A new study conducted by a team of researchers at the University of New Mexico suggests that success in reducing the number of uninsured in the United States requires addressing the large inequalities in health insurance coverage at the county level.
It has long been known that health insurance leads to better health and quality of life, yet researchers found that some U.S. counties are characterized by an exceptionally high rate of uninsured residents, a problem that goes largely unrecognized in traditional state-and national-level health policy analysis.
Uninsurance rates in U.S. counties ranged from 3 percent to 53 percent (the latter figure corresponding to the Louisiana parish of Tensas), the researchers say. Their study appears in this month's edition of the journal Health & Place.
The researcher found a number of predictors that impact insurance rates. Uneven economic development, differing local polices concerning access, and ideological predispositions that influence county policies on health care all emerged as conditions affecting the variation in insurance coverage.
The study, funded by the Robert Wood Johnson Foundation Center for Health Policy, is the first national research to examine multiple predictors explaining insurance coverage across all 3,112 counties in the U.S., said UNM Investigator Dr. Lisa Cacari Stone, an associate professor at the UNM Health Sciences Center Public Health Program.
"Traditionally, we have looked at the effects of health care policies made at the national and state levels," said Cacari Stone. "Examining how county-level health care decisions affect access helps us rethink the role of local governments, their political ideologies regarding reform and how that plays out at the front lines of policy implementation. Success in reducing the number of uninsured will require collaboration among the federal, state, tribal and county governments."
Using public databases from 2008 to 2012, the group's analysis suggested that poverty, unemployment, Republican voting, and percentages of Hispanic and American Indian/ Alaskan Native residents in a county were significant predictors of uninsurance rates.
In a comment today, Dr. Howard Waitzkin, distinguished professor emeritus at UNM who served as the project's co-principal investigator, drew a broader conclusion from the group's research.
"This study clearly shows the need for a uniform, single-payer national health program based on a Medicare-for-All model that would overcome local variability in access by giving everyone in the country full and equal insurance coverage for needed care," Waitzkin said.
"The Affordable Care Act is tied to state differences in policies, but these can obscure the even greater differences seen for coverage at the local level," he said.
"The ACA does not provide a consistent way of fixing the problem of local variability in coverage, whereas Medicare for All would directly resolve this very important problem."