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 some uninsured populations through a variety of federal and state programs. However, nearly 860,000 Virginians still lack health insurance.

Why is This Important?

Health insurance generally provides coverage for preventive care, medicine, needed visits to the doctor or emergency room, hospital stays, and other medical expenses. Since certain provisions of the Affordable Care Act (ACA, aka "Obamacare") went into effect, all health insurance policies must provide preventive care free of charge, cover pre-existing conditions without penalty, and place no lifetime caps on the cost of care. Beyond that, policies differ in what additional services they cover, the size of the deductible and/or co-payment, and 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 people 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 13.5 percent in 2014 -- a substantial improvement over 2013 (16.7%) and due in large part to improvements in access made possible by the Affordable Care Act (ACA, aka "Obamacare"). Virginia's rate was 12.5 percent in 2014, also a notable improvement over the 14 percent uninsured rate in 2013.

Because Virginia did not participate in the Medicaid expansion provision of the ACA, its relative position dropped from 20th best in the nation in 2013 to 27th in 2014.

In comparison with its peers, Virginia had a lower percentage of uninsured individuals than North Carolina (15.2%) and Tennessee (14.1%), but higher than Maryland (8.9%). Massachusetts, which in 2006-07 began mandating that every state resident acquire healthcare coverage, again had the lowest uninsured rate -- 3.8 percent -- in the nation.

In 2014, local uninsured rates dropped in all regions of Virginia. The Eastern (15.6%), Southside (15.4%), Valley (15.0%), and Southwest (14.9%) regions had the highest uninsured rates. The Northern region had the lowest rate at 10.8 percent uninsured. The 2014 regional statewide average for uninsured persons under the age of 65 was 12.4 percent.

Additional Points of Interest

• As of 2014, private health insurance covered about 75 percent of the U.S. population (up from 65% the previous year). This insurance covers families of workers and their dependents but does not cover the cost of long-term care.
• As of 2014, the public sector -- through Medicare at the federal level and Medicaid at the state level -- provided insurance for about 26 percent of the population, with services targeted to vulnerable persons including the poor, elderly, and disabled. The Veterans Administration covered an additional 4.0 percent.
• From FY 2007 to FY 2014, enrollment in Virginia's FAMIS/SCHIP program increased from 80,024 children to 113,956 children. Medicaid enrollment increased from 649,903 to 889,262 during the same period.

What Influences the Health Insurance Rate?

Income Level: People with income at or below 200 percent of poverty -- in 2014 that equated to $24,142 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 whose family incomes range from 30-133 percent of the federal poverty level. 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
• Strategies that encourage healthier living for all segments of the population

Although its reach in Virginia is somewhat muted, the Affordable Care Act specifically includes:

• 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 Medicare and Medicaid recipients