Uninsurance rates vary among states by a factor of roughly two for low income populations and about three for non-elderly populations as a whole. While variation in state health insurance coverage may reflect state political preferences, it also affects people as Americans and thus raises national policy concerns. Variation in employer sponsored insurance (ESI) coverage has a direct affect on uninsurance rates and thus affects state health policy; states with low rates of ESI have huge problems to address. Public program coverage also determines uninsurance rates for low-income people. States with higher per capita incomes tend to spend more on Medicaid. States that spend more on Medicaid also have the highest levels of non-Medicaid health spending. States with high uninsurance rates have greater access problems and the greatest proportion of people in fair or poor health.