Geography makes a difference in health coverage

ORLANDO, Fla. (AP) — Where someone lives makes a difference in whether or not that person has health insurance.

Census data released this week shows a vast geographic inequality in the uninsured that has been shaped by an area’s state laws, population makeup and jobs. Residents in vast swaths of the Southwest are many times more likely to lack health insurance than residents in pockets of the Northeast and upper Midwest.

“Depending on who you are and where you work, you can be very unlucky and not get covered,” said Dr. Bruce Siegel, director of the Center for Health Care Quality at George Washington University. “It’s a completely fragmented system.”

Of the nation’s 435 congressional districts, Texas districts topped the list with the highest percentage of uninsured residents, and the lowest percentage of the uninsured were in congressional districts in Massachusetts, which in 2006 legislated near-universal health insurance.

The extremes range from Democratic U.S. Rep. Gene Green’s congressional district in Houston, where 40.1 percent of the population is uninsured, to Democratic Rep. Jim McGovern’s district around Worcester, Mass., where only 3.4 percent of the population has no coverage.

McGovern’s district is helped by the state’s mandatory health- insurance requirement and having the University of Massachusetts Medical School and UMass Memorial Medical Center as two of the area’s largest employers.

Green attributed the large numbers of uninsured in his inner-city district to low-paying jobs where employers don’t provide insurance, and even if they do, employees often can’t afford the high co-payments.

“We’ve been trying to hold a finger in the dike,” Green said.

In between these extremes are the San Francisco congressional district of House Speaker Nancy Pelosi, where more than 11 percent of the residents are uninsured, and the South Carolina district of Republican U.S. Rep. Joe Wilson, where almost 15 percent of residents have no health insurance. Wilson gained fame for his outburst of “You lie!” during President Barack Obama’s speech to Congress on health-care reform.

The reasons for the geographic disparities boil down to state policies, types of jobs and demographics.

Eligibility for Medicaid, the federal health program for poor families managed by states, varies among states: Some are more generous than others. In Massachusetts’ case, lawmakers mandated that virtually everyone in the state be insured or face steadily increasing fines, dropping the percentage of uninsured to 4.1 percent.

An Associated Press statistical analysis showed that a county’s percentage of residents without health insurance was influenced by its percentage of Hispanics; the percentage of residents age 20 to 24 and 60 to 64; and the percentage of residents working in farming, fishing, hunting, mining, construction, real estate, support positions such as secretary or janitor and hotel and food-service workers.

Salaries matter too, as well as the presence of government and union jobs.

Though more than 90 percent of the nation’s highest-wage earners had access to health insurance, that was true for little more than a quarter of the nation’s lowest-wage earners. Just under three-quarters of the nation’s workers had access to health insurance, but the access rate jumped to 88 percent for government workers, according to the Bureau of Labor Statistics.

Construction workers in heavily unionized areas of the United States, such as the Northeast, Chicago and California, are more likely to have health coverage than in right-to-work states in the South and Southwest, said Jacob Hay, a spokesman for the Laborers’ International Union of North America. Workers in right-to-work states can’t be forced to join a union as a condition of employment.

Indeed, BLS data showed that 80 percent of union workers in private industry had health-insurance benefits in 2006, but only 49 percent of nonunion workers did.

“A solution we would point to is that when workers are able to come together in a union, they’re able to fight for better jobs, and part of that includes fighting for and negotiating health-care benefits,” Hay said.

Next to Massachusetts, the states with the least uninsured residents were Hawaii (6.7 percent), Minnesota (8.7 percent) and Connecticut (9 percent).

Behind Texas, the states with the largest percentage of uninsured residents were New Mexico (21.4 percent), Nevada (21.3 percent) and Florida (20.8 percent).

State-by-state breakdown of the percentage of uninsured residents in 2008, according to Census figures released this week.

Texas, 24.1 percent

New Mexico, 21.4 percent

Nevada, 21.3 percent

Florida, 20.8 percent

Alaska, 20.1 percent

Oklahoma, 19.5 percent

Georgia, 18.8 percent

Arizona, 18.7 percent

Montana, 18.5 percent

Arkansas, 18 percent

Mississippi, 17.9 percent

Idaho, 17.8 percent

Louisiana, 17.8 percent

California, 17.8 percent

South Carolina, 17.4 percent

Colorado, 17.2 percent

Oregon, 16.4 percent

North Carolina, 15.9 percent

West Virginia, 15.8 percent

Utah, 15.5 percent

Kentucky, 14.1 percent

Alabama, 14 percent

Wyoming, 13.9 percent

Indiana, 13.9 percent

Tennessee, 13.6 percent

Washington, 13.1 percent

Missouri, 13 percent

Illinois, 12.8 percent

New Jersey, 12.4 percent

Kansas, 12.2 percent

Virginia, 12.0 percent

Ohio, 11.8 percent

New York, 11.8 percent

South Dakota, 11.7 percent

Michigan, 11.5 percent

Nebraska, 11.1 percent

Maryland, 11.1 percent

Maine, 10.9 percent

New Hampshire, 10.8 percent

North Dakota, 10.5 percent

Rhode Island, 10.5 percent

Delaware, 10.3 percent

Pennsylvania, 9.4 percent

Wisconsin, 9.1 percent

Vermont, 9.1 percent

Iowa, 9.1 percent

Connecticut, 9 percent

Minnesota, 8.7 percent

Hawaii, 6.7 percent

Massachusetts, 4.1 percent

Source: American Community Survey