HRSA, our trusted link for February 2021

An agency of the U.S. Dept. of Health & Human Services, HRSA (the Health Resources and Services Administration) serves Americans who have trouble reaching healthcare because of poverty, geographic isolation, or medical challenges. Many of their clients are pregnant women, mothers, or people facing disabling diseases. HRSA also supports the training of health care providers and improvements in health care delivery in rural and underserved areas.  The HRSA mission is to address health disparities by improving access to high-value programs. It collects data about healthcare accidents, medical malpractice, and waste. It coordinates programs to improve the use of vaccines, transplants, and tissue donations.  Its 2021 in-house budget is $1.2 billion, and it employs over 2,200 people. In the last fiscal year reported, 2019, HRSA administered almost $10 billion in grants and cooperative agreements. 1,389 Health Centers received over $5 billion in funding.  The HRSA Health Center Program serves 1 in 11 people in the United States. Established in 1966, it funds nearly  1,400 health centers that support  33% of the people living in poverty,  20% of the rural population,  almost 400,00 veterans, as well as  over a million agricultural workers.  Its recent achievements include 68% of their diabetic patients controlled their blood sugar levels, compared to the 59% national average 65% of their hypertension patients controlled their blood pressure, compared to the 59% national average 24% lower healthcare spending per patient, especially due to less emergency room usage and hospitalization.  The Health Center Program unites patients, healthcare workers, and many government and nonprofit agencies to overcome unusual and persistent healthcare challenges.

See How HRSA Distributes their Funds

Medicare Advantage Market Share in the Southwest

Thanks to broader benefits and usually lower costs than Original Medicare coverage, Medicare Advantage (MA) Plans have much to offer budget-minded Medicare eligible individuals. Despite utilizing managed care protocols to control costs, MA plans have been attracting growing numbers of Medicare eligible seniors away from traditional Medicare coverage.  In bit more than four years, from October 2016 through January 2021, the market share of MA plans across the U.S. has grown from under 31% of Medicare eligible Americans to slightly more than 41%.

The growing popularity of Medicare Advantage plans nationally is reflected in the four-state Southwest region of the U.S., where MA plan enrollment has grown from a 31.1% share of the Medicare eligible market in October 2016 to 42.4% as of January 2021.  Here is a state-by-state look at how Medicare Advantage market share in the Southwest has expanded from October 2016 to January 2021:

Medicare Advantage Market Share in the Southwest

	Medicare Eligible (1)			MA Enrollment (1)			% MA Market Share
State	Jan-21	Oct-16		Jan-21	Oct-16		Jan-21	Oct-16
AZ	1,377.3	1,186.6		615.3	450.6		44.7%	38.0%
NM	435.7	386.3		175.1	124.8		40.2%	32.3%
OK	756.1	698.8		220.5	119.0		29.2%	17.0%
TX	4,316.2	3,778.6		1,906.9	1,185.4		44.2%	31.4%
Region	6,885.3	6,050.2		2,917.8	1,879.8		42.4%	31.1%
Total (2)	62,741.5	56,888.7		25,936.7	17,489.5		41.3%	30.7%

(1) in thousands; region totals may not equal sum of individual states due to rounding adjustments

(2) includes U.S. territories

Source:  Medicare Monthly Enrollment Reports

Private Sector Employee-Only Health Premium Costs in the Far West

Private employers in Far West states usually incur annual costs for single premium (i.e. employee-only) health insurance coverage that are lower than in other regions of the U.S.  An exception is Alaska, where small firms, with fewer than 50 employees, and larger firms both face annual premium costs well in excess of the national average for similar-sized firms.  Larger firms in the state of Washington also face higher than the national average employee-only premium rates, but only slightly higher.  Elsewhere in the Far West, private employers typically incur annual premium rates for employee-only health insurance coverage that are below the national average for similar-sized employers. Data from the most recent (2019) Medical Expenditure Panel Survey, which is a survey administered by the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality, reveals the following about private sector employee-only health premium costs in the Far West region and nationally:

State	(1) Small Firms	(2) Large Firms	Overall Avg.
AK	$9,427	$8,841	$8,933
CA	$6,874	$6,955	$6,939
HI	$6,746	$6,634	$6,671
OR	$5,933	$6,846	$6,651
WA	$6,259	$7,052	$6,897
U.S.	$6,920	$6,983	$6,972

(1) fewer than 50 employees

(2) 50 or more employees

Source:  Medical Expenditure Panel Survey  Table II.C.1 - Average total single premium (in dollars) per enrolled employee at private-sector establishments that offer health insurance by firm size and State: United States, 2019

Medicare Advantage Market Share in the Mid-East States

With typically lower costs and extra benefits, Medicare Advantage (MA) Plans provide a most compelling value proposition in comparison to traditional Medicare coverage. Despite employing managed care protocols to control costs, the value appeal of MA plans has drawn more and more Medicare eligible seniors away from traditional Medicare.  In the span of just over four years, from October 2016 through January 2021, the market share of MA plans across the U.S. has grown from under 31% of Medicare eligible Americans to over 41%.

The increasing popularity of Medicare Advantage plans nationally is mirrored in the Mid-East section of the U.S., where MA plan enrollment has grown from a 30.0% share of the Medicare eligible market in October 2016 to just over 39% as of January 2021.  Here is a state-by-state look at how Medicare Advantage market share in the Mid-East states has grown from October 2016 to January 2021:

Medicare Advantage Market Share in the Mid-East States

	Medicare Eligible (1)			MA Enrollment (1)			% MA Market Share
State	Jan-21	Oct-16		Jan-21	Oct-16		Jan-21	Oct-16
DC	94.8	90.5		22.7	7.1		23.9%	7.8%
DE	217.4	186.8		47.0	17.0		21.6%	9.1%
MD	1,064.5	964.8		149.7	53.3		14.1%	5.5%
NJ	1,644.6	1,532.2		558.7	254.3		34.0%	16.6%
NY	3,689.8	3,432.4		1,657.9	1,276.4		44.9%	37.2%
PA	2,788.1	2,598.2		1,278.5	1,031.3		45.9%	39.7%
Region	9,499.3	8,804.9		3,714.5	2,639.5		39.1%	30.0%
Total (2)	62,741.5	56,888.7		25,936.7	17,489.5		41.3%	30.7%

(1) in thousands; region totals may not equal sum of individual states due to rounding adjustments

(2) includes U.S. territories

Source:  Medicare Monthly Enrollment Reports

Private Sector Employee-Only Health Premium Costs in the Mountain States

The annual premium rate for employee-only (i.e. single premium) health insurance for Mountain states' private sector employers generally falls below national average rates. Wyoming private-employers, large and small, deal with single premium health insurance rates that typically run higher the national average rate for similar sized private employers.  Likewise, small employers (with fewer than 50 employees) in New Mexico and larger employers in Montana face higher than national average premium rates for employee-only health coverage.  But elsewhere in the region, annual premium rate rates for both small and large private employers typically run below national averages.  A detailed look at the data from the most recent Medical Expenditure Panel Survey (2019), which is administered by the Agency for Healthcare Research and Quality, reveals the following about private sector employee-only health premium costs in the Mountain states and nationally:

State	(1) Small Firms	(2) Large Firms	Overall Avg.
AZ	$5,924	$6,627	$6,517
CO	$6,144	$6,634	$6,550
ID	$5,962	$6,476	$6,346
MT	$6,063	$7,235	$6,899
NV	$5,464	$6,785	$6,586
NM	$7,249	$6,583	$6,696
UT	$5,067	$6,441	$6,253
WY	$7,590	$7,054	$7,209
U.S.	$6,920	$6,983	$6,972

(1) fewer than 50 employees

(2) 50 or more employees

Source:  Medical Expenditure Panel Survey  Table II.C.1 - Average total single premium (in dollars) per enrolled employee at private-sector establishments that offer health insurance by firm size and State: United States, 2019

Medicare Advantage Market Share in the Southeast

With additional benefits and typically lower costs, Medicare Advantage (MA) Plans can be a great value compared to Original Medicare. Despite employing managed care protocols to control costs, more and more Medicare eligible seniors are gravitating to the better value MA plans offer.  In just over four years, from October 2016 through January 2021, the penetration of MA plans across the U.S. has grown from under 31% of Medicare eligible Americans to over 41%.

The growing popularity of MA plans nationally is mirrored in the twelve-state Southeast region of the U.S., where Medicare Advantage plan enrollment has grown from a 30.7% share of the Medicare eligible market in October 2016 to almost 43% as of January 2021.  Here is a state-by-state look at how Medicare Advantage market share in the Southeast has grown from October 2016 to January 2021:

Medicare Advantage Market Share in the Southeast

	Medicare Eligible (1)			MA Enrollment (1)			% MA Market Share
State	Jan-21	Oct-16		Jan-21	Oct-16		Jan-21	Oct-16
AL	1,065.8	991.4		523.2	262.2		49.1%	26.5%
AR	648.0	609.0		211.1	125.3		32.6%	20.6%
FL	4,706.7	4,172.8		2,374.3	1715.1		50.4%	41.1%
GA	1,786.4	1,585.9		822.2	529.6		46.0%	33.4%
KY	946.2	882.7		392.3	240.1		41.5%	27.2%
LA	894.9	817.7		399.8	257.4		44.7%	31.5%
MS	613.3	574.3		168.6	89.8		27.5%	15.6%
NC	2,049.5	1,829.7		887.1	561.9		43.3%	30.7%
SC	1,112.4	977.5		383.6	230.3		34.5%	23.6%
TN	1,389.9	1,269.6		623.9	452.3		44.9%	35.6%
VA	1,557.9	1,404.1		427.9	204.3		27.5%	14.6%
WV	443.7	424.9		167.2	106.4		37.7%	25.0%
Region	17,214.7	15,539.5		7,381.4	4,774.8		42.9%	30.7%
Total (2)	62,741.5	56,888.7		25,936.7	17,489.5		41.3%	30.7%

(1) in thousands; region totals may not equal sum of individual states due to rounding adjustments

(2) includes U.S. territories

Source:  Medicare Monthly Enrollment Reports

Private Sector Employee-Only Health Premium Costs in the South Central Region

The annual premium cost for employee-only (i.e. single premium) health insurance for private sector employers in the South Central region of the U.S. generally falls below national average rates. Texas private-employers, large and small, face single premium health insurance rates that align fairly closely with the national average rate for similar sized private employers.  Elsewhere in the region, employee-only health premium rates typically fall below the national average.  An exception is in Louisiana, where small business rates run higher than the national average for private employers with fewer than 50 employees.  A closer look at the data from the most recent Medical Expenditure Panel Survey (2019), which is administered by the Agency for Healthcare Research and Quality, shows the following about private sector employee-only health premium costs in the South Central region and nationally:

State	(1) Small Firms	(2) Large Firms	Overall Avg.
AL	$6,420	$6,538	$6,519
AR	$5,545	$6,148	$6,054
KY	$6,697	$6,674	$6,678
LA	$7,402	$6,599	$6,748
MS	$6,885	$6,069	$6,199
OK	$6,381	$6,791	$6,711
TN	$6,221	$6,686	$6,630
TX	$6,974	$6,966	$6,967
U.S.	$6,920	$6,983	$6,972

(1) fewer than 50 employees

(2) 50 or more employees

Source:  Medical Expenditure Panel Survey  Table II.C.1 - Average total single premium (in dollars) per enrolled employee at private-sector establishments that offer health insurance by firm size and State: United States, 2019

CHIP and Medicaid Child Enrollment by Region

Government funded programs are a very important source of children's health insurance coverage in the United States. The National Health Interview Survey (2019) estimated that about 41% of American children under the age of 18 rely on publicly supported health insurance coverage.  Most of this coverage is through the Children's Health Insurance Program (CHIP) and Medicaid.

As of September 2020, federal reports indicate that there were about 37.4 million individuals who were either enrolled in CHIP or who were children enrolled in the Medicaid program. The twelve-state Southeast is the region most most dependent on publicly subsidized children's health insurance, both in absolute and relative terms.  The 10.7 million children in the Southeast with CHIP or Medicaid Child insurance coverage is the most of any region.  Moreover, this accounts for about 28.6% of all U.S. children with CHIP or Medicaid child coverage, which compares to the region's 25.7% share of the U.S. population.  No other region of the country has as much dependence, relative to its share of total U.S. population, on publicly supported children's health insurance than does the Southeast.  Here is a more detailed breakdown of CHIP and Medicaid child enrollment by region (for state-level details, follow the "region" link) as of 9/30/20:

Region	(1) CHIP	(2) Medicaid Child	Total Child
Far West	1,569.8	5,210.8	6,780.6
Great Lakes	732.5	4,304.0	5,036.5
Great Plains	239.3	1,873.5	2,112.8
MidEast	1,201.5	4,448.0	5,649.5
New England	274.5	1,150.6	1,425.1
Rocky Mountain	172.3	980.7	1,153.0
Southeast	1,657.1	9,015.9	10,673.0
Southwest	872.3	3,658.4	4,530.7
U.S.	6,719.1	30,641.9	37,361.0

(1) CHIP enrollment, in thousands

(2) Children enrolled in Medicaid plans, in thousands (derived by deducting State reported CHIP enrollment from State Reported Total Medicaid Child and CHIP enrollment)

Note:  Sum of regional figures may vary from U.S. totals due to rounding.  

Source: Medicaid.gov Enrollment Reports as of September, 2020

CHIP and Medicaid Child Enrollment in the Southeast

According to the National Health Interview Survey (2019), approximately 41% of U.S. children under the age of 18 have health insurance coverage that is supported through public funding. While health insurance plans for government employees, including military personnel, account for some of the child enrollment in publicly funded health insurance programs, the vast majority of such coverage is provided by the Children's Health Insurance Program (CHIP) and Medicaid. CHIP and Medicaid are joint federal-state health insurance programs for eligible Americans with limited income and resources.  Medicaid is aimed at low income individuals and families, whereas CHIP is aimed specifically at children from poor families that earn too much to qualify for standard Medicaid coverage.  September 2020 federal reports indicate that nearly 37.4 million individuals were either enrolled in CHIP or were children enrolled in the Medicaid program.

The September 2020 data reveals that the twelve-state Southeast region of the U.S. accounted for about 24.7% of all American children who were enrolled in CHIP and 29.4% of U.S. children enrolled in the Medicaid program.  Here is a closer look at the numbers for CHIP and Medicaid Child enrollment in the Southeast:

CHIP and Medicaid Child Enrollment in the Southeast

State	(1) CHIP	(2) Medicaid Child	Total
AL	174.0	513.5	687.5
AR	34.9	346.6	381.5
FL	201.2	2,418.0	2,619.2
GA	228.3	1,171,2	1,399.5
KY	93.8	500.0	593.8
LA	135.1	609.6	744.7
MS	81.5	363.6	445.1
NC	288.9	955.0	1,243.9
SC	98.3	572.0	670.3
TN	128.7	737.3	866.0
VA	158.6	641.4	800.0
WV	33.8	187.7	221.5
Region	1,657.1	9,015.9	10,673.0
U.S.	6,719.1	30,641.9	37,361.0

(1) CHIP enrollment, in thousands

(2) Children enrolled in Medicaid plans, in thousands (derived by deducting State reported CHIP enrollment from State Reported Total Medicaid Child and CHIP enrollment)

Source: Medicaid.gov Enrollment Reports as of September, 2020

Private-Sector Employee-Only Health Premium Costs in the Great Lakes States

From the most recent (2019) Medical Expenditure Panel Survey, a survey administered by the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality, select data about average private sector employee-only (i.e. single premium) health premium costs in the Great Lakes states and nationally:

State	(1) Small Firms	(2) Large Firms	Overall Avg.
IL	$7,315	$7,121	$7,157
IN	$7,305	$6,905	$6,957
MI	$6,133	$6,828	$6,705
OH	$7,113	$7,189	$7,178
WI	$6,479	$7,085	$7,001
U.S.	$6,920	$6,983	$6,972

(1) fewer than 50 employees

(2) 50 or more employees

Source:  Medical Expenditure Panel Survey  Table II.C.1 - Average total single premium (in dollars) per enrolled employee at private-sector establishments that offer health insurance by firm size and State: United States, 2019

20 Best Metropolitan Markets for EMT-Paramedic Pay

EMT-Paramedic Pay in the Top 20 Metro Markets reveals that the largest U.S. metropolitan areas are big employment centers for EMT-Paramedics. However, a closer look into data from the U.S. Bureau of Labor Statistics (BLS) tells us that better pay levels, sometimes much better, are often found in smaller metro areas. May 2019 (BLS) data indicates that only three of the biggest metro areas in the U.S. were among the 20 best metropolitan markets for EMT-Paramedic pay:

	Metropolitan Area		# Employed	Annual Mean Wages
1	Olympia-Tumwater, WA		50	$79,360
2	Bremerton-Silverdale, WA		150	$62,030
3	Racine, WI		110	$60,980
4	Palm Bay-Melbourne-Titusville, FL		210	$58,350
5	Durham-Chapel Hill, NC		380	$57,540
6	Urban Honolulu, HI		480	$56,450
7	Seattle-Tacoma-Bellevue (#)		2,360	$55,990
8	El Centro, CA		50	$55,950
9	Oxnard-Thousand Oaks-Ventura, CA		N/A	$54,940
10	San Francisco-Oakland-Hayward (#)		3,550	$54,180
11	Portland-Vancouver-Hillsboro, OR-WA		800	$54,060
12	Kennewick-Richland, WA		80	$52,920
13	Texarkana, TX-AR		90	$51,640
14	Baltimore-Columbia-Towson, MD		3,400	$51,420
15	Spokane-Spokane Valley, WA		180	$51,320
16	Stockton-Lodi, CA		520	$51,220
17	Sacramento--Roseville--Arden-Arcade		1,310	$50,630
18	Sioux City, IA-NE-SD		N/A	$49,680
19	Bridgeport-Stamford-Norwalk, CT		840	$49,530
20	Washington-Arlington-Alexandria (#)		2,340	$49,150
	National		260,600	$38,830

(#) a top 20 U.S metro population area

Source: U.S. Bureau of Labor Statistics OES. Data extracted on November 13, 2020

CHIP and Medicaid Child Enrollment in New England

Public financial support plays an integral role in children's health insurance coverage in the United States. National Health Interview Survey (2019) data reveals that about 41% of U.S. children under the age of 18 have health insurance coverage that depends on public support. Although health benefit plans for government personnel, including the military, account for some of the child enrollment in health insurance plans supported by taxpayer dollars, it is Medicaid and the Children's Health Insurance Program (CHIP) that are the two principal drivers of publicly supported health insurance coverage for American children. Federal reports indicate that, as of September 2020, there were 37.4 million individuals who were either enrolled in CHIP or who were children enrolled in the Medicaid program. Medicaid, a joint state-federal program which provides health insurance for eligible individuals with limited income and resources, covers more than 30 million American children. Another 6.7 million individuals are enrolled in CHIP plans. CHIP is a another joint state-federal program that makes available health insurance coverage to children from low-income families whose income is too high to qualify for standard Medicaid coverage.

As of September 2020, the New England states accounted for 4.1% of the national enrollment in CHIP and 3.8% of U.S. children enrolled in the Medicaid program.  Here is a summary look at CHIP and Medicaid Child enrollment in New England:

CHIP and Medicaid Child Enrollment in New England

State	(1) CHIP	(2) Medicaid Child	Total
CT	19.5	325.7	345.2
NH	15.2	80.4	95.6
MA	192.3	498.3	690.6
ME	12.9	97.8	110.7
RI	30.3	89.6	119.9
VT	4.3	58.8	63.1
Region	274.5	1,150.6	1,425.1
U.S.	6,719.1	30,641.9	37,361.0

(1) CHIP enrollment, in thousands

(2) Children enrolled in Medicaid plans, in thousands (derived by deducting State reported CHIP enrollment from State Reported Total Medicaid Child and CHIP enrollment)

Source: Medicaid.gov Enrollment Reports as of September, 2020

Private Sector Employee-Only Health Insurance Costs in the South Atlantic States

The annual cost for employee-only (i.e. single premium) health insurance coverage for private sector employers in the South Atlantic region is a mixed bag relative to national levels. In three states and the District of Columbia, most private employers pay higher single premium rates than do similar sized employers nationally.  Delaware employers, in particular, find themselves disadvantaged by health insurance costs that are well above national averages. However, in five other South Atlantic states most private employers pay, on average, employee-only premium rates that are less than national averages.  A deeper dive into data from the most recent Medical Expenditure Panel Survey (2019), which is administered by the Agency for Healthcare Research and Quality, reveals the following about private sector employee-only health premium costs in the South Atlantic states and nationally:

State	(1) Small Firms	(2) Large Firms	Overall Avg.
DE	$8,458	$8,008	$8,090
DC	$6,787	$7,466	$7,338
FL	$7,147	$6,694	$6,763
GA	$6,643	$6,905	$6,873
MD	$6,672	$7,189	$7,104
NC	$6,468	$6,855	$6,793
SC	$7,376	$6,534	$6,691
VA	$6,979	$6,737	$6,776
WV	$7,361	$6,995	$7,059
U.S.	$6,920	$6,983	$6,972

(1) fewer than 50 employees

(2) 50 or more employees

Source:  Medical Expenditure Panel Survey  Table II.C.1 - Average total single premium (in dollars) per enrolled employee at private-sector establishments that offer health insurance by firm size and State: United States, 2019