The lack of medical coverage in America is a serious problem as approximately 50 million people were uninsured all through 2010. But the U.S. Supreme Court on Thursday ruled the Patient Protection and Affordable Care Act, which was passed in 2010, was constitutional. The legislation, once implemented in its entirety, is expected to cover 30 million Americans currently lacking coverage.
The lack of medical insurance has had grave consequences on individuals and the nation. In 2010 alone, 26,100 people died because they had no health insurance — that is 502 preventable deaths a week. However, some states fared better than others. Based on the latest report by Families USA, a health care consumer advocacy group, 24/7 Wall St. identified the 10 states with the highest number of deaths per 100,000 people due to a lack of insurance.
Not surprisingly, nearly all of the states with the most residents dying due to a lack of insurance also had high numbers of uninsured residents. Seven of the states on the list were among the 10 states with the highest percentage of people without health coverage. Seven of the states were also in the bottom 10 for the lowest rates of private insurance coverage.
People without health insurance often forgo medical treatment for different reasons. According to Families USA, a supporter of President Obama’s health care reform law, uninsured adults are nearly four times more likely than insured adults to delay or avoid preventive care screening due to cost. Uninsured adults are also nearly seven times more likely to go without needed care due to cost than privately insured adults.
“You still see a very, very strong correlation between uninsurance and poor healthcare outcomes — including mortality — and [that is] because people aren’t getting the type of care that they need,” Kim Bailey, the research director for Families USA, told 24/7 Wall St.
Many of the states with high death rates due to a lack of insurance also were among the poorest states in the country. The top seven states on this list also are among the 10 states with the highest poverty rates. Every state on this list is in the top half.
Poor health also appears to play an important role. States with high death rates due to lack of insurance had a high percentage of people with lifestyle-related risk factors for poor health. Of the states on our list, five of them have among the 10 highest percentages of smokers and among the 10 lowest percentages of people who eat vegetables at least three times a day. Four have among the 10 highest proportions of overweight or obese adults. Seven states on the list were in the bottom 10 in terms of life expectancy.
Based on Families USA’s report, “Dying for Coverage: The Deadly Consequences of Being Uninsured,” 24/7 Wall St. identified the 10 states with the highest number of deaths from being uninsured per 100,000 residents. 24/7 Wall St. reviewed the methodology used by Families USA, first developed in 2002 by the Institute of Medicine, to determine excess mortality from being uninsured. This method considers the proportion of people who are insured and uninsured, the mortality risks for the uninsured and the number of expected deaths from a hypothetical fully insured population. 24/7 Wall St. also identified poverty rates and median income by state, provided by the U.S. Census Bureau. The Kaiser Family Foundation’s website — Statehealthfacts.org — provided health-related data, including life expectancy, obesity and diabetes rate.
These are the 10 states dying for health coverage.
> Excess deaths from a lack of insurance (per 100,000): 11.83
> Pct. of population uninsured: 22.6% (2nd highest)
> Pct. living below the poverty line: 14.9% (tied for 23rd highest)
> Life expectancy at birth: 77.59 years (14th lowest)
Nearly 23% of Nevadans lack health insurance, the second-highest proportion of all the states in the country. At the same time, the state also has comparatively few people who are eligible for either Medicare (13.44%) or Medicaid (11%). Few states spend less per capita on health care than Nevada, which spent $5,735 per person in 2009. The state also had the nation’s highest average unemployment rate in 2010 at 13.7%, which may help contribute to residents’ inability to obtain insurance.
> Excess deaths from a lack of insurance (per 100,000): 11.95
> Pct. of population uninsured: 19.7% (5th highest)
> Pct. living below the poverty line: 17.9% (tied for 9th highest)
> Life expectancy at birth: 77.09 years (10th lowest)
With a 10.2% unemployment rate in 2010 and 17.9% of residents living below the poverty line, many Georgians simply cannot afford health care. Additionally, the state of Georgia spent just $5,467 on health care in 2009, the third-lowest figure among all states that year. The state’s ability to provide for its residents is limited. Just 16% of Georgians were in the state Medicaid program in 2010, far lower than many other states.
> Excess deaths from a lack of insurance (per 100,000): 12.02
> Pct. of population uninsured: 18.9% (7th highest)
> Pct. living below the poverty line: 16.9% (14th highest)
> Life expectancy at birth: 75.6 years (5th lowest)
It can hardly be said that Oklahomans are healthy. Among all states, Oklahoma has the third-highest percentage of adults who smoke, the sixth-highest rate of heart disease death, the seventh-highest obesity rate and a lower proportion of adults who consume fruit twice a day than any other state. Making matters worse, Oklahoma spends just over $6,500 per capita on health care — one of the lowest amounts in the United States. Relatively few residents have employer-based health coverage, and many residents cannot otherwise afford private insurance because the median household income in the state is just $42,072 — one of the lowest figures in the country.
7. West Virginia
> Excess deaths from a lack of insurance (per 100,000): 12.03
> Pct. of population uninsured: 14.6% (24th highest)
> Pct. living below the poverty line: 18.1% (8th highest)
> Life expectancy at birth: 75.16 years (2nd lowest)
West Virginia residents have the second-shortest life expectancy among all 50 states. Contributing to shorter life spans are the 26.8% of West Virginians who smoke, a higher rate than in any other state. Additionally, the Mountain State has some of the highest rates of heart disease deaths, adult obesity and diabetes in the U.S. Perhaps indicative of the cost of such poor health factors is that there are more prescription drugs filled per capita in West Virginia than in any other state.
> Excess deaths from a lack of insurance (per 100,000): 12.06
> Pct. of population uninsured: 21.3% (3rd highest)
> Pct. living below the poverty line: 16.5% (16th highest)
> Life expectancy at birth: 79.7 years (12th highest)
The sheer number of excess deaths from a lack of insurance in Florida is staggering: 12,336 from 2005 through 2010. The driving factor for this imposing total is that 21.3% of the population is uninsured — the third-highest rate among all states. Floridians may have difficulty affording health insurance — median income was just $44,400 in 2010. Meanwhile, only 45.7% of residents have employer-based health insurance, while just 15.6% of residents received Medicaid benefits. Both of these rates are among the lowest in the country.
5. New Mexico
> Excess deaths from a lack of insurance (per 100,000): 12.15
> Pct. of population uninsured: 19.6% (6th highest)
> Pct. living below the poverty line: 20.4% (tied for the highest)
> Life expectancy at birth: 78.21 years (20th lowest)
New Mexico has a fairly healthy population, with relatively low heart disease and obesity rates. However, just 55.8% of residents have private health insurance — the lowest rate of any state in the country. One possible reason is that few employers provide insurance — just 45.6% of the population has employer-based health coverage. The relative poverty of the state also means many residents cannot afford medical coverage. The median income in the state was just above $42,000 in 2010, far below the national median of about $50,000, while 20.4% of people live below the poverty line — the highest rate in the country.
4. South Carolina
> Excess deaths from a lack of insurance (per 100,000): 13.48
> Pct. of population uninsured: 17.5% (tied for 12th highest)
> Pct. living below the poverty line: 18.2% (7th highest)
> Life expectancy at birth: 76.57 years (9th lowest)
South Carolina is not a particularly healthy state: 67.4% of the state’s residents are either overweight or obese, just 23.3% eat proper amounts of fruit, only 22.9% eat proper amounts of vegetables and 10.7% are diabetic. All of these are among the highest rates in the country. Meanwhile, much of the cost of health care falls to private individuals. The state spends about $6,300 per person on health care in 2009, among the lowest levels, and just 51.9% of residents have employer-based health coverage. Unfortunately, South Carolinians have trouble affording insurance on their own: median income was just $42,000 in 2010, significantly lower than the $50,000 national average, 18.2% of residents live below the poverty line and the cost of health care is higher than many states.
> Excess deaths from a lack of insurance (per 100,000): 13.49
> Pct. of population uninsured: 17.5% (tied for 12th highest)
> Pct. living below the poverty line: 18.8% (5th highest)
> Life expectancy at birth: 76.09 years (6th lowest)
According to the Council for Community and Economic Research’s ACCRA Cost of Living Index, Arkansas had the second-lowest cost of health care in the United States. However, with 18.8% of the population living below the poverty line and a median annual household income of just $38,307 — both among the lowest figures for any state — many Arkansans cannot afford private health coverage. As a result, just 58.78% of the population has private insurance, the sixth-lowest figure in the country.
> Excess deaths from a lack of insurance (per 100,000): 14.94
> Pct. of population uninsured: 17.8% (10th highest)
> Pct. living below the poverty line: 18.7% (6th highest)
> Life expectancy at birth: 75.39 years (4th lowest)
Louisiana has one of the lowest life expectancies at birth in the U.S. at 75.4 years. Though much of this certainly can be attributed to poor health choices — the state has a higher number of smokers and its residents eat comparatively little fruit or vegetables — the inability of many residents to receive proper care due to lack of insurance is also a contributing factor. In Louisiana, 17.8% of the population goes without health insurance, despite the fact that 21.9% of the population qualifies for Medicaid — the fifth-highest proportion among all 50 states. The high uninsurance rate is partly due to the relative economic disadvantage of the state’s residents. With 18.7% of residents living below the poverty line — the sixth-highest rate in the nation — and a median income that is more than $5,000 lower than the U.S. average, just 58.39% of the population have private insurance. That is the fourth-lowest such rate in the nation.
> Excess deaths from a lack of insurance (per 100,000): 15.82
> Pct. of population uninsured: 18.2% (9th highest)
> Pct. living below the poverty line: 22.4% (tied for the highest)
> Life expectancy at birth: 74.81 years (The lowest)
Many residents of Mississippi cannot afford insurance: the state has lowest median income in the nation and the highest percentage of residents living below the poverty line. As a result, Mississippi has the second-lowest percentage of residents with private health insurance coverage, at 56.49%. Exacerbating the problem, residents are especially unhealthy. Among all states, Mississippi has the second-highest obesity rate, the second-highest percentage of adults with diabetes and the fifth-highest percentage of adult smokers in the nation. Likely the result of both high uninsurance rates and poor personal health, Mississippi is the only state where life expectancy was below 75 years at birth in 2010. Mississippi’s excess death rate was the highest among all states and twice that of 28 states in 2010.
-Alexander E. M. Hess and Samuel Weigley