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www.downloadslide.com
CHAPTER 15
HEALTH-CARE REFORM;
INDIVIDUAL HEALTH
INSURANCE COVERAGES
“The supreme court’s decision to uphold the Affordable
Care Act ensures hard-working, middle class families will
get the security they deserve and protects every American
from the worst insurance company abuses.”
whitehouse.gov/healthreform
Learning O bj e c ti v e s
After studying this chapter, you should be able to
◆ Explain the major health-care problems in the United States.
◆ Identify the major provisions of the Affordable Care Act that affect individuals and families.
◆ Describe the basic characteristics of individual medical expense insurance.
◆ Identify the basic characteristics of health savings accounts (HSA).
◆ Describe the key characteristics of long-term care insurance.
◆ Describe the major characteristics of disability-income insurance contracts.
295
www.downloadslide.com
J
ustin, age 32, is a self-employed carpenter who was recently diagnosed with a brain
tumor that required immediate surgery. The surgeon’s fee, hospital expenses, other
medical bills, and lost earnings totalled more than $125,000. Like many self-employed
individuals, Justin had no health insurance. In addition, he could not work for six months
and did not have a disability-income policy to restore his lost earnings. Because of the
lack of health insurance, Justin was exposed to serious economic insecurity because of
the unexpected surgery. He eventually had to declare bankruptcy.
As Justin’s experience demonstrates, health insurance should receive high priority in a
personal risk management program. If you are seriously ill or injured, you face two major
problems: payment of your medical bills and the loss of earned income. A severe illness or
injury can result in catastrophic medical bills. Without proper protection, you may have
to pay thousands of dollars out of your own pocket for medical bills. In addition, a lengthy
disability can result in the loss of substantial amounts of earned income.
This chapter is the first of two chapters dealing with private health insurance.
This chapter is limited primarily to important individual health insurance coverages.
The following chapter discusses group health insurance coverages. Although most
people are covered under group plans, individual plans are still important for
individuals and families who are not covered by group health insurance.
This chapter is divided into three major parts. The first part discusses the major
health-care problems in the United States and the need for health-care reform. The
second part examines the major provisions of the new Affordable Care Act that was
enacted to reform the present health-care delivery system. The final part discusses several
individual health insurance coverages including individual medical expense insurance,
health savings accounts, long-term care insurance, and disability-income insurance.
HEALTH-CARE PROBLEMS IN
THE UNITED STATES
The United States overall provides high-quality health
care to the population. However, despite major
breakthroughs in medicine, experts believe the present health-care delivery system is broken and must
be reformed. Major problems that lead to enactment
of the Patient Protection and Affordable Care Act in
March 2010 include the following:
■
■
■
■
■
■
296
Rising health-care expenditures
Large number of uninsured in the population
Uneven quality of medical care
Considerable waste and inefficiency
Defects in financing health care
Abusive insurer practices
Rising Health-Care Expenditures
Total health-care expenditures in the United States
have increased substantially over time and are growing faster than the national economy. According
to the Centers for Medicare & Medicaid Services,
estimated national health expenditures totalled just
over $2.8 trillion in 2012 or 17.6 percent of the
nation’s gross domestic product. Thus, more than
one in six dollars of the nation’s income is now spent
on health care. If present trends continue, estimated
national health expenditures will total $4.6 trillion in
2020, or 19.8 percent of our gross domestic product.1
Comparison with Foreign Nations The United
States leads the world in total spending on health
care. Per capita spending on health care in the United
www.downloadslide.com
HEALTH-CARE PROBLEMS IN THE UNITED STATES
States was $7598 in 2009, or 48 percent higher than
the second highest spending country (Switzerland)
and almost 90 percent higher than in many countries
considered to be global competitors (see Insight 15.1).
According to a recent study by the Commonwealth
Fund, the higher spending in the United States should
not be attributed to higher incomes, an older population, or a greater supply or utilization of physicians
and hospitals. Instead, the higher spending may
be due to (1) higher prices paid for medical care,
including prescription drugs, office visits, and higher
physician and surgeon fees compared to foreign countries, (2) greater use of more expensive technology,
and (3) higher obesity rates. Despite higher spending,
the quality of health care in the United States shows
considerable variation of performance depending
on the disease being treated, and does not appear to
be markedly superior to less costly systems in other
industrialized countries.2
■
Reasons for the Increase in Health-Care
Expenditures Health-care economists have identified numerous factors that explain, at least in part,
the substantial increase in health-care expenditures
over time. Important factors include the following:
■
■
■
Increase in consumer demand. Consumer demand
for health-care services has increased over time
because of an increase in the population, rising
per capita incomes, and greater health awareness by Americans. Studies suggest that growth
in average per capita income could account for
5 percent to approximately 20 percent of the
growth in long-term spending on health care.3
Advances in technology. Development of new
technology and advances in existing technology
are major drivers of health-care costs in the
United States. Examples include magnetic
resonance imaging (MRI), coronary bypass
procedures, bone marrow transplants, neonatal
intensive care, and renal replacement therapy for
kidney failure. A Congressional Budget Office
(CBO) study estimates that about half of all
growth in health-care spending in the past several
decades was associated with changes in medical
care made possible by advances in technology.4
Cost insulation because of third-party payers.
Critics argue that consumers are insulated from
the true cost of health care because they are not
■
297
paying directly for the health care they receive.
Most health-care costs are paid by third-party
payers, such as employers, private insurers, and
government, which typically pay a large part
of the total cost. As a result, patients generally have little or no incentive to control cost,
which encourages them to consume more healthcare services than they ordinarily would. As a
source of spending, government payments from
Medicare, Medicaid, and other public sources, as
well as payments from private health insurance,
accounted for 88 percent of the nation’s healthcare dollars at the end of 2008. Consumers paid
out-of-pocket only 12 percent of the nation’s
health-care dollars.5 Because of the substantial
increase in third-party payers over time, patients
have less incentives to control cost.
Employment-based health insurance. Most
workers today obtain their health insurance
coverage through an employer-sponsored group
plan. Critics believe that many of the health-care
problems in the United States can be traced to
employment-based health insurance. This is true
for several reasons. First, qualified group health
insurance plans receive favorable tax treatment.
Employers receive an income-tax deduction for
their contributions, and the contributions are not
taxable income to employees. Critics argue that,
as a result of collective bargaining and the heavy
tax subsidy, employers and employees often
select the more costly and comprehensive types
of health insurance plans, which drive up costs.
Second, as stated earlier, critics argue that thirdparty payments for health insurance by employers
insulate the employees from the true cost of
health care, which reduces incentives of employees
to control costs. Finally, group health insurance
is temporary and not portable. Employees generally lose their group health coverage if they
are laid off, fired, or retire. To deal with these
problems, critics propose that individual health
insurance should receive greater emphasis so that
employees would still have coverage after they
leave the group and also have a greater incentive
to control cost.
State-mandated benefits. The states require
health insurers to cover certain specific diseases or groups, such as coverage of newly born
infants, alcoholism and drug addiction, mental
www.downloadslide.com
298
C H A P T E R 1 5 / H E A LT H - C A R E R E F O R M ; I N D I V I D U A L H E A LT H I N S U R A N C E C O V E R A G E S
INSIGHT 15.1
How Does U.S. Health-Care Spending Compare with Other Countries?
The U.S. spends substantially more on health care than other
developed countries. The figure below shows per capita health
expenditures in 2009 U.S. dollars for the Organisation for
Economic Co-operation and Development (OECD) countries
with above-average per capita national income. According to
OECD data, health spending per capita in the United States
was $7,598 in 2009. This amount was 48% higher than in
the next highest spending country (Switzerland), and about
90% higher than in many other countries that we would
consider global competitors. As a share of GDP, health care
spending in the U.S. also exceeds spending by other industrialized nations by at least 5 percentage points (not shown).
Despite this relatively high level of spending, the United
States does not appear to achieve substantially better health
benchmarks compared to other developed countries. A recent
study found that U.S. health-care spending is higher than that of
other countries most likely because of higher prices and perhaps
more readily accessible technology and greater obesity, rather
than higher income, an older population, or a greater supply or
utilization of hospitals and doctors.a
Per Capita Total Current Health-Care Expenditures, U.S. and Selected Countries, 2009
Austria
Belgium
Canada
Denmark
Finland
France
Germany
Iceland
Ireland
Italy
Luxembourg
Netherlands ^ *
New Zealand
Norway ^
Spain
Sweden
Switzerland
United Kingdom
United States
$4,045
$3,946
$4,139
$4,185
$3,053
$3,872
$4,072
$3,538
$3,609
$3,020
$4,808
$4,585
$2,983
$5,128
$2,982
$3,562
$5,144
$3,311
$7,598
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
$8,000
^OECD estimate.
*Break in series
Source: Organisation for Economic Co-operation and Development. “OECD Health Data: Health Expenditures and
Financing”, OECD Health Statistics Data from internet subscription database. http://www.oecd-ilibrary.org, data
accessed on 01/10/12.
aDavid
A. Squires, “Explaining High Health Care Spending in the United States: An International Comparison of Supply, Utilization, Prices, and Quality,” The
Commonwealth Fund, May 3, 2012.
.
Source: Excerpted from The Henry J. Kaiser Family Foundation, Health Care Costs, A Primer, Key Information on Health Care Costs and Their Impact, May 2012, p. 7.
www.downloadslide.com
HEALTH-CARE PROBLEMS IN THE UNITED STATES
■
■
■
■
■
health, and coverage of chiropractors, psychologists, and physically and mentally handicapped
persons. The mandated benefits increase the utilization of medical services and drive up cost.
Increased spending on prescription drugs. In
past years, spending on prescription drugs was
not a major factor in total health-care spending.
However, since the mid-1990s, spending on
prescription drugs has become relatively more
important as a driver of health-care costs.
Prescription drugs accounted for 10 percent of
total spending on health care at the end of 2008.6
Cost shifting by Medicare and Medicaid.
Medicare and Medicaid programs do not pay
the full cost of providing care to patients. As
a result, costs are shifted from Medicare and
Medicaid to private paying patients with health
insurance who must pay more for the care they
receive. Experts estimate that cost shifting adds
at least $1000 to the cost of a family policy
each year.
High administrative costs. The costs of administering private health insurance plans have also
increased over time. The share of private health
insurance premiums accounted for by administrative cost varies considerably by firm size. The
Congressional Budget Office estimates that the
average share of premiums that covers administrative costs ranges from about 7 percent of
employer-sponsored plans with 1000 or more
enrollees to nearly 30 percent for individuals and
small firms with fewer than 25 employees.7
Rising prices in the health-care sector. The prices
of medical goods and service have increased
more rapidly over time than the overall price
level. Some analysts believe that rising prices in
the health-care sector are another contributing
factor in total health-care spending. However,
a CBO study concludes that rising prices in the
health-care sector account for no more than
one-fifth of the long-term real increase in total
health-care spending.8
Defensive medicine. The fear of being sued for
medical malpractice has forced physicians to
practice defensive medicine. Defensive medicine
refers to unnecessary diagnostic tests by physicians, tests with little clinical value to patients,
and longer-than-necessary hospital stays. Healthcare costs are higher as a result.
■
■
299
Other factors. Other factors that drive up healthcare costs include the substantial cost of emergency room treatment and inpatient hospital care
for uninsured patients, and health-care fraud and
abuse by health-care providers and patients.
In addition, contrary to popular belief, aging
of the population is not a major contributing
factor to the overall long-run growth in
health-care spending. According to the CBO,
the percentage of aged people in the population
increased during the past four decades, but
the increase was too gradual and insubstantial
to account for a large percentage of the total
increase in per capita spending on health care.
The CBO estimates that changes in the age
distribution in the population from 1965 to
2005 accounted for only about 3 percent of
the cumulative increase in total spending that
occurred during that period.9
Large Number of Uninsured Persons in the
Population
The second major problem is the large number of
uninsured persons in the population. According to
the 2012 Current Population Survey, 48.6 million
people, or 15.7 percent of the population, had no
health insurance coverage in 2011.10 Groups with
relatively large numbers of uninsured persons include
the following:
■
■
■
■
■
■
Foreign born
Hispanic (any race)
Young adults
(ages 19 to 25)
Household income
under $25,000
Blacks
Asians
33.0 percent
30.1 percent
27.7 percent
25.4 percent
19.5 percent
16.8 percent
In addition, many states have a high proportion
of uninsured persons. In 2011, these states include
Texas (23.8 percent), New Mexico (19.6 percent),
Mississippi (16.2 percent), Florida (19.8 percent),
and Louisiana (20.8 percent).11
The problem is even more severe when the length
of time an individual remains uninsured is considered. A study by The Kaiser Family Foundation
showed that more than 70 percent of the people
without health insurance were uninsured for more
nguon tai.lieu . vn
CHAPTER 15
HEALTH-CARE REFORM;
INDIVIDUAL HEALTH
INSURANCE COVERAGES
“The supreme court’s decision to uphold the Affordable
Care Act ensures hard-working, middle class families will
get the security they deserve and protects every American
from the worst insurance company abuses.”
whitehouse.gov/healthreform
Learning O bj e c ti v e s
After studying this chapter, you should be able to
◆ Explain the major health-care problems in the United States.
◆ Identify the major provisions of the Affordable Care Act that affect individuals and families.
◆ Describe the basic characteristics of individual medical expense insurance.
◆ Identify the basic characteristics of health savings accounts (HSA).
◆ Describe the key characteristics of long-term care insurance.
◆ Describe the major characteristics of disability-income insurance contracts.
295
www.downloadslide.com
J
ustin, age 32, is a self-employed carpenter who was recently diagnosed with a brain
tumor that required immediate surgery. The surgeon’s fee, hospital expenses, other
medical bills, and lost earnings totalled more than $125,000. Like many self-employed
individuals, Justin had no health insurance. In addition, he could not work for six months
and did not have a disability-income policy to restore his lost earnings. Because of the
lack of health insurance, Justin was exposed to serious economic insecurity because of
the unexpected surgery. He eventually had to declare bankruptcy.
As Justin’s experience demonstrates, health insurance should receive high priority in a
personal risk management program. If you are seriously ill or injured, you face two major
problems: payment of your medical bills and the loss of earned income. A severe illness or
injury can result in catastrophic medical bills. Without proper protection, you may have
to pay thousands of dollars out of your own pocket for medical bills. In addition, a lengthy
disability can result in the loss of substantial amounts of earned income.
This chapter is the first of two chapters dealing with private health insurance.
This chapter is limited primarily to important individual health insurance coverages.
The following chapter discusses group health insurance coverages. Although most
people are covered under group plans, individual plans are still important for
individuals and families who are not covered by group health insurance.
This chapter is divided into three major parts. The first part discusses the major
health-care problems in the United States and the need for health-care reform. The
second part examines the major provisions of the new Affordable Care Act that was
enacted to reform the present health-care delivery system. The final part discusses several
individual health insurance coverages including individual medical expense insurance,
health savings accounts, long-term care insurance, and disability-income insurance.
HEALTH-CARE PROBLEMS IN
THE UNITED STATES
The United States overall provides high-quality health
care to the population. However, despite major
breakthroughs in medicine, experts believe the present health-care delivery system is broken and must
be reformed. Major problems that lead to enactment
of the Patient Protection and Affordable Care Act in
March 2010 include the following:
■
■
■
■
■
■
296
Rising health-care expenditures
Large number of uninsured in the population
Uneven quality of medical care
Considerable waste and inefficiency
Defects in financing health care
Abusive insurer practices
Rising Health-Care Expenditures
Total health-care expenditures in the United States
have increased substantially over time and are growing faster than the national economy. According
to the Centers for Medicare & Medicaid Services,
estimated national health expenditures totalled just
over $2.8 trillion in 2012 or 17.6 percent of the
nation’s gross domestic product. Thus, more than
one in six dollars of the nation’s income is now spent
on health care. If present trends continue, estimated
national health expenditures will total $4.6 trillion in
2020, or 19.8 percent of our gross domestic product.1
Comparison with Foreign Nations The United
States leads the world in total spending on health
care. Per capita spending on health care in the United
www.downloadslide.com
HEALTH-CARE PROBLEMS IN THE UNITED STATES
States was $7598 in 2009, or 48 percent higher than
the second highest spending country (Switzerland)
and almost 90 percent higher than in many countries
considered to be global competitors (see Insight 15.1).
According to a recent study by the Commonwealth
Fund, the higher spending in the United States should
not be attributed to higher incomes, an older population, or a greater supply or utilization of physicians
and hospitals. Instead, the higher spending may
be due to (1) higher prices paid for medical care,
including prescription drugs, office visits, and higher
physician and surgeon fees compared to foreign countries, (2) greater use of more expensive technology,
and (3) higher obesity rates. Despite higher spending,
the quality of health care in the United States shows
considerable variation of performance depending
on the disease being treated, and does not appear to
be markedly superior to less costly systems in other
industrialized countries.2
■
Reasons for the Increase in Health-Care
Expenditures Health-care economists have identified numerous factors that explain, at least in part,
the substantial increase in health-care expenditures
over time. Important factors include the following:
■
■
■
Increase in consumer demand. Consumer demand
for health-care services has increased over time
because of an increase in the population, rising
per capita incomes, and greater health awareness by Americans. Studies suggest that growth
in average per capita income could account for
5 percent to approximately 20 percent of the
growth in long-term spending on health care.3
Advances in technology. Development of new
technology and advances in existing technology
are major drivers of health-care costs in the
United States. Examples include magnetic
resonance imaging (MRI), coronary bypass
procedures, bone marrow transplants, neonatal
intensive care, and renal replacement therapy for
kidney failure. A Congressional Budget Office
(CBO) study estimates that about half of all
growth in health-care spending in the past several
decades was associated with changes in medical
care made possible by advances in technology.4
Cost insulation because of third-party payers.
Critics argue that consumers are insulated from
the true cost of health care because they are not
■
297
paying directly for the health care they receive.
Most health-care costs are paid by third-party
payers, such as employers, private insurers, and
government, which typically pay a large part
of the total cost. As a result, patients generally have little or no incentive to control cost,
which encourages them to consume more healthcare services than they ordinarily would. As a
source of spending, government payments from
Medicare, Medicaid, and other public sources, as
well as payments from private health insurance,
accounted for 88 percent of the nation’s healthcare dollars at the end of 2008. Consumers paid
out-of-pocket only 12 percent of the nation’s
health-care dollars.5 Because of the substantial
increase in third-party payers over time, patients
have less incentives to control cost.
Employment-based health insurance. Most
workers today obtain their health insurance
coverage through an employer-sponsored group
plan. Critics believe that many of the health-care
problems in the United States can be traced to
employment-based health insurance. This is true
for several reasons. First, qualified group health
insurance plans receive favorable tax treatment.
Employers receive an income-tax deduction for
their contributions, and the contributions are not
taxable income to employees. Critics argue that,
as a result of collective bargaining and the heavy
tax subsidy, employers and employees often
select the more costly and comprehensive types
of health insurance plans, which drive up costs.
Second, as stated earlier, critics argue that thirdparty payments for health insurance by employers
insulate the employees from the true cost of
health care, which reduces incentives of employees
to control costs. Finally, group health insurance
is temporary and not portable. Employees generally lose their group health coverage if they
are laid off, fired, or retire. To deal with these
problems, critics propose that individual health
insurance should receive greater emphasis so that
employees would still have coverage after they
leave the group and also have a greater incentive
to control cost.
State-mandated benefits. The states require
health insurers to cover certain specific diseases or groups, such as coverage of newly born
infants, alcoholism and drug addiction, mental
www.downloadslide.com
298
C H A P T E R 1 5 / H E A LT H - C A R E R E F O R M ; I N D I V I D U A L H E A LT H I N S U R A N C E C O V E R A G E S
INSIGHT 15.1
How Does U.S. Health-Care Spending Compare with Other Countries?
The U.S. spends substantially more on health care than other
developed countries. The figure below shows per capita health
expenditures in 2009 U.S. dollars for the Organisation for
Economic Co-operation and Development (OECD) countries
with above-average per capita national income. According to
OECD data, health spending per capita in the United States
was $7,598 in 2009. This amount was 48% higher than in
the next highest spending country (Switzerland), and about
90% higher than in many other countries that we would
consider global competitors. As a share of GDP, health care
spending in the U.S. also exceeds spending by other industrialized nations by at least 5 percentage points (not shown).
Despite this relatively high level of spending, the United
States does not appear to achieve substantially better health
benchmarks compared to other developed countries. A recent
study found that U.S. health-care spending is higher than that of
other countries most likely because of higher prices and perhaps
more readily accessible technology and greater obesity, rather
than higher income, an older population, or a greater supply or
utilization of hospitals and doctors.a
Per Capita Total Current Health-Care Expenditures, U.S. and Selected Countries, 2009
Austria
Belgium
Canada
Denmark
Finland
France
Germany
Iceland
Ireland
Italy
Luxembourg
Netherlands ^ *
New Zealand
Norway ^
Spain
Sweden
Switzerland
United Kingdom
United States
$4,045
$3,946
$4,139
$4,185
$3,053
$3,872
$4,072
$3,538
$3,609
$3,020
$4,808
$4,585
$2,983
$5,128
$2,982
$3,562
$5,144
$3,311
$7,598
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
$8,000
^OECD estimate.
*Break in series
Source: Organisation for Economic Co-operation and Development. “OECD Health Data: Health Expenditures and
Financing”, OECD Health Statistics Data from internet subscription database. http://www.oecd-ilibrary.org, data
accessed on 01/10/12.
aDavid
A. Squires, “Explaining High Health Care Spending in the United States: An International Comparison of Supply, Utilization, Prices, and Quality,” The
Commonwealth Fund, May 3, 2012.
.
Source: Excerpted from The Henry J. Kaiser Family Foundation, Health Care Costs, A Primer, Key Information on Health Care Costs and Their Impact, May 2012, p. 7.
www.downloadslide.com
HEALTH-CARE PROBLEMS IN THE UNITED STATES
■
■
■
■
■
health, and coverage of chiropractors, psychologists, and physically and mentally handicapped
persons. The mandated benefits increase the utilization of medical services and drive up cost.
Increased spending on prescription drugs. In
past years, spending on prescription drugs was
not a major factor in total health-care spending.
However, since the mid-1990s, spending on
prescription drugs has become relatively more
important as a driver of health-care costs.
Prescription drugs accounted for 10 percent of
total spending on health care at the end of 2008.6
Cost shifting by Medicare and Medicaid.
Medicare and Medicaid programs do not pay
the full cost of providing care to patients. As
a result, costs are shifted from Medicare and
Medicaid to private paying patients with health
insurance who must pay more for the care they
receive. Experts estimate that cost shifting adds
at least $1000 to the cost of a family policy
each year.
High administrative costs. The costs of administering private health insurance plans have also
increased over time. The share of private health
insurance premiums accounted for by administrative cost varies considerably by firm size. The
Congressional Budget Office estimates that the
average share of premiums that covers administrative costs ranges from about 7 percent of
employer-sponsored plans with 1000 or more
enrollees to nearly 30 percent for individuals and
small firms with fewer than 25 employees.7
Rising prices in the health-care sector. The prices
of medical goods and service have increased
more rapidly over time than the overall price
level. Some analysts believe that rising prices in
the health-care sector are another contributing
factor in total health-care spending. However,
a CBO study concludes that rising prices in the
health-care sector account for no more than
one-fifth of the long-term real increase in total
health-care spending.8
Defensive medicine. The fear of being sued for
medical malpractice has forced physicians to
practice defensive medicine. Defensive medicine
refers to unnecessary diagnostic tests by physicians, tests with little clinical value to patients,
and longer-than-necessary hospital stays. Healthcare costs are higher as a result.
■
■
299
Other factors. Other factors that drive up healthcare costs include the substantial cost of emergency room treatment and inpatient hospital care
for uninsured patients, and health-care fraud and
abuse by health-care providers and patients.
In addition, contrary to popular belief, aging
of the population is not a major contributing
factor to the overall long-run growth in
health-care spending. According to the CBO,
the percentage of aged people in the population
increased during the past four decades, but
the increase was too gradual and insubstantial
to account for a large percentage of the total
increase in per capita spending on health care.
The CBO estimates that changes in the age
distribution in the population from 1965 to
2005 accounted for only about 3 percent of
the cumulative increase in total spending that
occurred during that period.9
Large Number of Uninsured Persons in the
Population
The second major problem is the large number of
uninsured persons in the population. According to
the 2012 Current Population Survey, 48.6 million
people, or 15.7 percent of the population, had no
health insurance coverage in 2011.10 Groups with
relatively large numbers of uninsured persons include
the following:
■
■
■
■
■
■
Foreign born
Hispanic (any race)
Young adults
(ages 19 to 25)
Household income
under $25,000
Blacks
Asians
33.0 percent
30.1 percent
27.7 percent
25.4 percent
19.5 percent
16.8 percent
In addition, many states have a high proportion
of uninsured persons. In 2011, these states include
Texas (23.8 percent), New Mexico (19.6 percent),
Mississippi (16.2 percent), Florida (19.8 percent),
and Louisiana (20.8 percent).11
The problem is even more severe when the length
of time an individual remains uninsured is considered. A study by The Kaiser Family Foundation
showed that more than 70 percent of the people
without health insurance were uninsured for more