COVERAGE: Mapping the Uninsured by Congressional District
The Urban Institute has an excellent new analysis of variations in insurance coverage by congressional district.
Analyzing the latest data from the American Community Survey, the Urban researchers looked at rates of private coverage, public coverage, and uninsurance for non-elderly adults (under age 65). They also examined how these rates varied with poverty, producing the fascinating maps you see above (click to open in a new window) and the following conclusions:
- Rates of private coverage are lowest in districts that have higher poverty rates, which tend to be concentrated in the South and West;
- The needs in these high-poverty districts have led many to above-average rates of public coverage;
- Despite these higher rates of public coverage, uninsurance remains most serious in districts with low rates of private coverage.
The underlying context of this analysis is to provide a clearer picture of the states and districts which will benefit the most from the passage of health reform. So let's take a look at some particularly interesting and politically relevant districts and states (NPR has an equally nifty map of the uninsured using the latest Census data):
Texas: Everything's bigger in Texas, including the ranks of the uninsured. The Lone Star state boasts the highest levels of uninsurance in the country and the disparities are even bigger within the state. Around the northern Republican suburbs of Austin, rates of non-elderly uninsured are just below the national average of 17 percent. Compare that to the 29th congressional district of Democrat Gene Green in east Houston, where the number of nonelderly without insurance (43 percent of the population, the highest of any district in the U.S.) actually outnumbers that of those with private coverage (34.9 percent)
Arkansas: The state formerly known as the land of opportunity has rates of nonelderly private coverage 10 percent below the national average. Arkansas relies heavily on programs like Medicaid and CHIP to help fill in the gaps. After the District of Columbia, the state has the highest rate of public coverage among its nonelderly population, at 23.1 percent. The state also happens to be home to some particularly influential Democrats, including Sen. Blanche Lincoln and Rep. Mike Ross. Up for reelection in 2010, Lincoln holds one of the key votes on the Senate Finance Committee and has been taking a great deal of heat on health reform. Ross, a leading Blue Dog Democrat who has balked at some Democratic ideas on health reform, represents Arkansas' 4th district where rates of private coverage for those under the age of 65 is just over 55 percent and the number of uninsured is at 22.2 percent -- the highest in the state.
Maine: The state with the second highest level of public coverage after Arkansas is Maine (22.7 percent), a state which also happens to be home another key Senator on the Finance Committee, moderate Republican Olympia Snowe. While the state has fewer uninsured than the national average, insurance is particularly expensive in Maine. Premiums are growing much faster than incomes. Today the average family plan offered by an employer in Maine costs over $13,000. By 2016, it will cost over $30,000, or close to 60 percent of the 2016 median household income in Maine.
Missouri: Congressional Republican Reps. Roy Blunt and Jo Ann Emerson represent Missouri's 7th and 8th congressional districts, respectively, along the southern border of the state. The two districts both have highs rates of uninsurance (close to 20 percent) and below average rates of private coverage. Emerson has sponsored the bipartisan health reform bills such as the Healthy Americans Act and the SHOP Act in the House. Blunt is the chairman of the House Republican Health Care Solutions Group, and vowed to draft their own alternative legislation for health reform. What they produced was a four-page document pledging to protect Americans from "being forced into a new government-run health care plan" and ensure that important decisions are made "by patients and their doctors, not government bureaucrats."
It's not hard to see why someone like Rep. Green can support health reform. "We've been trying to hold a finger in the dike," Green recently told the AP, and the reforms being proposed could provide significant relief to his district. Similarly, you can understand why a moderate like Sen. Snowe would consider crossing party lines to help make health care more affordable for her constituents. Nor is it terribly surprising that Republicans like John Boehner, Eric Cantor and Paul Ryan, can freely and fiercely criticize, when they represent districts where rates of uninsurance are comfortably below the national average and rates of private coverage are comfortably above.
What is surprising is the willingness of politicians to vote against their constituents' long-term interests. A fifth of the nonelderly in South Carolina don't have health insurance, but the state's junior senator would rather talk about Waterloo than what to do about the uninsured. It takes courage for someone like Emerson (who isn't particularly moderate but who has bucked her party leadership on certain health care issues before) to be willing to reach across the aisle to offer real solutions. It takes a different kind of chutzpah to paint (as some of her colleagues have) the current health reform efforts as a government takeover that will lead to rationing and even euthanasia.