Po' White South: Another Look At The Uninsured

The Urban Institute has put together a series of policy briefs that take a close look at what health reform will mean for the millions of Americans who are uninsured. Their series of four reports are here. I base the rest of my post on their numbers and breakouts on the uninsured. In turn, they cite their numbers as coming from the Census Bureau's Current Population Survey.

My goal with this post is not to explore what reform means for the uninsured. Rather, it's to define the problem at baseline. My experience with most of these matters (e.g., uninsurance, welfare, government programs, etc.) is that people's factual understanding of the problem is rather lacking, and as a result their beliefs and opinions are colored heavily by stereotypes and biases that can be quite powerful. I'm not out to "convince" anyone of anything through this post. I don't think that's necessary or even possible. On the contrary, my goal is to present information on the 43.9 million uninsured--who they are--and ask some questions that I think are worth reflecting upon. Now, without further ado, here we go...

The first point that often comes up in the discussion of the uninsured deals with immigration status. I often hear things that range from the more passively inquisitive "How many of the uninsured are actually U.S. citizens?" to the hatefully bigoted "Those damned illegals don't deserve to be covered!" Here's the breakdown:
As you can see, the overwhelming majority of the uninsured residing in the United States are, in fact, U.S. citizens. What's more, none of the major health reforms would provide coverage for non-citizens beyond that which currently exists today. The remaining figures, therefore, are based only on the 37.8 million uninsured who are U.S. citizens.

Many people want to know who the uninsured are -- that is, what kind of people are we talking about? Are they predominantly children? Parents? Childless adults? More specifically, where do they fall in age? These questions are especially important given that our two government health insurance programs are highly targeted in nature. Medicaid is a program for low-income persons, but only specific kinds of low-income persons (e.g., pregnant mothers, children, and parents in some states). In no state does Medicaid offer coverage for low-income childless adults. It doesn't matter how poor they are. Then there's Medicare, which provides coverage for the elderly (age 65+) and the disabled. So, it can be important to see how many uninsured persons there are in the age group just under age 65. If many of them are uninsured, it might suggest that Medicare eligibility should be extended to younger persons (e.g., early retirees). Here are two charts showing this information:

From these charts, it's abundantly clear that most of the uninsured are childless adults, which is not surprising, since they are not eligible for existing programs. Beyond that, the age breakdown is pretty evenly distributed, suggesting that there's no simple incremental solution to fix the problem.

Another interesting variable to look at is region of the country where the uninsured reside. As the following graph shows, no region is immune, but the south takes the biggest hit:
The real question in all of this, though, is what being uninsured means for health outcomes. The results shown below may surprise you initially. Hopefully, my discussion will clarify some things for you that will cause it to all make sense. Here it is:
More than a quarter of respondents report being in excellent health, and in fact an overwhelming majority indicate that they are in good health or better. But if lacking insurance means you can't get to a doctor as often as you ought, shouldn't your health status suffer? The answer is yes, and it does. Keep in mind that these figures include a sizeable number of children and young adults. The simple truth is that younger persons are generally healthy and have not yet had as many chances for their lack of health insurance to fail them.

So, here's the big takeaway: The overwhelming majority of uninsured U.S. residents are adult American citizens without children living in the south with moderately good health status. Oh, and one more thing: They're predominantly white. I didn't make a slide for that, but just trust me. The reason behind that is simple: There are many more white people in the U.S. than there are other persons of any other single race. So, the po' white south makes up most of the uninsured. Chew on that for a while. Then ask yourself where the strongest opposition to health reform comes from (hint: it's red states) and contemplate how much sense that makes.

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Comments

[Freesia2]

There's a reason why the Republicans have devoted the last 3 decades to demonizing education, stripping its funding and with a furl of a flag and jingle of jingo here and there are then able to get these people to praise them for it. They actually are not only proud of, but downright grateful that they weren't "stupid" enough to get smart.

Do I paint them this way with a broad brush? Yes. There are intelligent people in the south, not just organically but by efforts. They actually do try. They read a newspaper rather than a propaganda rag, they check different news sources and channels, they did their best in school and encourage their children to do the same.But the norm is what I described above and I know this because I am very familiar with the rural south - the citizens as well as the Republican leadership style that has done this to them.

It is no surprise that they are what they are. It doesn't have to be that way, but as long as they keep swinging that lever to the R candidate,it probably always will be.

[janeycat]

yes i have experienced it too.....i have tried to tell people and they just look at me....
most people i talk to don't know or don't keep up with politics..... but will say they are repubes...
As the comedian says " you can't fix stu.pid "

[Freesia2]

Aye. It's depressing isn't it? But that Republican label seems be stamped on at birth in the southern states with the bright red counties and bless 'em - they just won't peel it off. Or at the very least demand that their own party clean it up and offer them more.

[Lowell Thompson - Huffpost Blogger]

Brad,

Nice try, but you're confusing most po' "white" folks with facts they don't want to hear...and their exploiters (LImbaugh, Gingrich, Armey, Buchannan, Beck, Murdoch, etc.) don't want them to know.

And after all these centuries of being pimped by their wealthy "white" leaders, they have no point of reference other than the myths, lies, half truths and bs they've been fed.

But I applaud your efforts. Who knows, maybe a few will start connecting the dots.

http://buythecover.

[MOCONSERVATIVE]

Nice jab, Lowell, but I'm not pimped by anyone, unlike the welfare class that libs intentionally perpetuate, so they can be led to the polls by their noses and told who will give them the most free cheese. I don't have any problem getting to sleep at night, because I'm not using anyone or being used.

[DannyDanson]

You don't know your being used, there's no conservative party in this country, and there are millions whom you would claim have "liberal" opinions when it comes to social issues, and yet live there lives within a manner that you would consider conservative. You would be surprize by the number of Republican voting welfare recipients out there, but it's convenient to assume that they are all voting democratic. When those oblivious "pimped" voters who are too proud to use the medicaid system, and get sick, guess would pays, us liberals and conservative alike, this article deals in facts, so if they offend you it's symptomatic of a problem with a thought process, if the south has the most number of uninsured citizens, and they just happen to be white, then there's only so much you can deduce from that since we know the south definition of RED country.

1.) That there are individuals here who state and vote as if they are against public assistance, and in their pride are costing the healthcare system,

2.) By doing so they are hurting the working class of the south and the nation, out of fear that using the services that they paid for is what makes them terrible "liberals" (whatever the heck that's supposed to mean)

3.) The only people actually benefitting from there self-destructive principles are those who want sky-rocketing cost, and underregulated business

if it walks, talks and looks like it's getting pimped??.....Guess what?

[passthesewords]

MOCONSERVATIVE, facts are fun. When conservatives speak of welfare, the first thought is Welfare Queens (people of color), Reagan used that pretty effectively. But the,facts and factoids are simple, just as Mr. Wright stated about the un-insured the (Po white folks).
There are MORE white people on welfare in America, because there are MORE white people in America (stats). CNN always ran down the street to Atlanta, New Orleans & Harlem to do welfare scenes and stories with a lot of black folks in lines. But you never saw welfare offices in Idaho, Montana, Utah, South & North Dakota, MN or Iowa for example. Example: 250mm whites w/10% on welfare = 25mm whites folks on welfare. Whereas,, 20% of 30mm (blacks) on welfare is just 6mm people. Stats;20% is higher than 10% sometimes, but not always, if you are smart.

[overd0g1]

I applaud them. They aren't voting to steal from their countrymen so they can get free goodies. Refreshing.

[MajorKong]

Great! Then I guess you won't mind if we take back the TVA?

[Freesia2]

Oh. Good one.

[MOCONSERVATIVE]

So get a clue. We don't want big government at any price. Progressives act like this agenda is to help others, when its nothing but a power grab. If the people you are purporting to help don't want your assistance, then why do you keep trying to force your agenda down our throats?

Sincerely,

Member of the Po' White South

[D. Brad Wright - Huffpost Blogger]

For the record, I am a born and raised southerner. I got into the world of health policy after first wanting to become a charitable physician and then having second thoughts about my ability to help as many people as I wanted while still feeding my family. I have relatives who are wealthy and privately insured, relatives who are low-income, elderly, and/or disabled who are on Medicaid, Medicare, or both, and still other relatives who are uninsured. On top of that, I grew up with poverty and poor health all around me. That life experience was the primary motivation for my getting into the field that I am in. For me, it IS all about helping people. And for me, it unites my Christian faith and desire to serve others with my career. If Republicans don't want "big government" then what the hell was the deficit and debt under "W" about? If Republicans are anti-government, then why are they so quick to want to be in charge of it? Just so they can vote themselves out a job? Get real. I got into this line of work to help people, but when I encounter attitudes like yours, I find it very hard not to throw up my hands and say "Fine. Eff it. And you'd better hope you or your family never, ever, get sick." Because we can do nothing now, and it WILL all come falling down. I'll bet it all on that.

[MOCONSERVATIVE]

Glad you could go for the low hanging fruit, Brad, by bringing up W. Typical liberal response and assumptions. GWB was as far from conservative as you can get, and I diagreed with the vast majority of his decisions loudly and long.

As far as your assistance goes, the faster you say "Eff it", the better off we'll all be. Thanks for your concern.

[Freesia2]

"If Republicans are anti-government, then why are they so quick to want to be in charge of it?"

Thank you for that. It always sticks in my craw. I wish they'd prove their point, pack up their toys elephants and autographed photos of Reagan and just go home. It would validate that specious battle cry.

[gman1232]

To quote you Moconservative:
" If the people you are purporting to help don't want your assistance, then why do you keep trying to force your agenda down our throats?"
I would argue on your definition of what "force" or "forcing" is. However, if you're that unaware let me let me fill you in. Our govt spends only more on national defense and the military than it does healthcare. The effort for healthcare reform is to make it more affordable AND to bring down costs overall. And the CBO's findings stated that costs would come down over a 10 year period...I don't about you, but whenever I can get my govt to spend less I'm for it especially when it has so many benefits. You're too hung up on "those liberals" and "progressives" in order to see the real benefit. It's not you vs. them sir...or right vs left as you're so quick to point out govt cheese in your stereotype.

[MOCONSERVATIVE]

And you believe the CBO, just like people like you believed the estimates on what social security, medicare, welfare and every other entitlement program that has come down the pike would cost. All of them now BROKE, but crutches we will forever be dependent upon.

If anyone can show me a working model of an ideal health care system that is fiscally sound, and what it has in common with this junk bill congress just passed, I would possibly jump on board.

[Carl Caroli]

Unfortunately those in the poor white south are also some of the most ignorant, fearful, biased and easily manipulated by the republican party. Don't forget many still like flying the confederate flag, still haven't thoroughly accepted northerners, integration, still favor capital punishment, hate immigrants, and many can't accept Obama as president.

[janeycat]

how true....and it makes me ashamed of them all...... they are poor in every way and have to much pride to admit it...so they fake their way through life not wanting people to know how poor they are...
have seen it all my life.....take their self into bankruptcy trying to keep up with the jones and have it all..... then get sick or have a accident with no health care....
they have brought this on their selves believing the repubes every word....
it's crazy that we are a red state.... TN

[LatteLibertine]

There is no doubt the Republicans have consistently motivated these people to vote against their own best interests on many levels.

[babaann]

Its the Propaganda Ministry.

[Xarnego]

On many different levels...

Manipulation by appeals to tribal identity is a big way in which they do it...

As far as I can tell "christian" in the deep south is a code word for white, you will never hear whites refer to Blacks or Latinos as Christians...

[dsws]

"The overwhelming majority of uninsured U.S. residents are adult American citizens without children living in the south with moderately good health status."

Not true, according to the pie charts: southerners aren't even a majority of uninsured, let alone the overwhelming majority. And when you narrow it down a little then narrow it down a little again, by restricting it to the most numerous single category on each criterion, you're going to end up way short of a majority. Think of it this way: most of the time when you roll a die, you don't roll a six. But most of the time if you roll five dice (analogous to the five different criteria of region, age, parenthood, citizenship, and health status), you'll get a six on at least one of them. (Specifically, a set of rolls with no sixes will come up about 40% of the time.)

[frankel1205]

I grew up in the South in one of the poorest counties in the nation. The overwhelming majority of people are very poor and uneducated. But the overriding social and cultural force is Christian fundamentalism.
The people are like sheep when it comes to doing whatever the preacher says to do. The preachers continue to tell the people to vote for Republicans because of abortion, gay rights, and too much "big government"(which is code for ANY government or public institutions at all.) The rest of the country will have to pull the white, rural South---who will be kicking, fighting, and screaming all the way---into the future and into progress.

[Xarnego]

So true,

The GOP affiliated "religious" groups such as focus on the family or TBN run "christian" radio & TV stations which are basically 24 hour beg-a_thons for the GOP agenda.

The GOP message is either pushed from the pulpit or informally before and after. Not one of their churches or media stations have lost their tax exempt status, yet Rove went out of his way to yank the 501C from under an church in California for opposing Bush in 2004...

[Xarnego]

Oh, and fanned!

[tristang]

You overlook something that leftists and liberals never, ever, understand.

"poor white" people, as a whole (there are always exceptions) don't always want something just given to them.

They want to work for it. They don't want government handouts. We want to earn our job, our wages, and we want to EARN our benefits. We DON'T WANT the government "to take care of us" without having to work for it.

You just can't get that through your head, can you? You EXPECT that we should be beggers in line pleading the government to come save us.


Hard working people don't want a government option. It's just one more piece of the lazy solution we seem to favor these days. Heaven forbid you do something to earn privileges!

I'll glady take the poor house over being given something because someone feels sorry for me. That way when I do fight my way back, when I do finally get what I have been working towards, I will feel all the better for it!

[COPerez]

You overlook something that "rightists" and "conservatives" never, ever, understand.

Nobody's trying to "give" you anthing. We'll ALL pay for it through taxes and premiums; healthcare is MORE important than things like roads, parks, police, fire protection, etc. Yet these other things are paid for by all of us without regard for who actually uses them. And in fact there are very good arguments that the rich disproportionally benefit more from the stable society provided by those things, but you won't hear anyone complaining about "socialized" roads, police or fire departments.

Besides which; ALL of society benefits when ALL citizens are healthy. We can all stay at work, kids can stay at school, fewer people are spreading their germs at work when they can't afford to go to the doctor, etc., etc.

We'll ALL earn our healthcare when - hopefull not too far in the future - we get REAL health reform: universal coverage.

[MOCONSERVATIVE]

You overlook something that lefties never, ever understand.

The VAST MAJORITY AGREES on government having limited roles in our lives such as roads, parks, poplice, fire protection, etc.

[stefiz]

fanned!

[Xarnego]

Fanned!
Co-sign!

After all, most of these folks still see Civil Rights as an intrusion into State's Rights, so much so, that Bush and Rove had to call in favors to get provisions of it extended in 2006 when the GOP still controlled the congress.

[NCScientist]

Tristang,

You make a fair point, and I understand. Have you managed to read Joe Bageant's 'Deer Hunting With Jesus'? It explores what you are talking about (Bageant is a Southerner, and a progressive). I recommend this book to everyone on this site.

[HalfBakedSushi]

There's more to this issue than hard working vs. lazy. Sad that you still don't see that.

[sheepherder]

tristang,

Feel free to explain why all the states at the top of the list for receiving more in federal funding than they pay in income taxes is filled with Southern and Midwest (red) states. I'm a liberal and that's something I can't understand. If you're so concerned with "government handouts" you could go a long way to convince people of your convictions by spending your time lobbying your congressional reps to STOP freeloading off the rest of the country instead of sounding ignorant on HuffPo. Why not have the red states set an example by only taking equal to or less than what you pay in in taxes like pretty much all the blue states do?

[brabc1]

The midwest is not red.

[mommamia526]

Tristang, I must continue here, too many words! So, there you are, Still the same guy you always were. You do not want anything for free and no handouts. BUT, if you are not wealthy to begin with, and even poor, scraping by from month to month, can not get a job, or healthcare after your accident, what will happen? Will you go on welfare, foodstamps and free handouts for life? Can you even get that? And if not, are you going to live in your car? Under a bridge? Have you seen those people? The new healthcare insurance program will make it possible for you to keep working, to keep paying your insurance bill each month, not to have to take handouts, and with the public option this will even continue if the insurer will no longer insure you. It is NOT A HANDOUT, and it IS NOT FREE. YOU WILL BE WORKING FOR IT. It just will cost less, and it will keep you working. Working, Tristang, earning a paycheck.

[epotruchyeahright]

tristang -- big fail here in your post. The government health-care plan is not a giveaway. It's NOT FREE. Those who are going to get it, for the most part, will pay premiums for it.

[kendraro]

Thank you for this. As a poor white southerner I have seen a lot of suffering because of lack of health insurance - particularly in the mental health realm. It is going to take a long time to get to where we need to be with that. The wasted potential is what gets to me.

[CRMurray]

So true. Mental health is overlooked way too much and usually is only paid attention to after a tragedy.

[brabc1]

What gets me is how gullible southerners must be to believe preachers who tell them to vote against their own self interests. I thought the south changed, but it is so obvious that they have not.

[happytrails]

IF your facts are believable, that is the very best reason to defeat the Health Care Bill.

[brabc1]

Why?

[ColumbiaPatricia]

Not surprisingly, Republican John McCain kept South Carolina in the GOP column in 2008, clinching 53.87% of the vote over
Democrat Barack Obama who received 44.90%, an 8.97-percent margin of victory

***44.90% of the people of South Carolina voted for Obama - proof that a lot of poor whites are not doing what they are told. ***

[lexkw]

Many of these 'poor whites' that so many of you think are dumb, are actually brilliant when it comes to manipulating the government systems and getting by without working a day in their lives. Those of us living among them know very well what will happen with government provided health care. The lines will be endless, faked symptoms to get drugs that can be re-sold for profit, and many other schemes the likes of which you've never seen. This already happens with the government programs in place now and it will get 10x worse.

[flatus]

Instead of complaining about government, which is misguided, direct your energies to fixing the fraud, corruption, and waste in government which, I think, is what is probably really bothering you.

[janejoad]

I agree with you. I just happen to know someone, whom I had not seen in years. Boy was I shocked, not only at her appearance (she had aged considerably and badly), but that she had gotten hooked on Viocodin, had a child at 38 (her 3rd) with a guy who is long gone and pays NO child support, and she stopped working and lives on SSI and Welfare. This is a person who had a job at the school for 10 years and was doing good, until her divorce from her 1st husband of 17 years and Viocodin addiction (she is now on Methadone with is paid for with Medical). Now she tells me she still gets the pills (but only to sell) and it helps make up the difference of what was cut from her benefits. Of course I get outraged and tell her that somebody has to go to work everyday for you to do this.......she doesn't get it. To her the government is "they" as in, "they cut me welfare" or "they cut my food stamps". I can't stand to talk to her anymore. You know that saying "be careful what you wish for"?, it's true, It cured me from the new trend of looking up old friends on the internet...there's the phone now and it's her.......­..........­...

[mommamia526]

Well, of course this should not happen, and it WILL not happen if, when we know this, we pressure those persons to change their ways and tell them that we will inform authorities. But with the healthcare overhaul it will be more difficult to say that you can not get hired, if there is employment available. I know, not firsthand, because it never happened to me or any familymember, that when I lived in The Netherlands, where there has been a functioning insurance system, that if you did not show up for work, a doctor came to visit you to check how sick you actually were. If you were unemployed you had to register for employment and take a job. I think that is how it worked. There is all sorts of fraud, sometimes it is billing. I go after it. Always get itemized bills, or I will not pay. Keep all my bills with cancelled checks together and extra copies, etc. So, I guess this will be our next project: help stamp out fraud and profiteurs. It will reduce our taxes and bills.

[motoGpifupleez]

To his grand credit, Republican Governor Bob Riley of Alabama attempted to raise the intellectual level of the state with his "Tax and Accountability" plan.
He even framed it in the context that Jesus would want this.
He failed mightily. The people issued a resounding rebuke of the idea, thus insuring that Alabama would remain at the bottom of the barrel.
Governor Riley responded by saying "the people have spoken, I will never try this again".
It is beyond amusing that these people are suddenly concerned about "passing on deficits to our children and grandchildren" after they so resoundingly showed their willingness to deliberately keep their children and grandchildren in ignorance.
Consistently voting against your own economic and physical health interests is a direct result of low intellect being manipulated by effective propaganda.

[Indra]

Most white people in southern states do not appear to be very bright to me. Of course I am biased as I am a yankee. I don't even travel down there below the country's waist as I find it repulsive.

[lexkw]

Spoken as another great example of the tolerant left.

[COPerez]

I grew up in Florida, spent a fair bit of time in the military in Georgia, Alabama, Kentucky and then later in business in North Carolina and Texas.

While I'd say "repulsive" might be a bit strong, I have to agree with Indra as far as the typical Southerner's intellectual curiosity. I have no desire to live down there again.

[tnmntgrl]

EXACTLY!!!

[NCScientist]

Indra,

Your comment is not helpful. I am a Canadian (with Scottish parents) who has lived in the South for 10 years. I am a teacher of High School science. I am well aware of the shortcomings of my region (as I was in other regions of the world where I have lived). I can tell you this, however: Young people of the South are as sensitive and intelligent as anywhere I have been...we have the good, and the bad. There are historic and cultural reasons (mainly insularity- which leads to many of the other ills) as to why there are some portions of the South that lag behind the rest of the nation. I am a very progressive person. I work here, 'in the trenches' as it were. I wouldn't have it any other way. Things here ARE changing- and faster than many of you believe. Let's live our values and reach out to help our Southern brothers and sisters, even if- especially if- they occasionally bite our hands and/or don't understand our motives.

[AnimalLover6]

You're a Canadian. Ten years in the South hardly gives you the historical context to understand a region of the United States.

[brabc1]

I would never last in the south. They have weird views about women too.

[mommamia526]

Well, Indra, you may be mistaken. Kemmons Wilson, who founded Holiday Inns was a southerner. If you spoke to him, and you came from Europe, or from the North, you might not think much of him. He was very low key, and on purpose. You see, if you do that, you get all sorts of information which will be very useful. It is a specific southern way of making a fool of those who think they are superior, because they speak rapidly. Kemmons Wilson had a card system, on which he noted all sorts of info about you, even the name of your dog and cat, your wife, your kids, and grandma. Next time you'd meet him, he was the same ol' good ol' boy, a little slow on the uptake (:)), but he did *remember* all those things you told him and asked about your dog molly, your grandma, and how the wife and kids were doing. Did Jimmy pass that bar exam? He was your very best friend, and he cared about you. He also cared about closing that sale. In fact, he was rather goal oriiented on closing that sale.

[mommamia526]

In fact, Indra, I have a grandson, and frankly, he did not appear to be interested in much, except hanging out, playing, having fun and seeing friends. I tried very hard teaching him math tricks, and all sorts of other stuff. I have lived in the South since 1969. It bored him, he said. I talked to him and his eyes glazed over! It was boring to him, he said. But, surprisingly, he speaks Spanish, English and Chinese (Mandarin) fluently, has an BBA and will get a MBA, studied in China this year, and still uses the math tricks that appeared to go in one ear and out another. His fiancee also has a MBA. Like everyone else in the family, he worked his way through high school and College. He comes in very handy to me, his grandma. He fixes my computeer , long distance, a.o. In fact all the other familymembers in the same age bracket, are all professionals and degreed, but you would never know it. Watch out for Southerners, Indra.