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America's Uninsured Belt

The geography of where in the U.S. people lack health insurance is striking.


As the U.S. Supreme Court readies itself to hear oral arguments over the constitutionality of the Affordable Care Act's "individual mandate," a map from Gallup shows us which states have the heaviest concentrations of people without health insurance. Nationally, 17.1 percent of Americans were uninsured in 2011. But that rate is not spread equally across the country. Indeed, there is something of an “uninsured belt” running through much of the deep south and the Sunbelt.

(Click the map for a larger image)

Despite the “economic miracle" that has sustained Texas throughout the crisis, more than one in four of its residents (27.6 percent) are uninsured – the highest percentage in the nation by far. More than one in five people are uninsured in roughly a dozen other states, including Mississippi (23.5 percent), Florida (22.9 percent), Oklahoma (22.1 percent), California (22.0 percent), and Nevada (21.9 percent).

On the other end of the spectrum, less than five percent of Massachusetts residents were uninsured last year, the lowest rate in the nation (thanks in part to Mitt Romney's advances in health-care, whether he likes to take credit for it or not). Less than 10 percent of Vermont, Hawaii, Connecticut, Minnesota, and Wisconsin residents are uninsured as well.

With the help of my Martin Prosperity Institute colleague Charlotta Mellander, I took a quick look at the economic, demographic, and political factors that might be associated with state-by-state levels of insurance coverage. As usual, I note that correlation does not imply causation; other factors may well come into play. Still, our findings are intriguing on a number of levels.

Uninsured states are significantly more religious, based on the percentage of state residents who say that religion plays an important role in their everyday life. The correlation between the two is .51.

Politics and ideology factor in as well. Conservative states (based both on the percentage of state residents who identify as conservatives (.58) and the percentage of who voted for McCain in 2008 (.60) have a higher percentage of uninsured citizens. Economics also comes into play. There is a positive correlation between the percent of a population that is uninsured and the poverty rate (.58). Blue-collar and working class states also boast a higher level of uninsured (.40). 

Not surprisingly, the share of the population that is uninsured is lower in more affluent and more highly educated states. The share of uninsured people is negatively associated with state income levels, the percentage of college grads, and the percentage of workers in professional, knowledge, and creative occupations.

Gallup notes that the share of the uninsured in Texas and other states may be driven up by the "high rate of uninsureds among U.S. Hispanics." We find a positive correlation between the two as well (.36). That said, we find no correlation between shares of uninsured populations and the percentage of foreign-born residents generally. There is no significant association between the share of uninsured and the percentage of black residents, either.

Also not surprisingly, lack of health insurance is associated both with lower levels of well-being and shorter overall life expectancy. The correlation between the share of the uninsured and well-being is negative and significant (-.33). The share of uninsured has an even bigger impact on life expectancy (where correlation is -.59). That should be reason enough to get more Americans covered by health insurance.

Photo credit: Jim Bourg / Reuters

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