Disparities in State Health Coverage: A Matter of Policy or Fortune?

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More than 47 million low-income, non-elderly Americans are at risk of being uninsured because they lack access to both private and federal sources of health insurance. For this “at-risk” population, Medicaid is by far the largest health insurer in every state. The proportion of this population actually covered by Medicaid in each state, however, displays striking variability. During the period 1996-1998, Medicaid coverage of the at-risk population ranged by nearly threefold, from a low of 27 percent in Nevada to a high of nearly 75 percent in Vermont. In turn, these two states had the lowest and highest rates of overall coverage of the low-income population — 61.3 percent and 85.2 percent, respectively. Other states displayed a similar relationship, establishing a close link between Medicaid coverage of the at-risk population and reduced rates of uninsurance.