Despite President Barack Obama’s sweeping health care reform bill, 15.1 percent of Americans did not have health insurance in 2011, according to the U.S. Census Bureau's American Community Survey data released last week.
The map shows a clear geographic divide. The highest levels of uninsured are in the Sunbelt and West, with the some of the lowest levels in the Northeast, the mid-Atlantic, the western Great Lakes, and some northern states in the Great Plains. This is in line with my previous analysis of Gallup survey data, which identified an "uninsured belt" running across the Sunbelt and deep South.
The variation is considerable among the metros included in the ACS. In the metro with the highest share of uninsured, more than 37 percent of people are without health insurance — more than double the rate nationally — compared to just 2.8 percent in the metro with the smallest percentage. In the 50 metros covered by the ACS, more than one in five people lack health insurance.
The table below shows the 20 large metros — those with at least 1 million in population — with the greatest percentages of uninsured.
Large Metros with the Highest Rates of Uninsured, 2011
|1||Miami-Fort Lauderdale-Pompano Beach, FL||25.7%|
|2||Houston-Sugar Land-Baytown, TX||24.1%|
|3||Dallas-Fort Worth-Arlington, TX||22.3%|
|4||Las Vegas-Paradise, NV||22.3%|
|5||Los Angeles-Long Beach-Santa Ana, CA||21.2%|
|7||Riverside-San Bernardino-Ontario, CA||20.4%|
|8||San Antonio-New Braunfels, TX||19.9%|
|9||Atlanta-Sandy Springs-Marietta, GA||19.7%|
|10||Austin-Round Rock-San Marcos, TX||18.8%|
|11||Tampa-St. Petersburg-Clearwater, FL||18.1%|
|12||Oklahoma City, OK||18.0%|
|14||San Diego-Carlsbad-San Marcos, CA||17.4%|
|15||New Orleans-Metairie-Kenner, LA||16.9%|
|16||Charlotte-Gastonia-Rock Hill, NC-SC||16.6%|
|19||Salt Lake City, UT||15.9%|
Table data from 2011 American Community Survey (Full data set available at the U.S. Census Bureau's American FactFinder)
Miami has the highest share of uninsured among large metros, 25.7 percent. More than one in five people lack health insurance in six other large metros: Houston (24.1 percent), Dallas (22.3 percent), Las Vegas (22.3 percent), Los Angeles (21.2 percent), Orlando (21.1 percent), and Riverside (20.4 percent). Most of the top 20 large metros are located in the Sunbelt, and many are concentrated in only a few states: Florida and Texas both have four on the list, and California has three.
Overall, four of the top five metro areas with the highest rate of uninsured are in Texas: McAllen-Edinburg-Mission tops the list, with 37.2 percent uninsured, followed by Laredo (36.3 percent), Brownsville-Harlingen (33.6 percent), and El Paso (27.7 percent). Farmington, New Mexico takes fifth place, with 27.3 percent.
At the other end of the spectrum, the metros with the smallest share of uninsured are all in Massachusetts — Pittsfield (2.8 percent), Worcester (3.5 percent), Springfield (4.6 percent), and Boston (4.7 percent). Metros with the some of the lowest share of uninsured outside of Massachusetts include college towns like Ithaca, New York (5.4 percent), Ames, Iowa (5.7 percent), Burlington, Vermont (5.9 percent), and Ann Arbor, Michigan (6.0 percent). Among large metros, those with the smallest share of uninsured include Buffalo (7.5 percent), Hartford, Connecticut and Rochester, New York (8.0 percent each), Pittsburgh (8.4 percent), Providence (8.6 percent), and Minneapolis-St. Paul (8.9 percent).
My MPI colleague Charlotta Mellander ran a basic correlation analysis to look at the economic, demographic, and social factors that might be associated with the variation in health insurance coverage across metros. As usual, I point out that correlation does not equal causation, and other factors that we did not analyze might come into play.
Economic factors, not surprisingly, play a considerable role. The share of population without health insurance was positively correlated with the percent below the poverty line (.48), the unemployment rate (.38), and level of income inequality (.30). Conversely, it was negatively correlated with income (-.42), the share of adults that are college grads (-.37), and the share of the workforce in professional, technical and knowledge occupations (-.33).
In their earlier analysis, Gallup noted that the share of the uninsured in Texas and other states may be driven up by the "high rates of uninsured among U.S. Hispanics." Our own earlier analysis of state-level trends found a positive association as well (.36). There is an even stronger association at the metro level (.62). However, there was no association between the share of population that is black.
President Obama's healthcare reform bill sought to extend medical insurance coverage to more Americans. While it is too early to chart its ultimate effectiveness, these figures remind us how widely health insurance coverage varies across the country.