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Midwest, New England Tops in Health Insurance Coverage

By Jane Norman, CQ HealthBeat Associate Editor

July 28, 2010 – You’d expect that residents of Massachusetts would lead the nation when it comes to health insurance coverage, given that a state law there requires that individuals be insured.

But county-by-county health insurance estimates released by the Census Bureau show that residents of the upper Midwest, along with their New England counterparts, enjoy some of the highest rates of health insurance coverage in the nation, while the South and Southwest lag behind.

The statistics indicate that the new health care law extending coverage to 31 million people when fully implemented in 2014 may have its most profound effect in those southern states. Texas alone has an estimated 5.7 million people without health insurance.

The Small Area Health Insurance Estimates provide 2007 data on the number of people in all 3,140 counties in the United States, and the percentages of those under age 65 who lack health insurance. The estimates are put together from census data such as population surveys and surveys of business patterns, as well as aggregated federal tax returns and Medicaid participation records.

Maps on the Census Bureau website show that while there are pockets in nearly every region of the country with rates of uninsured people higher than the national average of 17.1 percent, Texas, New Mexico and Florida are home to multiple counties with 29.2 percent to 49 percent uninsured people.

Census officials note that there can be wide variation in insurance rates within a state, and knowing which counties those are and the age range of those without insurance assists planners.

The estimates are broken down by age, sex, race, Hispanic origin and income categories at the state level and by age, sex and income categories at the county level.

The census says 26.8 percent of Texans don’t have health coverage, followed by 26.7 percent in New Mexico, 24.2 percent in Florida, 22.8 percent in Louisiana and 21.1 percent in Arizona.

On the other end, 7.8 percent of Massachusetts residents are uninsured, followed by 9 percent in Hawaii, 9.6 percent in Minnesota, 9.7 percent in Wisconsin, and 10.8 percent in Connecticut and Iowa.

New 2008 health insurance estimates for areas with populations of 65,000 or more will be released by the census in September.

The counties with the lowest rates of uninsured people are Henry County, Iowa, and Plymouth County, Massachusetts, each with 6.6 percent of residents without coverage; Waukesha County, Wisconsin, 6.9 percent; Worcester County, Massachusetts, 7 percent; Berkshire County, Massachusetts, 7.1 percent; Norfolk County, Massachusetts, 7.2 percent; Hampden County, Massachusetts, Anoka County, Minnesota, and Washington County, Wisconsin, 7.3 percent; and Carver County, Minnesota, 7.5 percent.

Counties with the highest rates of uninsured are in Texas. Leading the way is Kenedy County, a lightly populated county on the state’s southeastern border where 49.5 percent of the 341 residents under 65 are uninsured. It is followed by Hudspeth County, 48.5 percent; Jeff Davis County, 44.2 percent; Culberson County, 42.6 percent; Presidio County, 40.8 percent; Sherman County, 40.5 percent; Glasscock County, 40.4 percent; and Edwards County, 40 percent.

Echols County, Georgia, where 37.6 percent of residents don’t have insurance, is the non-Texas county with the nation’s highest percentage of uninsured. 

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