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Where do uninsured Americans live?

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Providing affordable health care has been a hot-button political issue for decades. Many Americans could not afford costs for regular checkups and other preventive health options because they didn’t have health insurance. The lack of insurance became increasingly critical as uninsured patients jammed emergency rooms and clinics. These facilities absorbed the extra cost of treatment, stretching already-strained budgets and increasing health insurance costs for others. According to the U.S. Census Bureau’s Small Area Health Insurance Program, 17.2% of Americans did not have health insurance in 2010. That figure was much lower for those younger than age 19 at just 8.45%. Hispanics had the highest percentage of those without health insurance. In 2010, 32.5% of Hispanics did not have health insurance.

A goal of the new health care initiative was to provide affordable health insurance for everyone. When the Affordable Care Act was passed in March 2010, health insurance was to be made available to every American. Provisions of the law will continue to be enacted in the next several years. Where do the uninsured live? Where and how does the government need to focus its marketing efforts for the Affordable Care Act? A goal is to ensure that Americans are fully informed about the provisions of this new law. These changes also provide numerous opportunities for companies in the health care industry.

Where are uninsured Americans?

People without health insurance live everywhere in the U.S. At 26.3%, Texas has the highest percentage of those without insurance. Florida follows at 25.3% and Nevada at 25.1%. In each of these states, at least 25% of the population is Hispanic. As noted above, Hispanics have a higher rate of uninsured than the average U.S. population.

Massachusetts has the lowest percentage of uninsured Americans at only 5.2%. State law mandates that nearly every resident of Massachusetts must obtain a state-government-regulated minimum level of health care insurance coverage. The law also provides free health care insurance for residents who earn less than 150% of the federal poverty level. The Massachusetts law, passed in 2006, is the basis for much of the Affordable Care Act.

At the county level, more than 41% of the population in Hudspeth County, Texas, and Aleutians East Borough, Alaska, is uninsured — the nation’s highest rates. However, reasons for the high uninsured rate in each county were very different. In 2010, the unemployment rate in Hudspeth County was relatively low at 6.2%, but the median income was approximately half of the U.S. median income. Conversely, Aleutians East Borough has a relatively high unemployment rate of 10.5% in 2010, but its median income was comparable to the U.S. median.

Explore the uninsured rates by state and county in this interactive map:

Click on image to navigate interactive map.

Uninsured people under age 19

It is critical that children have access to health care. Although a higher percentage of adults don’t have health care than children, many children are not covered by health insurance during their developmental years. At 17.8%, Nevada has the nation’s highest percentage of uninsured children, followed by Texas (15.3%), and Florida (13.4%). This trend follows closely the number of all uninsured Americans.

Counties with the highest rates of uninsured children are Garfield County, Mont. (40.1%), Esmeralda County, Nev. (33.3%), and Petroleum County, Mont. (31.2%). Each of these counties has very small populations; Garfield County has the largest — just 1,206 people. Although the unemployment rates are relatively low in these three counties and median incomes are just slightly below the U.S. figure, many people still do not have medical insurance coverage. This may be because many work in industries such as agriculture that may not provide medical insurance to employees.

Explore this interactive map to find the percentage of uninsured Americans under the age of 19:

Click on image to navigate interactive map.

Health insurance costs

Cost is a major reason why people don’t buy health insurance. Although they want it, many families and individuals simply cannot afford it, so they gamble on good health and remain uninsured. According to Esri, the average household spends about $2,350 per year on health insurance. This amount varies greatly by family composition, individual health conditions, employer contributions and location. Some households may have low insurance costs because employers pay for much of the benefit.

Households in ZIP codes 10514 (Chappaqua, N.Y.), 22066 (Great Falls, Va.), 60022 (Glencoe, Ill.), and 94027 (Atherton, Calif.), pay three times what the average American household pays for health insurance. All of these ZIP codes have affluent households.

Click on image to enlarge map.

Who might pay the most for health insurance? Esri has developed the Tapestry Segmentation system that classifies U.S. residential neighborhoods into 65 unique market segments based on socioeconomic and demographic characteristics.

On average, residents of Connoisseurs, Suburban Splendor and Top Rung neighborhoods, pay at least 1.5 times more in health insurance than the average American household. All three of these Tapestry segments include wealthy households.

Connoisseurs neighborhoods tend to be older, affluent, established and slow-growing. Residents are well‐educated and have a median age of 47.7 years. Although they’re closer to retirement than child-rearing, many of these married couples have children who still live at home. They have a median household income of $123,663 and supplement their salaries with income from interest, dividends and rental properties.

Suburban Splendor residents are successful suburbanites. They have a median household income of $116,617. Most are two-income, married-couple families with or without children. With a median age of 43.4 years, they’re well educated and have good jobs.

Top Rung neighborhoods are the wealthiest. Their median household income of $173,172 is more than three times higher than that of the U.S. median. These residents are married couples with and without children, highly educated and in their peak earning years of age 45-64.

Residents of City Commons and Dorms to Diplomas neighborhoods pay the least for health insurance. On average, they pay about half what at the average American household pays. Both of these segments have young residents.

Found primarily in large Southern and Midwestern metropolitan areas, residents of City Commons neighborhoods are young, single or single parents, and most likely, unemployed, or work part‐time. They have a median household income is $15,831 and a median age is 26.7 years. Some residents may not be able to afford health insurance. Younger residents may still be covered under their parent’s policies.

Most residents in Dorms to Diplomas communities are focused on their education; approximately 81% are enrolled in college and graduate school. Nearly three‐fourths of employed residents work part‐time in low‐paying service jobs. The median household income is $23,807 and the median age is 21.9 years. Residents may be covered under their parent’s policies are through their school tuition.

Why this matters

The Affordable Care Act will have far-reaching effects for every American as the law is implemented over the next several years. The Department of Health and Human Services must understand which communities have the highest demand for health insurance. The agency should provide these communities with information for obtaining health insurance and locating services convenient to local populations. Health care providers such as hospitals, clinics, urgent care facilities and large medical practices can use this information to expand their services into high-demand areas that may not have existed in the past.

More information about Esri’s data can be found at www.esri.com/data or to learn more about Esri in general, go to www.esri.com.

Pam Allison is a digital media, marketing strategist and location intelligence consultant. You can visit her blog at www.pamallison.com.