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Where the Uninsured Live

Now that the U.S. Supreme Court has upheld the Affordable Care Act, it's worth taking another look at a visual representation of the millions of Americans who still lack health insurance. A few months back, our own Richard Florida broke down the geography of America's uninsured, noting the "uninsured belt” he saw running through much of the South and the Sunbelt.

Nationwide, 17.1 percent of Americans lacked health insurance in 2011, according to the Gallup Healthways Well-Being Index, which also produced the map below. But there are stark differences between the states. More than one in five people are uninsured in roughly a dozen states, starting with Texas (27.6 percent), Mississippi (23.5 percent), Florida (22.9 percent), Oklahoma (22.1 percent), California (22.0 percent), and Nevada (21.9 percent). Compare those figures with Massachusetts, which boasts the lowest rate of uninsured people in the nation, at less than five percent. Massachusetts, of course, already has an individual mandate thanks to the health-care reform efforts of former governor Mitt Romney.

(Click the map for a larger image)

Here's Richard Florida on some of his findings on the geography of the uninsured:

Uninsured states are significantly more religious, based on the percentage of state residents who say that religion plays an important role in their everyday life. The correlation between the two is .51.

Politics and ideology factor in as well. Conservative states (based both on the percentage of state residents who identify as conservatives (.58) and the percentage of who voted for McCain in 2008 (.60) have a higher percentage of uninsured citizens. Economics also comes into play. There is a positive correlation between the percent of a population that is uninsured and the poverty rate (.58). Blue-collar and working class states also boast a higher level of uninsured (.40). 

Not surprisingly, the share of the population that is uninsured is lower in more affluent and more highly educated states. The share of uninsured people is negatively associated with state income levels, the percentage of college grads, and the percentage of workers in professional, knowledge, and creative occupations.

Legal scholars are still parsing today's complicated ruling, which upheld the mandate as a tax and precluded the federal government from withholding Medicaid funds from states that choose not to participate in the law's Medicaid expansion. In that sense, there remains some uncertainty as to how the landscape of the uninsured might vary state-by-state once the law is fully implemented in 2014. Still, regardless of any potential variation in Medicaid expansion, one thing at last seems certain: This map of uninsured Americans will soon look very, very different.

Keywords: Health Care

Sommer Mathis is editor of The Atlantic Cities. Previously she spent five years editing and reporting on the D.C. metro area at DCist.com and TBD.com. All posts »

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