New "Small Area" Data From Census Reveal Wide Fluctuations in Insurance Coverage

The U.S. Census Bureau released a report last week that includes the latest figures on the number of uninsured in each county, of each state. It’s an exhaustive breakdown that highlights the wide fluctuations both between states and among individual localities. At 26.8%, Texas has the highest rate of uninsured residents under 65 in the nation—there are a whopping 6.1 million uninsured residing there. New Mexico (26.7% ) and Florida (24.2%) round out the top three. The state with the fewest uninsured residents is, not surprisingly, Massachusetts (7.8%) where the state mandates health coverage for most residents. These figures, which are from 2007 “do not include the impact on millions of people who lost their jobs and health insurance after the recession began in December 2007,” according to this piece in The Washington Post, so are likely to underestimate the problem.

According to this report, the Census Bureau puts the percentage of people without health insurance nationally at 15.3 percent in 2007. But there are fascinating outliers that highlight key problems in our current health care system. For example, in Florida, De Soto county (located inland in the central part of the state) 37% of residents lack insurance. In Culberson County, Texas, with just 2300 residents  (almost all designated as “White,” with a median household income of $30,000), some 42.6% are uninsured. Lower-income Hispanics fair poorly in most states; in Florida almost 55% of Hispanic residents earning 200% or below the poverty level are uninsured. How many of these residents are here legally and not able to access Medicaid or other programs because they haven’t lived here for more than 5 years? Delving deeper into what specific issues are impacting localities like these and other pockets of high numbers of uninsured could be very illuminating in crafting regional health policy.

For those who like to really sink their teeth into data, this Census report is a good companion to The Commonwealth Fund’s “state scorecard” that assesses how well states perform on 38 benchmark indicators of access, quality, costs, and health outcomes. The scorecard contains a wealth of data—including how many more state residents would be insured, how much money would be saved on hospital readmissions and finally, how many lives would be saved if any given state performed at benchmark levels. Also, you can use the scorecard (along with the new Census figures) to get an idea of the “equity gap”—a way of comparing how well the health care system functions for people based on their income level, health insurance status, and race/ethnicity.

Just a quick observation: There are now 19 states whose attorney generals have filed suit to block implementation of the individual mandate and other provisions of federal health reform. All but one of these attorney generals is Republican, so the impetus is clearly political. And in places like Idaho and Utah that score relatively high on insurance coverage, the general culture of opposition to federal mandates overrides any benefits of the legislation. But a quick search of the Census and Commonwealth data show that some of the resistant states have poorly performing health care systems in place that would greatly benefit from the Patient Protection and Affordable Care Act: 

Alabama (#40 on Commonwealth’s scorecard)
Florida (24.2% of residents are uninsured,  #44 on the scorecard)
Louisiana (22.8% uninsured, #49 on the scorecard
South Carolina (18.2% uninsured, #33 on the scorecard)
Texas (26.8% uninsured, #46 on scorecard)

For those who take the time to dig into these data, there are many insights and conclusions that can be made from the new Small Area Health Insurance Estimates from the Census. It’s probably best summed up in the latest version of Commonwealth’s scorecard, published in October 2009; “where you live within the United States makes a difference in your access to care, quality of care, and experiences with care providers.” As we begin to implement the provisions of the Affordable Care Act, we would do well to recognize the differences in pressing health care issues between states, and even within regions of states. This legislation is broad, but the devil will be in the details.

Comments

[Bill Bishop]

Here's a map of the rural counties and their health insurance rates -- and a list of the 50 counties with the highest percentage of residents with health insurance: http://www.dailyyonder.com/health-insurance-it-depends-where-you-live/2010/08/03/2872