MCDC News and Updates

Map of the Month

Missouri’s Uninsured Population, Before and After ACA

In March 2015, the U.S. Census released the 2013 data collected by the Small Area Health Insurance Estimates Program (SAHIE). The SAHIE data is a valuable reference that provides annual estimates of health insurance coverage for every county in the United States. That year, MCDC published a map showing insurance coverage rates for Missouri counties. The 2013 SAHIE data was of particular interest, as that was the last round collected before the first enrollment period of the Affordable Care Act (ACA, or “Obamacare”).

More than five years have passed since the Affordable Care Act was enacted, and we now have an opportunity to compare rates of uninsured persons across Missouri between 2013 and 2018. These two maps both use SAHIE data and the same value scale. (Note that the 2013 map shown here differs slightly from the one we published in 2015. This is due to a different classification scheme, but the underlying data is the same.)

Uninsured in Missouri, before and after ACA

Taking a look first at the 2013 map, we can see that the percentage of uninsured working adults aged 18-64 in Missouri ranged from a low of 11.6% in St. Charles County to a high of 29,3% in Knox County. All counties in the state had an uninsured working population of 11.6% or greater.

The picture is quite different in 2018. Almost all Missouri counties now have uninsured rates of less than 20%, with many under 15%, especially in the central areas of the state. A few counties in the Kansas City and St. Louis areas have uninsured rates of less than 10%.

More significantly, the number and rates of Missouri’s most-uninsured counties have gone down substantially. In 2013, there were 20 Missouri counties where more than a quarter of the adult population were uninsured. By 2018, there were none.

Despite the differences in uninsured rates over the five-year period, one thing hasn’t changed much: The number of hospitals. In fact, between 2013 and 2018, the number of Missouri counties that lack a hospital increased from 41 to 46, according to the Missouri Hospital Profiles By County list, maintained by the Missouri Department of Health and Senior Services (DHSS).

However, only eight of those counties — Hickory, Knox, McDonald, Morgan, Ozark, Shannon, and Wright — had uninsured populations of 20% or more in 2018. That compares with 15 counties without hospitals that had uninsured populations of 25% or more in 2013. So, the overall picture for access to affordable health care has improved.

In addition, the DHSS list of hospitals does not include smaller facilities such as rural clinics, which can better serve a rural population with higher insured rates.

Map of the Month

Selected Characteristics of Veterans in U.S. States

To mark Veteran’s Day this year, the U.S. Census Bureau published infographics detailing a variety of state-level statistically derived characteristics of the men and women who served in the U.S. Armed Forces.  The infographics covered a wide range of topics, including educational attainment, economic circumstances, health care accessibility, age, voting tendencies, and labor force statistics.

Selected characteristics of U.S. veterans, 2009-2013

Missouri appeared in the middle range in the majority of the featured national statistics when compared to the other states. Specifically, Missouri had 479,828 veterans, with over 35% of those serving in the Vietnam Era. Nearly 50,000 of these veterans owned their own business, and 5.7% were unemployed. The median household income for veterans in Missouri was $54,311.

Although only four maps are presented here, the complete set of U.S. Census infographics and the data used to create them are available at U.S. Census Veteran’s Day report.

Map of the Month

Hospital Availability and Uninsured Population in Missouri

In March 2015, the U.S. Census released the 2013 data collected by the Small Area Health Insurance Estimates Program (SAHIE). The SAHIE data is a valuable reference that provides annual estimates of health insurance coverage for every county in the United States. The 2013 SAHIE data is of particular interest, as that was the last round collected before the first enrollment period of the Affordable Care Act.

Hospital availability and estimated uninsured population in Missouri, 2013

Based on the SAHIE 2013 county-level data, the percentage of uninsured working adults aged 18-64 in Missouri ranged from a low of 11.6% in St. Charles County to a high of 29% in Knox County. This information is interesting in and of itself, as it indicates that no Missouri county had an uninsured working population of 10% or less. When combined with the locations of Missouri hospitals, though, the SAHIE data presents an important lesson.

According to the Missouri Hospital Profiles By Name list, maintained by the Missouri Dept of Health and Senior Services, 41 Missouri counties do not have a hospital within their administrative boundaries. Combining that information with the SAHIE’s estimates reveals that 15 of those counties — Benton, Carter, Daviess, Douglas, Hickory, Knox, McDonald, Morgan, Oregon, Ozark, Schuyler, Shannon, Stone, Webster, and Wright — had uninsured populations between 25.1% and 29% in 2013. Although the list of hospitals does not include smaller facilities (such as rural clinics), this overlap does strongly suggest that some of Missouri’s most medically underserved counties were also home to very high numbers of uninsured working adults.

Reference: U.S. Census report on 2013 SAHIE