The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors, and should not be attributed to The Urban Institute, its trustees, or its funders. Background This is a study of why health insurance coverage varies across the country and within a state. While individual characteristics of the uninsured are well known, relatively little research has been devoted to explaining the systematic variation in state and county-level rates of uninsurance. Since these aggregate rates are the targets of many recent policies health insurance market reforms, Medicaid expansions, high risk pools the policy development process can only be helped by a better understanding of the covariates of rates of determinants coverage and uninsurance.
Policy makers care about rates of health insurance coverage for at least two reasons.
One, the uninsured often need and receive expensive acute care to stabilize or cure their medical conditions, and few are able to pay the full costs of these services. These costs are then shifted in various ways onto the population at large. Two, despite these implicit subsidies for expensive care, the uninsured generally use fewer health services than the insured population, and some suffer physical, financial, and emotional consequences from the relative lack of care. Given the established links between health insurance coverage and access to timely health care, and given the importance of that access to the overall well-being of any population, the sheer amount of variation in rates of health insurance coverage is striking. These are the phenomena we are trying to explain.