A large share of medically uninsured Ohioans who might be eligible for subsidized health coverage under the Affordable Care Act would come from the local area and surrounding counties, based on the most recent U.S. Census Bureau estimates.
More than 272,000 southwest Ohio residents under age 65 were uninsured in 2011 — the last year for which figures were available, according to the Census Bureau’s Small Area Health Insurance Estimates.
The figure represents about 18 percent of the nearly 1.5 million uninsured Ohioans, most of whom will be required to buy health insurance next year to satisfy the health care law’s individual mandate. The mandate requires non-exempt adults to obtain health coverage next year for themselves and any dependents or pay a tax penalty.
In Montgomery County alone, 63,646 residents were uninsured in 2011 or just over 14 percent of the nonelderly population, the Census Bureau found. Hamilton County had an uninsured rate of 13.9 percent, representing 94,671 residents; 40,693 Butler County residents had no insurance in 2011 or 12.9 percent of the nonelderly population.
Across the state, the rate of uninsurance varied widely, from a high of 23.4 percent in Holmes County to a low of 7.5 percent in Delaware County.
The largest counties tended to have the highest numbers of uninsured adults, but rural counties had the highest percentage of uninsured residents.
In the local area, for example, Darke County had the highest percentage of uninsured residents at 15.5 percent, while Warren County had the lowest percentage of uninsured at 9.1 percent — reflecting the state and national trend in which poorer rural areas generally had higher rates of uninsured than more affluent metropolitan areas.
According to the USDA Economic Research Service, the average per-capita income for Ohioans in 2011 was $37,836, while rural per-capita income lagged at $31,387.
“There are several reasons for large numbers of uninsured rural residents, including migrant farm workers, who can be seasonal and challenging socio-economic conditions,” said Tina Turner, administrator of the Ohio Department of Health’s Rural Health Unit.
“Plus, a lot of industry is farming, which would mean self-employed health insurance premiums,” said Turner, who noted that insurance rates tend to be higher for people who are self-employed or who work for very small firms.
Statewide, Ohio’s overall uninsured rate was 13.9 percent in 2011 — well below the national rate of 17.3 percent and ranking the state No. 32 for the highest percentage of uninsured residents, according to the Census report.
Texas ranked No. 1 among states for the highest uninsured rate with more than a quarter of its non-elderly population — 25.7 percent — going uninsured in 2011; followed by Florida at 24.8 percent, Nevada at 23.8 percent, and New Mexico at 23 percent.
Massachusetts, the first state to enact comprehensive health care reform in 2006, had the lowest uninsurance rate at 4.9 percent.
The health care law, which begins full implementation in January, is expected to reduce the number of uninsured in Ohioans. But experts say the numbers won’t be reduced significantly unless the state decides to expand Medicaid to all residents earning up to 138 percent of the federal poverty level as was originally proposed in the health care law.
The U.S. Supreme Court decided last year to let each state decide whether to expand Medicaid coverage, and the Ohio General Assembly is still considering its options. Gov. John Kasich supports expanding Medicaid and included it in his budget. The GOP-led legislature stripped the proposal from his budget, but negotiations are still ongoing.
Without a Medicaid expansion an estimated 1.2 million Ohioans would remain uninsured by 2022, according to a recent study from the Urban Institute. That study found the number of uninsured Ohioans would be cut almost in half to about 636,000 with an expansion of the state-federal health care program for the poor.
In all states, lack of coverage was greatest among ethnic minorities, who had higher uninsured rates compared to non-Hispanic whites.
In Ohio, the uninsured rate for Hispanics in 2011 was 26.2 percent; followed by blacks at 18 percent and non-Hispanic whites at 12.7 percent.
But whites saw the biggest jump in the uninsured population over the past five years, climbing from 10.9 percent in 2006. Hispanics saw their uninsured rate decline from 29.2 percent and the black uninsured rate remained statistically unchanged from 17.4 percent five years ago.