Place as a Predictor of Health Insurance Coverage: A Multivariate Analysis of Counties

• In Event: 509 - Section on Medical Sociology Paper Session. Health Inequalities and Place

Abstract

Despite the Affordable Care Act, counties continue to serve as an important locus of access to care for the uninsured, the underinsured, and those covered under medically indigent adult programs. Yet counties have received surprisingly little attention in health policy reform. Our study assessed the importance of county characteristics in explaining county-level variations in health insurance coverage. We approached this work from several theoretical perspectives: Andersen’s behavioral model of health services utilization; critical social geography to focus on structural differences depending on “place”; and economic sociology to clarify the impact of ideology and beliefs on economic behavior. Using public databases from 2008 to 2012, we studied 3,112 counties in the United States. Rates of uninsurance ranged widely from 3% to 53%. Multivariate analysis suggested that poverty, unemployment, Republican voting, and percentages of Hispanic and American Indian/ Alaskan Native residents were significant predictors of uninsurance rates. The associations between uninsurance rates and both race/ethnicity and poverty varied significantly between metropolitan and non-metropolitan counties. Inter-county variability in insurance coverage may reflect uneven economic development, varying local policies concerning access to services for low-income people and ethnic minorities, and ideological predispositions that lead county-level policy makers to make differing decisions about access to services. Policy interventions under the ACA and subsequent reforms should consider the county as a fundamental unit of health insurance coverage and county jurisdictions as partners in implementing health reform.

Authors

• Lisa Cacari-Stone, University of New Mexico

• Blake Boursaw, University of New Mexico

• Sonia Patricia Bettez, University of New Mxico

• Tennille L. Marley, Arizona State University

• Howard Waitzkin, University of New Mexico