Place as a predictor of health insurance coverage: A multivariate analysis of counties in the United States

The lack of attention that counties have received in health policy reform proposals is surprising in light of policies enacted in other countries and in the United States that might serve as models of innovation. Partly because counties remain “forgotten governments” in research and policy analyses, national- and state-level proposals for improving health care access usually have not considered current policies and potential interventions at the county level.   However, 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. To address this gap, we assessed the relative importance of county characteristics in explaining county-level variations in health insurance coverage for 3,112 located in the 50 states of the US. Health insurance coverage rates ranged from 3.0% to 52.9% uninsured.  Our findings from our multi-variate analysis suggest that unemployment plays a factor in uninsurance rates in some counites.   The proportion of racial and ethnic minority residents (Hispanic, non-Hispanic Black, Asian/Pacific Islander) and those living in poverty impacts uninsurance rates differently between metro and non-metro counties.  We will discuss why county government actions are needed to assist in enrolling the uninsured into the health reform market places, investing in programs that address social determinants of health at the local level and promoting health equity.