Austin Frakt, Lisa Iezzoni and Steven Pizer

Among U.S. adults age 25 to 61, rates of lacking health insurance vary widely by region and income level, according to a recent publication in Health Affairs by Steven Pizer and Austin Frakt (Health Care Financing and Economics, U.S. Department of Veterans Affairs, Boston) and Lisa Iezzoni (Mongan Institute for Health Policy). With R01 funding from the Agency for Health Care Research and Quality (Dr. Iezzoni, PI), the researchers used data from the 2000-2005 Medical Expenditure Panel Survey to explore health insurance coverage among different subgroups of working-age adults.

Overall uninsurance rates varied geographically, from 10.3% in the Northeast to 18.3% in the South. This pattern held for different population subgroups. Among persons reporting disabilities, 15.9% of those living in the South lacked health insurance, compared with only 5.0% in the Northeast. Regional discrepancies were especially wide for persons with incomes < 125% of the federal poverty level (FPL). Among these low-income persons who reported no disability or health conditions, 52.3% of southern residents lacked health insurance, compared with 27.4% in the Northeast, 37.6% in the Midwest, and 41.6% in the West. Among persons with incomes < 125% FPL who reported disabilities, 21.5% in the South were uninsured, compared with 4.6% in the Northeast. The subgroup with the highest rate of uninsurance – at 56.0% in 2005 – was persons with incomes < 125% FPL , who reported no disabilities or health conditions, and who did not fall into one of Medicaid’s several eligibility categories.

The researchers identified two large and growing gaps in the public health insurance programs that mean to serve as the nation’s “safety net.” The first involved regional discrepancies, with high rates of uninsurance in the South and much lower rates in the Northeast. The second related to eligibility for Medicaid: among those who were poor, but did not meet categorical Medicaid requirements. Given current economic conditions, the size of this latter population has likely grown substantially since 2005, the final year of the study data. These findings hold implications for health reform strategies that are currently on the table, specifically proposals to eliminate Medicaid’s categorical eligibility standards and open the program to persons based only on low income with consistent income targets nationwide.

More information is available in: SD Pizer, AB Frakt, LI Iezzoni. Uninsured adults with chronic conditions or disabilities: Gaps in Public Insurance Programs. Health Affairs. 2009; 28(6):w1141-1150, epublication October 20, 2009.