Last night at his 100-Day press conference, President Obama again promised that health care reform would be a high priority, right behind the economy in the first year. This raised a question in my mind; is there a geographic constituency for health care reform? What might it look like?
In 2005, the U.S. Census estimated the size of the uninsured population for every county in the nation. The result is mapped below as the percentage of each county’s population (under age 65, since the elderly are covered by Medicare) that has no health care coverage:
Clearly the South and Southwest stand out on this map as areas where the uninsured are highly concentrated. In the Deep South states, across counties, the percentage uninsured runs 5.5 percent higher, on average, than everywhere else in the nation. In Texas and Oklahoma, the percentage uninsured runs 10 percentage points higher than elsewhere.
In the Southwest and Western U.S. the percentage of uninsured residents is also very high, partly due to large uninsured immigrant populations (both legal and illegal). Immigrants are about 2.5 times more likely to be uninsured than natives. An estimated one-third of Latinos are without health insurance, the highest rate for any ethnic group. Californians and Arizonans are, by now, very familiar with the health care and general fiscal impact of high levels of immigration—a reminder that health care reform and immigration reform are linked. Immigration is a challenge for policymakers who are trying to reduce the size of the uninsured population.
The president was much less clear in his remarks about when he might take on the immigration issue. But does an expansive new health care plan for the uninsured make sense as long as the immigrant inflow is as large as it is?
The geographic concentration of the uninsured seems a bit ironic, given that the South and Southwest are not known for being Democratic strongholds agitating for a universal-coverage-single-payer system. But most of the uninsured fall heavily among the ranks of non-voters. The Republican congressional delegations from these states have little political incentive to work on this issue with President Obama. But the President doesn’t look like he needs them, either.
Republicans, for their part, will rightly be focused on the bottom line—emphasizing the fiscal and tax implications of a generous new health care plan in the presence of what is among the world’s most generous and lenient of immigration policies.