Advancing Sexual and Reproductive Health and Rights
 
Guttmacher Policy Review
Winter 2007, Volume 10, Number 1
 
For the Record

More Reproductive-Age Women Covered by Medicaid—But More Are Also Uninsured

Over the first half of the decade, the proportion of women of reproductive age covered by Medicaid increased by one-third, from 9% in 2000 to 12% in 2005. Yet, this increase—of nearly two million women—was matched by an increase in the proportion of reproductive-age women who were uninsured (from 18% in 2000 to 21% in 2005). Both trends were likely driven, in part, by the continuing decline of employer-sponsored health insurance and by the recession that followed the 2000 stock market crash.

In 2005, 7.4 million women aged 15–44 looked to Medicaid (and related public programs, including the State Children's Health Insurance Program) for their health care, including contraceptive services and supplies, prenatal care and delivery services, screening and treatment for sexually transmitted infections, and other vital sexual and reproductive health services. Among women of reproductive age in families with incomes below the federal poverty line, 36% were covered by Medicaid in that same year. Yet, because Medicaid eligibility is severely restricted, and because poor reproductive-age women are unlikely to be offered or able to afford private insurance, 41% were uninsured.

The importance of Medicaid to women of reproductive age varies widely by state, reflecting differences both in states' economic climate and their eligibility criteria for the program. The proportion of reproductive-age women enrolled in Medicaid in 2004–2005 ranged from 6% in New Hampshire to 26% in Maine (see table); Maine covers working parents up to an income level nearly four times as high as the limit in New Hampshire. In eight states and the District of Columbia, at least 15% of such women looked to Medicaid for their care; in 13 states, fewer than 10% were covered under the program. Mirroring in part the same influences, the proportion uninsured ranged from 10% in Minnesota to 32% in Texas.

Decidedly uncertain is whether Medicaid can continue to serve as a levee against the tide of the uninsured. The Deficit Reduction Act of 2006 gave states new flexibility to impose cost-sharing and restrict their package of Medicaid benefits—flexibility that could undermine the program's provision of reproductive health services (related article, Spring 2006, page 2). Another provision of that law, which requires Medicaid recipients who are citizens to provide documentary proof of their status, has the potential to delay or deny care for millions of Americans (related article, page 7). Nevertheless, there are early signs of promise: As the political, economic and social costs of uninsurance become increasingly clear, federal and state policymakers, with Massachusetts leading the way, have renewed debate over ways to counter the problem, either incrementally or through some form of universal coverage.

—Adam Sonfield

NOT NEARLY ENOUGH
Even in states where Medicaid enrollment is relatively high, considerable numbers of women remain un-insured—nationally, almost twice as many.
  Women Aged 15–44, 2004–2005
Covered by Medicaid Uninsured
Number % Number %
U.S. Total* 7,433,000 12.0 12,860,000 20.8
Alabama 120,000 12.7 197,000 20.8
Alaska 18,000 12.9 30,000 21.9
Arizona 201,000 16.6 287,000 23.7
Arkansas 71,000 12.6 143,000 25.3
California 1,095,000 14.2 1,846,000 23.9
Colorado 62,000 6.2 214,000 21.4
Connecticut 77,000 10.8 104,000 14.8
Delaware 20,000 11.6 26,000 14.7
Dist. of Columbia 27,000 19.8 18,000 13.5
Florida 290,000 8.4 956,000 27.7
Georgia 218,000 10.9 464,000 23.2
Hawaii 23,000 9.3 27,000 11.1
Idaho 30,000 10.1 63,000 21.3
Illinois 289,000 10.8 478,000 17.7
Indiana 165,000 12.7 269,000 20.8
Iowa 73,000 12.3 73,000 12.2
Kansas 50,000 9.0 81,000 14.5
Kentucky 119,000 13.7 154,000 17.7
Louisiana 114,000 12.3 245,000 26.5
Maine 69,000 26.2 31,000 11.9
Maryland 72,000 6.0 228,000 19.0
Massachusetts 186,000 13.7 190,000 13.9
Michigan 270,000 12.9 316,000 15.2
Minnesota 109,000 10.0 112,000 10.3
Mississippi 102,000 16.5 143,000 23.1
Missouri 169,000 14.2 209,000 17.5
Montana 18,000 9.8 46,000 25.1
Nebraska 38,000 10.5 52,000 14.4
Nevada 32,000 6.3 118,000 23.3
New Hampshire 15,000 5.5 42,000 15.7
New Jersey 122,000 6.9 349,000 19.6
New Mexico 59,000 15.2 118,000 30.4
New York 756,000 18.5 727,000 17.8
North Carolina 220,000 12.0 355,000 19.4
North Dakota 11,000 9.1 16,000 13.0
Ohio 306,000 13.1 336,000 14.4
Oklahoma 74,000 10.3 201,000 27.8
Oregon 88,000 11.9 178,000 24.2
Pennsylvania 278,000 11.3 360,000 14.6
Rhode Island 44,000 19.2 31,000 13.6
South Carolina 120,000 13.6 183,000 20.8
South Dakota 17,000 11.2 24,000 15.3
Tennessee 245,000 19.5 211,000 16.8
Texas 404,000 8.1 1,586,000 31.9
Utah 51,000 9.3 106,000 19.0
Vermont 27,000 21.3 17,000 13.8
Virginia 108,000 6.8 286,000 18.0
Washington 152,000 11.5 211,000 16.0
West Virginia 42,000 11.8 86,000 24.3
Wisconsin 160,000 14.0 143,000 12.5
Wyoming 10,000 10.3 20,000 20.3
*2005 data. Source: Guttmacher Institute tabulations from Current Population Survey, 2005–2006.