Uninsured Countries Report

8/22/2019 Uninsured Countries Report

1/28www.americanprogressaction.o

The Counties that Need the

Afordable Care Act the MostBy Anna Chu and Charles Posner July 2013


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The Counties that Need theAfordable Care Act the Most

By Anna Chu and Charles Posner July 2013


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1 Introduction and summary

3 How the Aordable Care Act is helping Americans

6 Top 30 worst counties

15 Looking deeper at three counties

15 DeSoto County, Florida

16 Polk County, Texas

17 McKinley County, New Mexico

18 Conclusion

19 About the authors

20 Methodology

22 Endnotes

Contents


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1 Cnr r Amrcan Prgrss Acn Fund |t Cuns Nd Ardabl Car Ac Ms

Introduction and summary

Millions o Americans who are unable o aord healh care will nally be able o

ge he healh insurance hey need o ake care o hemselves and heir amilies

when he Aordable Care Ac goes ino eec nex year. Bu conservaives in

Congress have been ghing ooh and nail o dismanle and desroy he healh

care law and preven he American people rom even learning abou he benes

o he law or heir new insurance opions.

From warning he proessional spors leagues1 no o assis in spreading he wordabou he healh care law, o he House voing 40 imes o repeal he law, o denying

unding or he governmen o educae consumers abou he benes o he law or

enrollmen, conservaive lawmakers no only have reused o work on srengh-

ening he law bu are doing everyhing hey can o orpedo i. Many o hese

opponens o he healh care law represen disrics wih some o he highes raes

o uninsured people in he naion. Tese eleced ocials have abandoned heir

responsibiliy o assis consiuens and reuse o recognize ha heir consiuens

include he uninsured and amilies who will bene immensely when he healh

care markeplaces go ino eec in January 2014. In conras, hough Democras

had ough agains he passage o Presiden George W. Bushs Medicare Par D drug

bene, Democras did no ry o undermine he laws implemenaion and, in ac,

underook o educae heir consiuens on how o navigae he law.2

I is one hing o gh he passage o he healh care law, bu as Norm Ornsein

a he American Enerprise Insiue wroe, Wha is going on now o saboage

Obamacare is no reasonousjus sharply beneah any reasonable sandards o

eleced ocials wih he duciary responsibiliy o governing.3

Bu i is no jus conservaives in Congress who4

are blocking heir consiuensrom accessing he benes o he healh care law. Governors and sae legis-

laures in saes across he counry are reusing o expand Medicaid. I every

governor acceped he ederal unds guaraneed under he healh care law o

expand Medicaid, nearly 17 million Americans would gain coverage.5 Bu aer


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he Supreme Cours decision o allow saes o decide wheher o accep und-

ing, conservaive legislaures and governors in 13 saes decided no o expand

Medicaid coverage in heir sae, leaving millions o Americans wihou access

o aordable healh insurance.6 Anoher six saes are leaning agains expansion.7

Tese governors and sae legislaures are no only denying care o hose who

need i he mos, bu hey are also cosing heir saes ens o millions o dollars.

Yes, poliicians can play heir games, bu a he end o he day, is heir job o gh

or he bes ineress o all heir consiuens, including he uninsured. o do any-

hing less is an abdicaion o heir consiuional duy.

In jus a ew shor monhsin January 2014millions o uninsured Americans

will nally have access o he aordable healh care ha hey and heir amilies

need o live healhy and secure lives. Tis repor akes an in-deph look a some

o he counies ha may sand o gain he mos rom ull implemenaion o he

healh care law. A number o hese counies are represened by congressionalmembers who, insead o helping hose in heir disrics learn more abou he law

and how o access he laws benes, are acually working agains wha is bes or

heir consiuens.


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How the Affordable Care Act

is helping Americans

Since is passage in 2010, he Aordable Care Ac has already beneed millions

o Americans. From he 6.6 million seniors who have received more han $7 bil-

lion8 in discouns on heir prescripion drugs o he 3.1 million young aduls who

now have insurance hrough heir parens insurance plans, he healh care law is

beneing Americans rom all walks o lie. In ac, more han 77 million consum-

ers have already saved $3.9 billion9 in 2012 because he healh care law is making

insurance companies operae more ecienly.

Come nex year in 2014, even more Americans will sand o gain remendous ben-

es rom he Aordable Care Ac. Te law is providing consumers wih access o

aordable healh care and is also improving he qualiy o care, including reorm-

ing insurance-indusry rules so hose wih pre-exising condiions will no longer

be denied coverage.

The Affordable Care Act is bringing

Americans access to affordable health care

Alhough conservaives bemoan he healh insurance markeplaces and claim ha

he cos o healh insurance will skyrocke because o he healh care law, he real

sory o wha is happening on he ground shows ha he law is osering compei-

ion among insurers and lowering he cos o healh care or consumers. Consider

New York, where premiums are se o all by a leas 50 percen.10 According o Te

New York imes,Beginning in Ocober, individuals in New York Ciy who now

pay $1,000 a monh or more or coverage will be able o shop or healh insurance

or as litle as $308 monhly. Wih ederal subsidies, he cos will be even lower.11

New Yorkers will see lower premiums and will be able o choose rom 17 diereninsurance plans when enrolling in coverage in Ocober.12


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In Caliornia, he mos populous sae in he naion, 13 insurers would be able o

sell policies in he saes healh care markeplace nex year, and he bids submited

by he companies are signicanly less expensive ha wha orecasers expeced,

as repored byTe Washington Post.13Te leas expensive bid or a silver-level plan,

he second-mos-aordable caegory o healh care plans, came in wih a premium

o$276 a monh, while he mos aordable coverage opion, he bronze-level plan,came in a $172 a monh. Meanwhile, in Oregon, one insurance company submi-

ed a plan wih a monhly premium o abou $169. While oher insurers submited

bids or more han $400, hey asked he sae i hey could recalculae heir raes

aer seeing heir compeiors lower price poins.14

Oregon and Caliornia are no he only places where he healh care law is helping

lower he cos o insurance. Compeiion has lowered he average cos o pre-

miums in Monana by close o 6 percen.15 Meanwhile, he Maryland Insurance

Adminisraion recenly approved nal raes or healh plans ha are among he

lowes o he 12 saes ha have proposed or approved raes. 16 In Maryland, a25-year-old buying he cheapes bronze plan would pay abou $119 o $129 a

monh, compared o $151 in Washingon, D.C., and $134 in Virginia.17

In addiion o driving down he cos o healh insurance, he healh care law will

provide nancial assisance o moderae- and lower-income individuals o help

hem pay heir premiums, urher reducing he cos o healh care coverage. Te

law provides nancial help in several dieren ways. Te healh care law oers

ederal ax credis on a sliding scale o individuals making up o 400 percen o he

ederal povery levelabou $45,960 or an individual and $94,200 or a amily o

our in 2013o help hem ose he cos o healh care premiums.18 In all, abou

18 million individuals and working-class amilies will receive ax credis averaging

$4,000 a year.19 In addiion o ax subsidies, he healh care law also provides cos-

sharing subsidies o individuals making up o 250 percen o he ederal povery

level$28,725 or an individual in 2013.20 Cos-sharing subsidies help reduce he

ou-o-pocke coss or covered benes.

I obsrucioniss in Congress have heir way, many Americans will never see hese

benes. Insead, healh care premiums will go back o rising a asronomical raes,

and millions o Americans would coninue o go wihou he care hey need o livehealhy lives.


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The Affordable Care Act is improving the quality of our health care

Uninsured individuals are generally he leas likely o receive medical care. Tese

people, however, are oen he mos in need o care because o heir poor healh

saus. For hese individuals, healh care coverage is especially imporan in ensur-

ing a healhy and nancially secure lie. Good primary care, prevenive and well-ness services, and care coordinaion would go ar in helping individuals wih poor

healh and chronic condiions. Te healh care law would no only give individu-

als access o aordable healh care coverage, as explained above, bu i is already

improving he qualiy o he care received.21

Te Aordable Care Ac is providing consumers wih a muliude o beter healh

care benes. For insance, he law requires ha healh plans oered on he

markeplace include docors visis, maerniy care, and emergency-room care.22

Te healh care law has also provided consumers wih criical prevenive care

services, such as cancer screenings, healh screenings, and imporan immuniza-ions. Because o he law, 71 million Americans wih privae healh insurance have

received a leas one ree prevenive healh care service such as a mammogram or

a fu sho. Addiionally, abou 34 million seniors have received a leas one ree

prevenive service as well.23

Anoher way he healh care law is improving he qualiy o care is by proec-

ing hose wih pre-exising condiions. Beore he law, many paiens wih pre-

exising condiions did no have access o aordable healh care.24 Bu saring in

2014, insurance companies will no longer be able o deny coverage or or charge

higher premiums o people wih pre-exising condiions. Conservaive eors

o repeal he healh care law would le big insurance companies go back o being

able o deny coverage or or charge high premiums o people wih pre-exising

condiions.

Tese are jus wo o he many examples o how he healh care law improves

he qualiy o healh care. Americans sand o bene in numerous oher ways,

including hrough an increase in he number o healh care providers, school-

based healh ceners, and communiy healh ceners.25 Oher pars o he law are

already encouraging docors and oher healh care providers o work ogeherand coordinae care.


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Top 30 worst counties

Despie all he ways he individuals who currenly lack healh care coverage would

bene rom access o aordable, qualiy healh care coverage because o he

healh care law, many congressional leaders are acively ghing o deea he law

insead o helping heir consiuens access he coverage and benes hey need o

live healhy lives.

Te lis below represens 30 o some o he wors counies in America when i

comes o he percenage o uninsured individuals and healh-relaed oucomes.Tese counies appear mos requenly on he op 200 liss o wors counies in

he counry based on he ollowing acors:

Highes overall percenage o uninsured individuals

Highes percenage o uninsured women

Highes percenage o uninsured individuals ages 18 o 39

Highes percenage o uninsured young men

Highes percenage o uninsured people o color

Highes percenage o uninsured working-class individuals

In addiion o he numbers o uninsured, hese counies have some o he wors

insurance raes. Moreover, some o he counies on his lis also have he wors

healh oucomes in he naion on acors such as hear disease, sroke, and diabe-

es. Below is more inormaion on each o hese acors.


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The 30 worst: 30 counties that rank among the 200 worst counties in the nation across ive key actors

among counties with population greater than 25,000

Out o the 3,142 counties we observed, the ollowing counties were among the 200 worst in each o these ive key actors.

County name

County

population,

2010

Percent

uninsured,

under Age 65

Percent

uninsured,

women under

Age 65

Percent

uninsured,

men age

18-39

Percent

uninsured,

overall age

18-39

Percent uninsured,

income 138 percent

to 400 percent

o ederal

p overt y l ine Count y r ep resentative(s)

Burnet County, TX 33,873 29.6 28.2 50.2 47.2 31.7 Roger Williams (R-25)

Cameron County, TX 357,400 37.6 37.4 60.8 56.6 36.4 Filemon Vela (D-34)

Cherokee County, TX 40,647 30.5 28.3 50.1 46.0 29.5 Jeb Hensarling (R-5)

Collier County, FL 233,707 29.5 26.7 51.1 46.4 34.4Trey Radel (R-19), Mario Diaz-Ba

(R-25)

Cooke County, TX 31,772 28.6 27.1 47.6 43.9 30.4 Mac Thornberry (R-13)

Dallas County, TX 2,139,366 31 29.1 48.6 44.9 34.6

Jeb Hensarling (R-5), Kenny Ma

(R-24), Michael Burgess (R-26),

Johnson (D-30), Pete Sessions (

Marc Veasey (D-33)

DeSoto County, FL 25,813 34.4 29.9 57.2 51.0 33.6 Tom Rooney (R-17)

Ector County, TX 120,948 29.5 28.4 46.7 42.5 30.7 Mike Conaway (R-11)

El Paso County, TX 703,756 32.8 33.5 46.7 46.5 32.5Beto O-Rourke (D-16), Pete Gall

(D-23)

Henderson County, TX 62,540 28.8 27.9 50.4 45.3 28.9 Jeb Hensarling (R-5)

Hendry County, FL 33,174 34.5 31.2 56.9 51.1 34.6Alcee Hastings (D-20), Mario Di

(R-25)

Hidalgo County, TX 696,062 38.1 38 58.8 58.0 37.1Ruben Hinojosa (D-15), Henry C

(D-28), Filemon Vela (D-34)

Hopkins County, TX 29,476 30.7 29 51.4 47.3 31.1 Ralph Hall (R-4)

Kerr County, TX 35,970 27.8 27.4 47.3 44.0 29.7 Lamar Smith (R-21)

Lagrange County, IN 32,873 34.9 32.5 50.6 49.0 33.5 Marlin Stutzman (R-3)

Matagorda County, TX 31,147 28.5 26.9 50.4 45.4 30.6 Blake Farenthold (R-27)

Maverick County, TX 47,445 33.9 34.3 54.4 52.2 32.9 Pete Gallego (D-23)

McKinley County, NM 65,429 31.4 29.4 51.6 45.0 31.2 Ben Lujan (D-3), Steve Pearce (R

Miami-Dade County, FL 2,119,895 35.8 33.9 51.4 47.4 38.0

Debbie Wasserman-Schultz (D-

Frederica Wilson (D-24), Mario D

Balart (R-25), Joe Garcia (D-26),

Ros-Lehtinen (R-27)

Monroe County, FL 59,556 28.7 26.2 48.2 43.2 34.3 Joe Garcia (D-26)

Navarro County, TX 40,369 29.6 27.8 50.0 46.6 29.4 Joe Barton (R-6)

Polk County, TX 32,787 29.3 28.1 51.7 45.5 29.5 Steve Stockman (R-36)

Potter County, TX 102,046 29.7 26.4 54.2 45.4 30.2 Mac Thornberry (R-13)

San Juan County, NM 115,579 28.9 27.4 48.8 44.9 29.6 Ben Lujan (D-3)

Starr County, TX 53,768 35.8 35.8 59.5 55.7 33.9 Henry Cuellar (D-28)

Titus County, TX 28,399 31.9 29.8 53.5 48.9 31.5 Ralph Hall (R-4)

Val Verde County, TX 41,070 30.9 31 49.4 47.0 31.2 Pete Gallego (D-23)

Waller County, TX 35,437 30.6 29.4 47.0 45.0 32.3 Michael McCaul (R-10)

Webb County, TX 227,616 36.8 37.4 54.5 52.8 36.2 Henry Cuellar (D-28)

Wharton County, TX 34,962 28.2 26.8 48.0 44.2 29.2 Blake Farenthold (R-27)

Source: Center or American Progress Action Fund analysis based on data rom the Census Bureaus Small Area Health Insurance Estimates database


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Counties with highest percentage

of uninsured individuals

Te ollowing is a lis o he counies wih he

overall highes percenage o nonelderly unin-

sured residens.

Counties with the highest rates o uninsured individuals under a

Among counties with population greater than 25,000

Rank County nameCounty

population

Perce

uninsu

1 Hidalgo County, TX 696,062 38.1

2 Cameron County, TX 357,400 37.6

3 Webb County, TX 227,616 36.8

3 Miami-Dade County, FL 2,119,895 35.8

3 Starr County, TX 53,768 35.8

6 Lagrange County, IN 32,873 34.9

7 Hendry County, FL 33,174 34.5

8 DeSoto County, FL 25,813 34.4

9 Maverick County, TX 47,445 33.9

10 El Paso County, TX 703,756 32.8

11 Titus County, TX 28,399 31.9

12 McKinley County, NM 65,429 31.4

13 Erath County, TX 31,422 31.3

14 Dallas County, TX 2,139,366 31.0

15 Val Verde County, TX 41,070 30.9

16 Hopkins County, TX 29,476 30.7

17 Waller County, TX 35,437 30.6

18 Cherokee County, TX 40,647 30.519 Harris County, TX 3,733,203 29.9

20 Potter County, TX 102,046 29.7

21 Burnet County, TX 33,873 29.6

21 Navarro County, TX 40,369 29.6

23 Collier County, FL 233,707 29.5

23 Cherokee County, OK 39,365 29.5

23 Ector County, TX 120,948 29.5

26 Polk County, TX 32,787 29.3

27 Okeechobee County, FL 31,043 28.9

27 San Juan County, NM 115,579 28.9

29 Henderson County, TX 62,540 28.8

30 Monroe County, FL 59,556 28.7

31 Cooke County, TX 31,772 28.6

32 Highlands County, FL 66,469 28.5

32 Matagorda County, TX 31,147 28.5

34 Duplin County, NC 49,852 28.4

35 Nacogdoches County, TX 52,093 28.3

36 Wharton County, TX 34,962 28.2

37 Kerr County, TX 35,970 27.8

37 Van Zandt County, TX 42,766 27.8

39 Caldwell County, TX 32,065 27.5

39 Jeerson County, TX 205,199 27.5

41 Grayson County, TX 100,663 27.4

42 Clayton County, GA 238,352 27.3

42 Wood County, TX 31,001 27.3

44 Lee County, FL 467,136 27.2

44 Smith County, TX 176,933 27.2

46 Broward County, FL 1,484,849 27.1

46 Osceola County, FL 237,926 27.1

46 Hill County, TX 28,105 27.1

49 Holmes County, OH 37,376 27.0

49 Yakima County, WA 213,798 27.0

Source: Census Bureau, Small Area Health Insurance Estimates, 2010. http://www.census.gov/did/wsahie/data/interactive/


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Worst counties for women

Women sand o bene grealy rom he healh

care law. Because o he law, saring in 2014,

being a woman will no longer be considered a

pre-exising condiion. Currenly, some insur-ance companies deny coverage o or charge

women more or pre-exising condiions such

as pregnancy or being a vicim o domesic

violence. Te healh care law will end gender

raing, ensuring ha women will no have o

pay more or he same healh care coverage as

men. Addiionally, women in new privae plans

will be able o receive ree prevenive services

under he law, including coverage or cancer

screenings, maerniy care, and birh conrol.26

I heir conservaive congressional leaders had

heir way, he women in hese counies may

never see he benes o he healh care law.

Tis lis consiss o he counies in he coun-

ry wih he highes percenage o nonelderly,

uninsured women.

Counties with the highest rates o uninsured women under a



population

Percen

uninsure


















18 Harris County, TX 3,733,203 28.8


20 Cherokee County, TX 40,647 28.3











31 Matagorda County, TX 31,147 26.932 Wharton County, TX 34,962 26.8


33 Van Zandt County, TX 42,766 26.7




37 Jeerson County, TX 205,199 26.4


30 Caldwell County, TX 32,065 26.2

41 Holmes County, OH 37,376 26.1

42 Wood County, TX 31,001 26.0

42 Brown County, TX 30,325 26.0


44 Hill County, TX 28,105 25.9


47 Wise County, TX 50,872 25.4

47 Gregg County, TX 102,171 25.4



49 Osceola County, FL 237,926 25.3

49 Harrison County, TX 55,666 25.3

Source: Census Bureau, Small Area Health Insurance Estimates, 2010. http://www.census.gov/did/wsahie/data/interactive/


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Worst counties for adults ages 18 to 39

Aduls ages 18 o 34 are he age group mosly

likely o be uninsured. More han 27 percen o

individuals in his age group are uninsured and

in oal hey make up abou 38 percen o all heuninsured individuals in he counry.27 Many

uninsured young aduls do no have healh

insurance, no because hey do no wan i, bu

because hey do no have access o aordable

healh care coverage.28 Also, as a prior repor

by he Cener or American Progress noed,

a disproporionae number o young aduls

lack insurance because o he ype o work

hey do. Many people in heir early 20s work

in low-income or emporary jobsemploy-men ha rarely oers healh insurance.29

Moreover, young Americans have aced barriers

o coverage, including discriminaion based on

pre-exising condiions and oher pracices ha

raised premiums or erminaed coverage i he

person became sick.

Te healh care law has helped grealy in reduc-

ing he uninsured raes or many aduls ages 19

o 25 by allowing hese young aduls o remain

on heir parens healh care plans unil age

26.30 Sill, much more remains o be done o

ensure ha his groups healh care needs are

adequaely addressed.

Tough he available daa did no break down

he uninsured rae exacly or hose ages 18 o

34, i does oer his breakdown or uninsurance

or hose ages 18 o 39.

Counties with the highest rates o uninsured individuals aged



population

Perc

unins

1 Hidalgo County, TX 696,062 58

2 Cameron County, TX 357,400 56

3 Starr County, TX 53,768 55

4 Webb County, TX 227,616 525 Maverick County, TX 47,445 52

6 Hendry County, FL 33,174 51

7 DeSoto County, FL 25,813 51

8 Duplin County, NC 49,852 49

9 Lagrange County, IN 32,873 49

10 Titus County, TX 28,399 48

11 Miami-Dade County, FL 2,119,895 47

12 Hopkins County, TX 29,476 47

13 Burnet County, TX 33,873 47

14 Val Verde County, TX 41,070 47

15 Highlands County, FL 66,469 46

16 Navarro County, TX 40,369 46

17 El Paso County, TX 703,756 46

18 Collier County, FL 233,707 46

19 Cherokee County, TX 40,647 46

20 Polk County, TX 32,787 45

21 Potter County, TX 102,046 45

22 Matagorda County, TX 31,147 45

23 Henderson County, TX 62,540 45

24 Waller County, TX 35,437 45

25 McKinley County, NM 65,429 45

26 Okeechobee County, FL 31,043 44

27 Dallas County, TX 2,139,366 44

28 Cherokee County, OK 39,365 44

29 San Juan County, NM 115,579 44

30 Yakima County, WA 213,798 44

31 Nacogdoches County, TX 52,093 4432 Wharton County, TX 34,962 44

33 Kerr County, TX 35,970 44

34 Cooke County, TX 31,772 43

35 Okanogan County, WA 33,961 43

36 Lee County, FL 467,136 43

37 Colquitt County, GA 39,137 43

38 Monroe County, FL 59,556 43

39 Clayton County, GA 238,352 43

40 Harris County, TX 3,733,203 43

41 Robeson County, NC 117,199 43

42 Habersham County, GA 34,233 42

43 Wood County, TX 31,001 42

44 Brown County, TX 30,325 4245 Grayson County, TX 100,663 42

46 Ector County, TX 120,948 42

47 Jeerson County, TX 205,199 42

48 Indian River County, FL 98,985 42

49 Holmes County, OH 37,376 42

50 Gordon County, GA 48,186 41

Source: Census Bureau, Small Area Health Insurance Estimates, 2010. http://www.census.gov/did/ww

data/interactive/


14/28


Worst counties for men ages 18 to 39

Medical bills are he number-one cause o

bankrupcy lings in America.31 Tis year alone,

abou 1.7 million American households will

le bankrupcy because o rising medical bills.32

Despie he nancial srain ha medical bills

place on Americans, many do no have access o

aordable care. Uninsured young aduls are par-

icularly vulnerable. Polling has ound ha hey

ace problems because o a lack o insurance

coverage, including medical deb, diculy pay-

ing medical bills, and oher hardships due o a

lack o sucien healh care coverage.33

Access o healh care coverage would no onlyhelp ease many nancial worries or young

aduls, bu i would also be here or hem as

hey age and ace healh problems. For insance,

men generally suer rom chronic healh

condiions such as hear disease and diabees

a higher raes han women, and men also have

shorer liespans. Men are also disproporion-

aely aeced by cancer and srokes. Ensuring

ha men have access o aordable healh care

coverage and he abiliy o obain prevenive

healh services saring rom a young age is

criical o ideniying risk acors or hese dis-

eases and or improving healh.34

Below is a lis o counies in he counry wih

he highes percenages o uninsurance among

men ages 18 o 39.

Counties with the highest rates o uninsured men aged 18-39

(among counties with population greater than 25,000)


population

Percen

uninsure




















20 Robeson County, NC 117,199 50.3





25 Grant County, WA 78,193 49.8




29 Colquitt County, GA 39,137 49.0

30 Okanogan County, WA 33,961 49.0

31 San Juan County, NM 115,579 48.832 Lee County, FL 467,136 48.7




36 Atascosa County, TX 38,950 48.1






42 Angelina County, TX 72,621 47.0

43 Indian River County, FL 98,985 46.9


45 Fannin County, TX 25,568 46.7


47 Macon County, NC 25,773 46.2


49 Manatee County, FL 244,589 45.9

50 Hall County, GA 157,317 45.9

Source: Census Bureau, Small Area Health Insurance Estimates, 2010. http://www.census.gov/did/wwdata/interactive/


15/28


Worst counties for

working-class households

Low-income amilieshose making less han

$25,000 a yearare he mos likely o be unin-

sured. Tis group makes up abou 31 perceno all he uninsured in he Unied Saes, and

abou 25 percen o his group does no have

healh insurance. Households making beween

$25,000 and $49,999 do no are much beter.

Tis group makes up abou 32 percen o all he

uninsured, and abou 21 percen o his group

does no have healh insurance coverage.35

Under he law, saes may expand heir

Medicaid program36 o cover individuals mak-ing up o 138 percen o he ederal povery

level, which is abou $33,000 or a amily

o our.37 Some people making below his

amoun in saes ha op ou o expanding heir

Medicaid programs may sill be eligible or

ederal subsidies. Individuals making beween

100 percen and 400 percen o he ederal

povery levelabou $94,200 or a amily o

our38receive ax credis o help lower heir

healh care coverage coss. Tis group will also

bene rom urher nancial assisance in he

orm o cos-sharing subsidies i hey make less

han 250 percen o he ederal povery level.

Te ollowing is a lis o he counies wih he

highes percenage o nonelderly uninsured

individuals making beween 138 percen and

400 percen o he ederal povery level.39

Counties with the highest rates o uninsured individuals

under 65 earning between 138 percent and 400percent

o the Federal Poverty Line



population

Percen

uninsur


2 Hidalgo County, TX 696,062 37.13 Cameron County, TX 357,400 36.4






9 Harris County, TX 3,733,203 34.2







16 Erath County, TX 31,422 31.817 Burnet County, TX 33,873 31.7








25 Palm Beach County, FL 1,018,145 30.4


27 Los Angeles County, CA 8,668,692 30.2


29 Kerr County, TX 35,970 29.730 Hudson County, NJ 564,876 29.7

31 Kenai Peninsula Borough, AK 48,161 29.6





36 Lee County, FL 467,136 29.4




40 Elko County, NV 44,088 29.0


42 Eagle County, CO 48,824 28.9

43 Henderson County, TX 62,540 28.944 Jeerson County, TX 205,199 28.9

45 Wise County, TX 50,872 28.9

46 Washoe County, NV 367,022 28.8

47 Indian River County, FL 98,985 28.7

48 Garfeld County, CO 50,584 28.5

49 Midland County, TX 120,607 28.4

50 Van Zandt County, TX 42,766 28.4Source: Census Bureau, Small Area Health Insurance Estimates, 2010. http://www.census.gov/did/wsahie/data/interactive/


16/28


Counties with the highest rates o uninsured Arican America



population

Percent

uninsure

1 Dare County, NC 33,051 56.3

2 Rio Arriba County, NM 39,795 49.8

3 Independence County, AR 35,879 49.0

4 Wythe County, VA 28,896 41.85 Cooke County, TX 37,442 40.7

6 Kosciusko County, IN 76,277 40.4

7 Williamson County, IL 64,327 40.3


9 Williamsburg County, SC 33,037 38.5

10 Hardee County, FL 26,476 38.2

10 Jasper County, MO 114,888 38.2


13 Monroe County, TN 44,020 37.1

14 Green County, WI 36,448 36.8

15 Cullman County, AL 79,231 36.3

16 Bryan County, OK 41,218 36.2

17 Indian River County, FL 136,505 35.118 Walker County, GA 67,288 34.9

19 Orleans County, NY 40,004 34.2

20 Randall County, TX 117,589 33.6

21 Marshall County, AL 91,275 33.2

22 Johnson County, TX 147,874 33.0

23 Warren County, NY 64,836 32.9


25 Wayne County, IN 67,740 32.5

26 Vermilion Parish, LA 56,879 32.4

27 Jeerson County, TN 50,247 32.3

28 Cherokee County, SC 55,005 32.2

28 Victoria County, TX 85,603 32.2

30 San Jacinto County, TX 25,755 31.9

31 Wise County, VA 39,578 31.8

32 Palm Beach County, FL 1,298,124 31.7

33 Marion County, OR 305,192 31.5

34 Upshur County, TX 36,986 31.4

35 Livingston Parish, LA 125,716 31.3

36 Stephens County, GA 25,649 31.2

37 Franklin County, AL 31,039 31.0

37 Schuylkill County, PA 141,902 31.0


40 Harrison County, TX 64,634 30.7

41 Monroe County, GA 25,419 30.4

41 Logan County, WV 36,009 30.4


44 Wood County, WV 86,034 29.9

45 Alexander County, NC 37,007 29.6

46 Ouachita Parish, LA 149,388 29.5

46 Brown County, TX 36,904 29.5

48 Fayette County, OH 28,526 29.4

48 Warren County, VA 37,260 29.4

50 Cass County, ND 146,206 29.2

Source: Census Bureau, American Community Survey 3-year estimates 2008-2010. Accessed using AFact Finder: http://actfnder2.census.gov/aces/nav/js/pages/index.xhtml

Worst counties for people of color

Overall, people o color make up more han

54 percen o he oal uninsured populaion,

despie making up only 35.7 percen o he

populaion overall. Abou 3 in 10 Hispanics areuninsured and abou 2 in 10 Arican Americans

are uninsured. More han 16 percen o Asian

Americans also do no have healh insurance40

and close o 30 percen o Naive Americans

lack healh insurance coverage as well.41

Te ollowing are liss o he counies wih

he highes percenages o uninsured Arican

Americans and Hispanics.


17/28


Counties with the highest rates o uninsured Hispanics


Rank County name County population Percent uninsured

1 Ware County, GA 33,968 77.4

2 Petersburg city, VA 31,545 76.0

3 Tallapoosa County, AL 40,888 75.3

4 Union County, MS 27,018 72.5

4 Chesterfeld County, SC 46,371 71.56 Scott County, MS 28,036 71.1

7 Webster County, IA 37,311 68.2

8 Calloway County, KY 36,677 66.1

9 Accomack County, VA 33,077 64.5

10 Georgetown County, SC 59,962 64.4

11 Wayne County, IN 67,740 64.0

12 Polk County, GA 40,909 63.5

13 Henry County, VA 54,009 63.1

14 Garfeld County, CO 55,989 63.0

15 Jeerson County, IN 31,256 62.8

16 Orangeburg County, SC 91,604 60.4

17 Summit County, CO 27,634 60.3

17 Peach County, GA 27,342 60.319 Door County, WI 27,891 60.2

20 Rockdale County, GA 84,252 60.0

21 Jones County, MS 66,921 59.6

22 Coshocton County, OH 36,552 59.3

23 Warren County, MS 48,274 59.2

24 Chilton County, AL 43,204 58.9

24 Richmond County, NC 46,120 58.9


27 Pontotoc County, MS 29,324 58.7

28 Bibb County, GA 150,423 58.6

28 Horry County, SC 263,569 58.6

28 Uintah County, UT 31,717 58.6

31 Winchester city, VA 25,849 58.432 Clarke County, GA 115,396 57.6

33 Richmond city, VA 201,133 57.1

34 DeKalb County, GA 681,388 56.9

34 Madison County, MS 92,872 56.9

36 Glynn County, GA 78,163 56.7

37 Shelby County, IN 43,941 56.5

37 Hamblen County, TN 61,910 56.5


40 Summit County, UT 35,824 55.4

41 Jeerson County, AL 648,869 54.7

41 Gilmer County, GA 28,002 54.7

43 Monroe County, WI 43,565 54.6

44 Spalding County, GA 63,280 54.545 Gwinnett County, GA 790,671 54.2

45 Clark County, OH 137,051 54.2

47 Gaston County, NC 203,504 53.9

48 Le Flore County, OK 49,160 53.8

49 Tuscaloosa County, AL 189,722 53.7

49 Colquitt County, GA 44,564 53.7

Source: Census Bureau, American Community Survey 3-year estimates 2008-2010. Accessed using American Fact Finder: http://actfnder2.

census.gov/aces/nav/js/pages/index.xhtml


18/28


Looking deeper at three counties

Population

34,712

Median

household incom

$36,407

Unemployment r8.1 percent

(June 2013)53

DeSoto CounFlorida52

Highlighed below are hree counies rom he wors 30 counies lis. Tese coun-

ies come rom dieren saes, bu all are a snapsho o places wih boh high

uninsured raes and poor healh oucomes. Tese are counies whose residens

would bene grealy rom he healh care law.

DeSoto County, Florida

DeSoo Couny, Florida, has one o he wors uninsured raes in he counry.

More han 3 ou o every 10 people in DeSoo Couny under he age o 65 do no

have healh insurance.42 Te couny also ranks a he botom o he naionless

han 1 percenileor insurance coverage.43 Across he counry, DeSoo Couny

ranks 27h or having he highes percenage o uninsured individuals.44 Te coun-

ys lowly ranking means ha oo many o is young people are geting by wihou

healh care, which more han hal o hose ages 18 o 39 lack.45 DeSoos Hispanic

communiy is paricularly impaced by a high rae o uninsurancemore han 53

percen o Hispanics in he couny do no have healh insurance.46

No only is he insurance rae in DeSoo Couny among he wors in he naion,

bu he couny also has a high rae o diabees. More han 12 percen o he

counys populaion has diabeesa rae more han 45 percen higher han he

naional average.47

Te healh care law would help he residens o DeSoo Couny remendously.

aking a look a he 17h Congressional Disric o Florida, which includes

DeSoo Couny, he healh care law is helping 6,400 young aduls obain healh

care coverage hrough heir parens.48

Addiionally, 144,000 seniors are now eli-gible or Medicare prevenive services ree o addiional charge.49


19/28


Population

34,712

Median

household incom

$36,073

Unemployment r

8.4 percent

(June 2013)60

Polk CountyTexas59

Despie he remendous benes ha he healh care law will bring o he residens

o DeSoo Couny, Republican Rep. om Rooney, who represens he couny and

he 17h Congressional Disric o Florida, has ough o block his consiuens

rom having he healh care benes hey need. He has voed o repeal he law 38

imes,50 saying, For Florida, Obamacare means more ederal and sae govern-

men spending, higher axes, increased premiums and lower qualiy o carewecan aord ha.51

Wha Rep. Rooneys consiuens can aord is o remain sruggling wihou he

peace o mind ha comes wih having healh care coverage.

Polk County, Texas

Polk Couny residens also suer rom high raes o uninsurance. Like DeSoo

Couny, abou 3 in 10 people in Polk Couny under he age o 65 do no havehealh insurance. 54 Te number is even worse or young menmore han hal o

Polk Counys young men are uninsured.55 Ta uninsurance rae is mirrored in

he counys Hispanic populaionhal o all Hispanics in he couny are liv-

ing wihou healh care coverage. Polk Couny ranks in he op 100 o counies

naionwide wih he highes raes o uninsured among Hispanics.56

Like all Americans, he residens o Polk Couny would bene remendously

rom healh care as many suer rom errible healh oucomes. For every 100,000

people under he age o 75 in Polk Couny, 107 suer rom hear disease. Tis

rae is 63 percen higher han he naional average. Meanwhile, he rae a which

residens under he age o 75 die rom srokes is nearly double he naional average

o 11.8 deahs or every 100,000 people.57

Insead o helping his consiuens access he aordable care hey need hrough

he healh care law, Republican Rep. Seve Sockman, who represens Polk Couny

and he 36h Congressional Disric o exas, claims he law will desroy exas. 58

Bu wha he does no say is how he high number o uninsured in his disric would

bene rom nally being able o access aordable healh care hrough he law.


20/28


Population

73,016

Median

household incom

$31,947

Unemployment r

10.1 percent(June 2013)69

McKinley CouNew Mexico

McKinley County, New Mexico

More han 31 percen o he people in McKinley Couny under he age o 65 do

no have healh insurance.61 I ranks 67h across he counry or he highes overall

rae o uninsured.62 Te counys uninsured rae is also high among women wih

close o 30 percen o women in McKinley Couny lacking healh care coverage.63

In ac, McKinley Couny ranks in he second percenile in he whole counry or

healh insurance coverage raes among women. I also ranks in he second per-

cenile in erms o insurance raes among young men ages 18 o 39.64 Like DeSoo

Couny in Florida, McKinley Couny also has a high rae o diabees. Abou 12.5

percen o he populaion has diabees, which is more han 50 percen higher han

he naional average.65

McKinley Couny is represened by wo members in Congress: Republican Rep.

Seve Pearce and Democraic Rep. Ben Ray Lujan. While Rep. Lujan voed or he

healh care law and has applauded i or puting he people o New Mexico aheado healh insurance companies,66 Rep. Pearce has ough agains he law,67 claim-

ing ha i will leave ens o millions o Americans wihou healh insurance. Tere

is one congressman in McKinley Couny ghing or all is residens, and is no

Rep. Pearce. Insead o liigaing he law over and over, Rep. Pearce should gh or

his consiuens, making sure hey ge he healh care coverage hey need.


21/28


Conclusion

Te naions leaders have been ghing or decades o bring access o aordable

healh care o all Americans. In January 2014 ha goal will be close o being

achieved. Millions o Americans will nally be able o have access o he aord-

able healh care hey need in order o live healhy and secure lives because o he

healh care law. Bu sanding in he way o achieving his imporan milesone and

blocking he hopes o he millions o uninsured are he legions o conservaive

poliicians more concerned wih scoring poliical poins and oppling he opposi-

ion pary han wih serving he people. Is ime or poliicians o all sripes opu aside heir personal and pary poliical agendas and sar working again or all

Americans and especially heir consiuens.


22/28


About the authors

Anna Chu is he Policy Direcor or he TinkProgress War Room a he Cener

or American Progress Acion Fund. She brings experience serving as he policy

direcor or he Democraic Senaorial Campaign Commitee during he suc-

cessul 2012 cycle ha saw Democras adding wo seas o heir majoriy in heSenae. As policy direcor, Anna oversaw and managed all policy issues or he

commitee and Democraic Senae candidaes. Prior o working a he Democraic

Senaorial Campaign Commitee, Anna served as he policy advisor or he House

Democraic Caucus. She previously served as a ederal law clerk and worked as

an associae a Paul Hasings. Anna graduaed rom he Universiy o Caliornia,

Berkeley, and has a J.D. rom he Universiy o Souhern Caliornia.

Charles Posner is he Sae Communicaions Assisan a he Cener or American

Progress Acion Fund, where he provides communicaions, research and analyi-

cal suppor on issues rom healh care reorm o gun violence prevenion. Prioro joining CAPAF, he worked a Greenberg Quinlan Rosner Research, where he

specialized in U.S. poliical issues, and wih Organizing or America in Ohio on

campaigns o overurn a voer suppression law and proec collecive-bargaining

righs or public-secor unions. Posner graduaed wih a bachelors degree in

poliical science rom Brown Universiy. He hails rom Cambridge, Massachusets.


23/28


Methodology

Tis repors analysis relied primarily on wo daa sources provided by he U.S.

Census Bureau. Te rs is he Small Area Healh Insurance Esimaes, or SAHIE,

which provides model-based esimaes o insured and uninsured populaions

down o he couny level. Te numbers do no represen specic individuals,

bu raher are projecions based on hard daa gahered in he Censuss American

Communiy Survey, or ACS; demographic populaion esimaes; Childrens

Healh Insurance Program, or CHIP; paricipaion records; and oher sources.

More inormaion on SAHIEs mehodology is available a htp://www.census.gov/did/www/sahie/mehods/index.hml.

SAHIE breaks down couny-level insurance gures by a number o subgroups,

including gender, age, and income, all o which were used o generae he liss pre-

sened in his repor. Bu i does no oer couny-level gures by race or ehniciy.

Tereore, he daa we used o examine insurance coverage raes among Arican

Americans and Hispanics came rom he Censuss American Communiy Survey.

As a saisical survey, he ACS is limied in he couny-level daa i can produce

given sample sizecounies ha are oo small o have reliable daa on any given

opic are omited. o compensae or his, we used hree-year esimaes o healh

insurance coverage, which provide a more complee picure. Bu when looking

a hree-year esimaes among specic racial or ehnic groups, here are sill a num-

ber o smaller counies or which no daa are available.

Calculating the 30 worst counties

Te 30 wors counies were evaluaed by deermining which counies ell amonghe very wors counies in he naion along ve key acors: overall uninsured,

uninsured among women, uninsured among all hose ages 18 o 39, uninsured

among men ages 18 o 39, and uninsured among hose making beween 138

percen and 400 percen o he ederal povery line. I a couny was among he 200


24/28


wors in all ve o hese acors, i was included in he lis, or a oal o 30 counies

wih populaions above 25,000. Using he SAHIE daabase, his was drawn rom

daa or 3,142 couniesmeaning ha every couny on he lis is below he 10h

percenile or healh insurance coverage on each o hese ve acors.

While his is by no means he only way o calculae he wors counies in henaion, we el ha i appropriaely demonsraes counies ha suer rom some

o he highes levels o uninsurance across a variey o groups and hereore would

sand o bene when he Aordable Care Ac akes ull eec.

Selecting the factors

Te repor elaboraes on why each o he groups acored ino he overall lis o

wors counies is criical o consideraion. Tese are a variey o groups ha show

how many dieren populaions will bene rom he law. Te wors counies henare counies ha consisenly have some o he very highes raes o uninsurance

across all o hese varied groups. From a mehodological perspecive, we excluded

considering he counies wih high raes o Arican American and Hispanic

uninsured rom he overall wors counies because while all ohers came rom he

SAHIE daabase, hose daa were aken rom he American Communiy Survey.

Dieren mehods o esimaion and dieren populaion values make compari-

sons beween hem ill-advised. Addiionally, here were some counies or which

daa or Hispanic and Arican American insurance raes were no available.

Why counties with more than 25,000 people?

A nal mehodological consideraion was o only display counies ha had popu-

laions above 25,000 in boh he overall analysis o wors counies and or each

o he ables o subgroups. American Communiy Survey daa omi a number o

counies, especially hose ha are smaller. Moreover, smaller counies are more

likely o be exposed o a number o oher ouside acors ha would abnormally

infuence insurance raes. A populaion o 25,000 was deermined o be he num-

ber ha bes balanced hese consideraions wih he goal o sill casing as wide ane as possible.


25/28


1 Sandya Smasar and Lnny Brnsn, NFL saysn prmng obamacar, The Washington Post,Jun 28, 2013, aalabl a p://www.wasngn-ps.cm/nanal/al-scnc/n-says-n--prmng-bamacar/2013/06/28/1d02a1-026-112-b2d4-a6d8477a01_sry.ml.

2 Jnaan Cn, Flagran Ful: t GoPs Lasobamacar Aac, New Republic, July 1, 2013, aalabla p://www.nwrpublc.cm/arcl/113711/rpub-lcans-pr-sprs-lagus-say-away-bamacar#.

3 3 Nrm ornsn, t Unprcdnd, CnmpblGoP Qus Sabag obamacar, t Alanc,July25, 2013, aalabl a p://www.alanc.cm/pl-cs/arc/2013/07/-unprcdnd-cnmp-bl-gp-qus--sabag-bamacar/278098/.

4 Nam N. Ly, GoP slams undrasng, r rs prm obama al law, Los Angeles Times, May13, 2013, aalabl a p://arcls.lams.cm/2013/may/13/nan/la-na-al-law-undrasng-20130514.

5 Quc ta: W Bns rm ACA Mdcadexpansn, t hnry J. kasr Famly Fundan,

Jun 14, 201 2, aalabl a p://.rg/al-rrm/ac-s/w-bns-rm--aca-mdcad-xpansn/.

6 Wr ac sa sands n ACAs Mdcad xpan-sn, t Adsry Bard, Jun 14, 2013, aalabl ap://www.adsry.cm/Daly-Brng/2012/11/09/MdcadMap#lgbx/0/.

7 ibd.

8 tara Culp-Rsslr, obamacar has hlpd SnrsSa or $6 Blln on tr Prscrpn Drugs,

tnPrgrss, Marc 21, 2013, aalabl a p://n-prgrss.rg/al/2013/03/21/1754711/bamacar-dnu-l-6-blln/.

9 U.S. Dparmn hal and human Srcs, Cn-sumrs Sad $3.9 blln n Prmums n 2012, Prss

rlas, Jun 20, 2013, aalabl a p://www.s.g/nws/prss/2013prs/06/20130620a.ml.

10 Apprd Mnly Prmum Ras r inddualhal insuranc Crag n Nw Yr Sa, TheNew York Times, aalabl a p://www.nyms.cm/nrac/2013/07/16/al/17nsuranc-dcumn.ml?r=al&_r=2& (las accssd July 2013).

11 Rn Caryn Rabn and Rd Ablsn, hal PlanCs r Nw Yrrs S Fall 50%, The New YorkTimes, July 16, 2013, aalabl a p://www.nyms.cm/2013/07/17/al/al-plan-cs-r-nw-yrrs-s--all-50.ml?pagwand=all&_r=1&.

12 igr vlsy, tans t obamacar, Nw Yrrshal insuranc Prmums Wll Plung 5 0 Prcn,

tnPrgrss,July 17, 2013, aalabl a p://n-prgrss.rg/al/2013/07/17/2313111/ans--

bamacar-nw-yrrs-al-nsuranc-prmums-wll-plung-50-prcn/.

13 Sara kl, Calrna obamacar prmums: N rasc r, t Wasngn Ps Wnblg, May 23,2013, aalabl a p://www.wasngnps.cm/blgs/wnblg/wp/2013/05/23/calrna-bam-acar-prmums-n-ra-sc-r/?wprss=rss_zra-ln&wpsrc=nl_wn_b.

14 ezra kln and ean Slas, Sm ry gd nws robamacar, t Wasngn Ps Wnblg,May 24,2013, aalabl a p://www.wasngnps.cm/blgs/wnblg/wp/2013/05/24/wnb-sm-ry-gd-nws-r-bamacar/.

15 M Dnnsn, insuranc cmmssnr: Prc plcs rd n obamacar xcang n Mnanarlaly lss xpns, The Billings Gazette,Jun 25,2013, aalabl a p://bllngsg az.cm/nws/sa-and-rgnal/mnana/nsuranc-cmmssnr-prc--plcs-rd-n-bamacar-xcang-n/arcl_0cb5aada-ad-5da7-b1-69c44a606342.ml#xzz2XkML3di3.

16 Lna h. Sun, Maryland ssus nsuranc ras a aramng lws n U.S., The Washington Post, July26, 2013, aalabl a p://www.wasngnps.cm/lcal/maryland-ssus-nsuranc-ras-amng-lws-n-us/2013/07/26/724552-612-112-a21-a7ac9bd5d3a_sry.ml.

17 ibd.

18 Fr mr nrman n r ways Ard-

abl Car Ac s drng dwn al car css, semly osma L, only 3 Yars old, ArdablCar Ac is Alrady hang a Bg impac, Cnr rAmrcan Prgrss, Marc 25, 2013, aalabl ap://www.amrcanprgrss.rg/ssus/alcar/nws/2013/03/25/57946/nly-3-yars-ld--ard-abl-car-ac-s-alrady-ang-a-bg-mpac/.

19 t W hus, tax Rl r Mddl-Class Famlsand Small Busnsss, aalabl a p://www.w-us.g/cnmy/jbs/ax-rl-r-160-mlln-wrrs (las accssd July 2013).

20 L, only 3 Yars old, Ardabl Car Ac isAlrady hang a Bg impac.

21 Agncy r halcar Rsarc and Qualy, Accss hal Car,aalabl a p://www.arq.g/rsarc/ndngs/nqrdr/nqr11/cap9.ml (las

accssd July 2013).

22 halCar.g, Wa ds Marplac alnsuranc cr?, aalabl a ps://www.alcar.g/wa-ds-marplac-al-nsuranc-cr/(las accssd July 2013).

23 U.S. Dparmn hal and human Srcs, A-rdabl Car Ac xndd r prn car 71mlln Amrcans w pra al nsuranc, Prssrlas, Marc 18, 2013, aalabl a p://www.s.g/nws/prss/2013prs/03/20130318a.ml.

24 L, only 3 Yars old, Ardabl Car Ac isAlrady hang a Bg impac.

25 ibd.

26 Lndsay Rsnal, tr is a L Clbra r

Wmns hal n trd Annrsary obam-acar, Cnr r Amrcan Prgrss, Marc 29, 2013,aalabl a p://www.amrcanprgrss.rg/ssus/alcar/nws/2013/03/29/58344/r-s-a-l--clbra-r-wmns-al-n--rd-annrsary--bamacar/.

Endnotes


26/28


27 U.S. Dparmn hal and human Srcs, or-w Unnsurd n Und Sas: A Summary 2012 Currn Ppulan Sury Rpr (2012),aalabl a p://asp.s.g/al/rprs/2012/unnsurdnus/b.sml.

28 Maura Calsyn and Lndsay Rsnal, hw A-rdabl Car Ac hlps Yung Aduls (Wasngn:Cnr r Amrcan Prgrss, 2013), aalabl ap://www.amrcanprgrss.rg/ssus/alcar/rpr/2013/05/20/63792/w--ardabl-car-ac-lps-yung-aduls/.

29 Calsyn and Rsnal, hw Ardabl Car Achlps Yung Aduls.

30 U.S. Dparmn hal and human Srcs, or-w Unnsurd n Und Sas.

31 Dan Mangan, Mdcal Blls Ar t Bggs Caus USBanrupcs, CNBC Nws, Jun 25, 2013, aalabl ap://www.cnbc.cm/d/100840148.

32 Bggs caus prsnal banrupcy: Mdcal blls,NBC Nws, Jun 25, 2013, aalabl a p://www.nbcnws.cm/busnss/bggs-caus-prsnal-ban-rupcy-mdcal-blls-6C10442408.

33 Calsyn and Rsnal, hw Ardabl Car Achlps Yung Aduls.

34 Cnrs r Mdcar & Mdcad Srcs, hw Ardabl Car Ac is hlpng Mn Lad halrLs & Ard hal in suranc, Prss rlas,Jun 14,2013, aalabl a p://www.cms.g/Nwsrm/MdaRlasDaabas/Fac-Ss/2013-Fac-Ss-ims/2013-06-14.ml


36 Alug subjc Mdcad xpansn susd prmary scp s rpr, s wrnng a narly 17 mlln Amrcans wuld gancrag rug Mdcad xpansn all sasparcpad n xpansn. Fr nrman nw Mdcad xpansn culd mpr alsaus mllns Amrcans and rduc mralyras, s karn Bacr and Amy Fnlsn, tecs Mdcad CragLarnng rm

orgn exprmn, Nw england Jurnal Mdcn,Augus 25, 2011, aalabl a p://www.njm.rg/d/ull/10.1056/NeJMp1108222; Bnjamn D. Smmrs,karn Bacr, and Arnld M. epsn, Mralyand Accss Car amng Aduls ar Sa Mdcadexpansns, Nw england Jurnal Mdcn,Spmbr 13, 2012, aalabl a p://www.njm.rg/d/ull/10.1056/NeJMsa1202099. Many cnsragrnrs and sa lgslaurs, wr, a csnn mplmn law. Sas suc as olama,

txas, and Lusana a n sug pass blls awuld nully Ardabl Car Ac n r sa.

37 t hnry J. kasr Famly Fundan, Subsdy Cal-cular, aalabl a p://.rg/nrac/subsdy-calcular/ (las accssd July 2013).

38 Famls USA, 2013 Fdral Pry Gudlns, aal-abl a p://www.amlsusa.rg/rsurcs/ls-r-

adcas/guds/dral-pry-gudlns.ml (lasaccssd July 2013).

39 t Small Ara hal insuranc esmas, wc was surc r daa n un nsurd by cuny rs mang bwn 138 prcn and 400 prcn dral pry ll, ds n bra dwn 100 prcn 400 prcn dral pry ll.

trr, smas unnsurd lsd acuallyundrcuns numbr wrng-class nddu-als n s cuns w qualy r ax crds andcs-sarng subsds undr al car law. Mrnrman n SAhies mdlgy s aalabl ap://www.cnsus.g/dd/www/sa/mds/ndx.ml.


41 U.S. Dparmn hal and human Srcs, ofc Mnry hal, Amrcan indan/Alasa NaPrl, aalabl a p://mnryal.s.g/mplas/brws.aspx?ll=2&lliD=52 (las accssdJuly 2013).

42 U.S. Cnsus Burau, Small Ara hal insuranc es-mas, aalabl a p://www.cnsus.g/dd/www/sa/daa/nrac/ (las accssd July 2013).

43 ibd.

44 ibd.

45 ibd.

46 U.S. Cnsus Burau, Amrcan Cmmuny Sury,r-yar smas rm 2008 rug 2010. Ac-cssd usng U.S. Cnsus Burau, Amrcan Fac Fndr,aalabl a p://acndr2.cnsus.g/acs/na/js/pags/ndx.xml (las accssd July 2013).

47 Cnrs r Dsas Cnrl and Prnn, inracDabs Alass, aalabl a p://www.cdc.g/dabs/alas/ (las accssd July 2013).

48 Cmms n enrgy and Cmmrc, Ways andMans, and educan and Wrrc, Bns hal Car Rrm Law n 17 CngrssnalDsrc Flrda (2013), aalabl a p://usdcs.us.g/nrgycmmrc_dm/cc_2013/hal-Car-Rrm-Bns-FL-Dsrc-17.pd.

49 ibd.

50 Basd n nrnal calculans. Addnally, r s ac haywr Amndmn h.R. 1 nFbruary 19, 2011 r wc r s n rcrdd .

t haywr Amndmn was n ncludd n calculan bcaus lac a rcrdd .

51 Rp. tmas Rny, Rny: Flrda Can A-rd obamacar Mandas, Prss rlas, Janu-ary 7, 20 13, aalabl a p://rny.us.g/ndx.pp?pn=cm_cnn&w=arcl&d=3453:rny-rda-can-ard-bamacar-mandas&cad=50:2012-prss-rlass

52 U.S. Cnsus Burau, Sa & Cuny QucFacs: DSCuny, Flrda, aalabl a p://qucacs.cnsus.g/qd/sas/12/12027.ml (las accssd July 2013).

53 U.S. Burau Labr Sascs, Lcal Ara Unmply-

mn Sascs Map, aalabl a p://daa.bls.g/map/MaptlSrl?sury=la (las accssd July2013).


27/28


54 U.S. Cnsus Burau, Small Ara hal insurancesmas.

55 ibd.

56 U.S. Cnsus Burau, Amrcan Cmmuny Sury,r-yar smas rm 2008 rug 2010. Ac-cssd usng U.S. Cnsus Burau, Amrcan Fac Fndr.

57 Cnrs r Dsas Cnrl and Prnn, inracAlas har Dsas and Sr tabls, aalabl ap://apps.nccd.cdc.g/DhDSPAlas/rprs.aspx (las

accssd July 2013).

58 obamaCar wll dsry txas prspr y, Rp. SScman blg, January 10, 2013, aalabl a p://scman.us.g/mda-cnr/blg-pss/bam-acar-wll-dsry-xas-prspry.

59 U.S. Cnsus Burau, Sa & Cuny QucFacs: PlCuny, txas, aalabl a p://qucacs.cnsus.g/qd/sas/48/48373.ml (las accssd July 2013).

60 U.S. Burau Labr Sascs, Lcal Ara Unmply-mn Sascs Map, aalabl a p://daa.bls.g/map/MaptlSrl?sury=la (las accssd July2013).

61 U.S. Cnsus Burau, Small Ara hal insurancesmas.

62 ibd.

63 ibd.

64 ibd.

65 Cnrs r Dsas Cnrl and Prnn, inracDabs Alass.

66 Rp. Bn Lujan, hal insuranc Rrm, aalabl ap://lujan.us.g/ndx.pp?pn=cm_cnn&w=arcl&d=240&imd=85 (las accssd July

2013).

67 Rp. S Parc, Amrcans Nd Ral halcar S-luns, Prss rlas, May 26, 2013, aalabl a p://parc.us.g/prss-rlas/parc-amrcans-nd-ral-alcar-sluns.

68 U.S. Cnsus Burau, Sa & Cuny QucFacs: Mckn-ly Cuny, Nw Mxc, aalabl a p://qucacs.cnsus.g/qd/sas/35/35031.ml (las accssdJuly 2013).

69 U.S. Burau Labr Sascs, Lcal Ara Unmply-mn Sascs Map, aalabl a p://daa.bls.g/map/MaptlSrl?sury=la (las accssd July2013).


28/28

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