Which Voter Has the Health Insurance?

A closer walk with the U.S. Census -- who has health care coverage, who'll benefit most from proposed reforms, and how the uninsured voted in 2008.

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In the debate over proposed health care reform, there’s been a flurry of claims as to which Americans would benefit from any changes.

The Los Angeles Times reported last week that “Wyoming, with an economy marked by farming, ranching and small businesses, has a disproportionate number of people without medical insurance. And by that measure and others, its people are among the likely winners, if Congress approves healthcare overhaul.”

Is that so? Ranching and farming play only a slightly larger role in the Wyoming’s economy than in the nation as a whole. Only three percent of the state’s total personal income comes from farm or ranch jobs, and agriculture contributes a negligible portion to Wyoming’s gross domestic product. (Over 30% of Wyoming’s gross domestic product comes from mining.)

Nor does Wyoming have a disproportionate number of people without health insurance. According to the Census Bureau’s recent surveys,  Wyoming’s rate of uninsured is LOWER than the national average — and therefore the state won’t benefit more than any other from health care reform.

The Times story, written by James Oliphant, is one of many that tries to establish a simple relationship between rural America, politics, health insurance and Congressional dickering about health care reform. The common assumption is that rural places would stand to gain the most from health care reform because the people who live in rural America are the least likely to have health care coverage. Yet we read that rural places are the most resistant to reform — as evidenced, according to Oliphant, by meetings in “small towns across America last month” where “red-faced, screaming taxpayers filled TV screens with criticism of pending health-care plans.”

But the relationships among geography, politics and health insurance aren’t so divisive and extremist as the Times and the TV screens would suggest. So show details of a very recent Census Bureau report on health insurance coverage.

The Census data reveals that cities would benefit most from any legislation that would extend health insurance to those who aren’t now covered. Nationwide, rural areas have a lower rate of uninsured residents than do urban counties. Americans who live in counties with the lowest percentages of insured residents are overwhelmingly urban. 

(By the way, there has been considerable “red-faced screaming” in cities, too. One of the first confrontational town hall sessions took place in very urban and very Democratic Austin, Texas, and six people were arrested outside a town hall forum in St. Louis.)

Photo at left: Los Angeles Times; at right, Joel Page, AP
Equal opportunity for activists: opponents of the Obama health plan (left) demonstrated in Denver August 7; supporters of the Obama plan rallied in New Hampshire the following week.


Secondly, exurban areas — the faster-growing counties located between metro and rural America — are really the communities that have the least to gain from any reform, because suburban residents  are the most likely to have health insurance now. (See the chart below.)

Third, in places with higher rates of uninsured residents, there tends also to be a higher rate of Republican voting, as measured by the ballots cast in the 2008 presidential election. This relationship is strongest in rural America. Rural counties with the highest rates of uninsured residents voted in landslides for John McCain. (See chart at top.)

Fourth, rates of health care coverage vary dramatically from state to state, especially for rural residents. In Minnesota, 89.7% of rural residents under 65 have health insurance. In rural New Mexico, however, only 72.5% of people under 65 have some form of health care coverage. (Citizens age 65 and over were excluded from the Census report, as they are eligible for Medicare.)

Daily Yonder
Again, when we divided the population into fifths (or quintiles), we found that those living in the counties with the least health insurance were also the most urban. And the least exurban.

The national press has, for the most part, missed the facts and the variations in health insurance rates across rural America. The New York Times editorial page continues to describe as “unrepresentative” the so-called “group of six” on the Senate Finance Committee that is negotiating a reform bill. The reason these six senators — three Republicans and three Democrats — don’t represent the nation as a whole, according to a Times editorial Sunday, is because they “hail from largely rural states with small populations, namely Iowa, Maine, Montana, New Mexico, North Dakota and Wyoming.”

In terms of their health insurance coverage, however, these states are entirely representative. Iowa, Maine, North Dakota and Wyoming are better insured than the national average.  Montana and New Mexico are below average, with New Mexico having the highest rate of uninsured residents among the 50 states.

 

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