Half of all uninsured Americans live in just 116 of the country’s 3,143 counties, according to a new analysis by the Associated Press. That trend also holds for the young and uninsured — half of whom live in just 108 counties — making outreach and enrollment efforts in these counties particularly important for the Affordable Care Act.
Many of the counties with the largest numbers of uninsured Americans are in high-poverty regions. For instance, nearly one in five of Los Angeles County’s 10 million residents have incomes below the Federal Poverty Line (FPL), and about five percent of all uninsured Americans live in LA.
Federal officials are concentrating enrollment efforts on highly uninsured urban areas in states that haven’t set up their own ACA marketplaces, including the counties containing Dallas, Houston, Atlanta, and Miami. Those efforts, which include a series of new ad campaigns that will intensify as the Sochi Winter Olympics begin being televised in several weeks, could prove critical — especially since previous research has found that the poorest Americans who could benefit the most from Obamacare are the least likely to know about its benefits, and the most likely to doubt the law will help them.
But the outreach campaign could hit a major roadblock in some states when it comes to signing up the poorest uninsured Americans. Texas, Florida, Georgia, North Carolina, and Tennessee have all refused Obamacare’s optional Medicaid expansion. That means that millions of the working poor in these states will fall into a coverage gap where they make too little money to qualify for federal Obamacare subsidies but too much to qualify for their state’s existing Medicaid program — a consequence of the Supreme Court’s decision to make the expansion optional.
In fact, a Commonwealth Fund study found that 42 percent of Americans living below the poverty level are in states that haven’t expanded Medicaid. Texas, Louisiana, Florida, South Carolina, North Carolina, Mississippi, and Georgia all have uninsurance rates significantly higher than the national average, and approximately 20 percent of Americans residing in these states have incomes below the poverty line. These states are also at the bottom of public health rankings, leading one doctor to call existing economic and health disparities in America “death by zip code.”