Suburban Population Makes Up Large Portion of the Uninsured in the US

A significant proportion of the uninsured population in the United States lives in suburban areas, which is a deviation from historic findings, according to a study.

A recent study, published in Health Affairs, compared the patterns of insurance coverage and healthcare access in suburban, urban, and rural areas through an investigation of data from 2005 to 2015 to compare outcomes before and after the implementation of the Affordable Care Act.

The researchers collected data from the 2005 to 2015 waves of the Behavioral Risk Factor Surveillance System (BRFSS), a national cross-sectional telephone survey of noninstitutionalized adults (over the age of 18). The study defined suburban as the areas outside the center city of a Metropolitan Statistical Area (MSA), but inside the county containing the center city, and the areas inside a suburban county of the MSA. The sample included individuals between the ages of 18 to 64 and their access to health insurance coverage and access to health care was assessed using the data from the BRFSS.

“Historically, rates of health insurance coverage have been higher in suburban areas than urban or rural areas, but the recent rapid uptick in suburban poverty has likely affected uninsurance rates in the suburbs, as people living below poverty are at high risk of being uninsured,” the authors explained.

The study found that the suburbs made up 38.4% of the population and 41.2% of the uninsured population, with an uninsured rate of 18.7%. The uninsurance rate also was lower in the suburbs, when compared to other geographical areas, but narrowed over time until 2015, when the rate was practically equal to the urban areas. Additionally, the adjusted probability of having no usual source of care in the suburbs was 20.1% and 34.7% for having no receipt of a routine check-up.

When considering income categories, 36.4% of low income people in the suburbs had an unmet need because of the cost and 42.4% had not had a recent check-up. Also, the study found that the coverage and access outcomes increased following the Affordable Care Act, as there was a 3.8% drop in the uninsurance rate in suburban areas.

“Although the suburbs do have a small advantage over urban and rural areas for our unadjusted study measures, overall uninsurance rates there were not low, and access barriers were quite common, particularly for low-income adults,” the authors noted. “After adjustment for demographic differences by area, rates of access to care were similar across all geographic areas. This implies that living in the suburbs provides little if any protective effect, after income and other demographic features are taken into account.”

The authors recommend increased attention to the issues of the relation of healthcare access and coverage to certain geographic areas. The results could help shape future healthcare policies in the United States.