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The uninsured: Montana's health insurance coverage rates are among the worst in the nation.

Article Excerpt
Montana has always ranked near the bottom in cross-state and national comparisons of health insurance coverage. Current estimates suggest that anywhere from 14 percent to 19 percent of Montanans have no health insurance.

During the winter of 2003, the Montana Department of Health and Human Services and The University of Montana's Bureau of Business and Economic Research conducted two surveys designed to help fill major gaps in the state's knowledge of its uninsured population.

The Montana Household Survey and Montana Employer Survey were then bolstered by a series of 30 interviews with "key informants" statewide--health care providers, clinic and hospital administrators, private business people, farmers, ranchers, insurance executives, and community leaders and advocates who have contact with Montanans who are either uninsured or at high risk of becoming uninsured.

At the time of the surveys, 19 percent of Montanans, or about 173,000 people, were uninsured. Slightly more than half (51 percent) of those surveyed had employer-based health insurance. Individual health insurance policies covered 9 percent of the state's population. And Medicaid and the Children's Health insurance Program (CHIP) covered 6 percent, a rate that was lowered somewhat by counting people who were dual-enrolled in Medicaid and Medicare.

Finally, 15 percent of Montanans were insured under Medicare. Uninsured rates for the non-elderly population are a more accurate measure of the health insurance gap in Montana, since nearly everyone 65 years of age and older has health insurance through Medicare (Figure 1).

Montana's uninsured rate is higher when the elderly who are covered by Medicare are taken out of the sample and population numbers. Twenty-two percent of Montana's non-elderly population has no health insurance--public or private. Employer-based insurance covers 58 percent of Montanans under age 65, compared to the national rate of 67 percent. Individual health insurance coverage is 10 percent in Montana, compared to a national rate of 7 percent. Medicaid and CHIP account for 10 percent of the state's non-elderly health coverage.

Health insurance rates by age show considerable differences between younger and older Montanans (Figure 2). Thirty-nine percent of young people between 19 and 25 years of age have no health insurance. Montanans 26 to 49 years of age have an uninsured rate of 24 percent, while 14 percent of older residents between 50 and 64 years of age have no coverage. Children--ages 18 and younger--have an uninsured rate of 17 percent, one of the highest such rates in the nation.

Sources of insurance vary by age. Fifty-seven percent of children 18 years of age and under have insurance coverage through employers, primarily based on their parents' employment. About 16 percent of Montana children 18 and under receive health coverage from Medicaid or CHIP, one of the highest coverage rates of any age group.

Household income levels are a major determinant of health coverage. As would be expected, lower-income households have higher rates of uninsurance. About 43 percent of Montanans in households with incomes below the 2002 federal poverty level ($18,100 for a family of four) have no health insurance. Alternately, Montanans who live in households with incomes more than twice the poverty level have a relatively low uninsured rate of 13 percent.

A number of uninsured rates show racial, geographic, and employment variations in health care coverage. American Indians under age 65 had an uninsured rate of 38 percent, compared...