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D. Brad Wright Headshot

Po' White South: Another Look At The Uninsured

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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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