatest concern were those determined
by several key factors including age, employment (status and firm size), income level
relative to the FPL, ethnicity, education, citizenship, and geography. Typically, these
groups included low-income uninsured children and their parents, low-income uninsured
adults, working uninsured in small size firms, and the rural uninsured. Several states
expressed concern regarding seasonal workers. Alaska, for example, has many workers
who come for oil field work, tourism related jobs, fishing and fish processing. These
workers face significant challenges in obtaining health care coverage. Maryland
expressed concern regarding individuals who are experiencing a job or life transition that
results in a break in coverage.
As discussed above, a number of states specifically oversampled subpopulations that
have historically included the greatest percentages of uninsured individuals, a benefit that
state-sponsored surveys afford. States typically included over-sampling for rural and
other areas, racial and ethnic groups, low-income groups, and children. As a result, states
obtained a wealth of information on these important sub-groups, groups that are typically
not included in national surveys. The following is an overview of some of the statespecific
findings pertaining to these populations.
• Poor and near poor more likely to be uninsured. Not surprisingly, states found that
their low income residents were more vulnerable to periods of uninsurance than their
moderate to high income residents. In addition, the chance of a state resident having
coverage appears to increase with income. California, where the poor and near poor
were most likely to be uninsured in 2001, offers a text book example of this
vulnerability. For adults, approximately 52 percent with incomes under 100 percent
of poverty were insured for the entire 12 months preceding the 2001 California
Health Interview Survey. This figure rises to about 60 percent of adults with incomes
between one and two times poverty. The comparable percentage of insured adults
with incomes between two and three times poverty was about 88 percent. The state
found a similar pattern for children with about 75 percent of children with incomes
below poverty insured for the 12 month period preceding the survey, while the
comparable percentage for children in families with incomes above 300 percent of
poverty rose to 96 percent.
• More adults than children lack health care coverage; young adults comprise largest
proportion of uninsured for many states. Many states found that more adults than
children lack health care coverage. This finding may reflect the success of states in
insuring children through programs such as the State Children’s Health Insurance
Program (SCHIP). In Connecticut, the majority of the uninsured are working adults
(69 percent). In Maryland, the largest proportion of uninsured individuals is young
adults between ages 18 and 34, comprising 40 percent of the state’s uninsured.
Pennsylvania had similar findings with nearly half the uninsured falling between 18
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