Uninsurance Rates Vary Widely Across Communities and Regions

National statistics on the uninsured have long been at the center of health care policy discussions, but what receives less attention is the substantial variation in uninsurance rates from one community to the next. Data from the Community Tracking Study's Household Survey revealed that among 12 randomly selected communities, the share of residents without health insurance ranged from 23 percent in Miami down to just 9 percent in Seattle. In 10 of the 12 communities studied, uninsurance rates diverged significantly from the 14 percent average for all metropolitan areas with populations above 200,000.

Regional Variations in Uninsurance

Regional differences in uninsurance also existed, though they were smaller than the gaps between individual communities. The Center's nationally representative survey found that uninsurance rates were lowest in the Northeast (11 percent) and Midwest (12 percent), and highest in the South (14 percent) and West (16 percent).

Within two of these four regions, the variation among the sampled communities was pronounced. Among the three Southern communities, uninsurance rates ranged from 11 percent in Greenville, South Carolina, all the way up to 23 percent in Miami. In the West, rates spanned from 9 percent in Seattle to 18 percent in Phoenix. Communities sampled from the Northeast and Midwest showed more uniform rates.

Community Characteristics and Uninsurance

Earlier research had identified several important predictors of whether individuals had health coverage. People who lacked insurance were disproportionately likely to live in families headed by workers at small firms or by the self-employed, and to have lower incomes. Hispanic Americans had markedly higher uninsurance rates than other racial or ethnic groups.

Did these same factors help explain why some communities had higher uninsurance levels than others? Although a full causal analysis was beyond the scope of this bulletin, a pattern did emerge: the three communities with the highest uninsurance rates tended to have higher poverty rates and substantially larger Hispanic populations than the three communities with the lowest rates. Miami, the community with the most uninsured residents (23 percent), also had the highest share of workers in small firms (fewer than 25 employees) or who were self-employed (40 percent). However, the variation in small-firm employment across communities was generally modest and did not correspond strongly to differences in uninsurance.

Other factors were likely at work as well, including differences in state Medicaid eligibility rules and other public programs, along with labor market characteristics such as industry composition and the prevalence of union membership among the working population.

Community-Level Data

Comparing the communities with the highest and lowest uninsurance rates highlighted the relationship between demographics and coverage gaps. Among the highest-rate communities: Miami had 23 percent uninsured (significantly different from the metropolitan average), 22 percent below the federal poverty level (significantly different), 40 percent of workers in small firms or self-employed (significantly different), and 50 percent Hispanic (significantly different). Phoenix had 18 percent uninsured (significantly different), 17 percent in poverty, 28 percent in small firms or self-employed, and 22 percent Hispanic (significantly different). Little Rock had 17 percent uninsured, 19 percent in poverty, 26 percent in small firms or self-employed, and 3 percent Hispanic (significantly different).

Among the lowest-rate communities: Syracuse had 10 percent uninsured (significantly different), 17 percent in poverty, 22 percent in small firms or self-employed (significantly different), and 3 percent Hispanic (significantly different). Lansing had 9 percent uninsured (significantly different), 11 percent in poverty (significantly different), 26 percent in small firms, and 3 percent Hispanic (significantly different). Seattle had 9 percent uninsured (significantly different), 8 percent in poverty (significantly different), 28 percent in small firms, and 6 percent Hispanic (significantly different). The metropolitan area average stood at 14 percent uninsured, 16 percent in poverty, 29 percent in small firms or self-employed, and 14 percent Hispanic.

Sources and Further Reading

This Data Bulletin presents findings from the Community Tracking Study Household Survey, a nationally representative telephone survey of the civilian, non-institutionalized population conducted in 1996 and 1997. The survey included 12 randomly selected metropolitan communities. Statistical significance is noted where site values differ from the mean for metropolitan areas with populations over 200,000.