Health Care Insurance

Insurance:

Status and Characteristics

There are uninsured residents in every county, but the highest concentrations are found in Jackson, Johnson and Wyandotte counties.

In order to report data for the smallest counties, the American Community Survey (ACS) collects survey responses over a five-year period in order to achieve a sample size sufficient to produce statistically reliable results. The latest data was collected during the 2012–2016 period, known as the 2016 ACS 5-year data. While not as useful as 1-year data in tracking trends, it provides the only data allowing uninsurance rates to be consistently compared across all the counties in the REACH service area.

Based on the 2016 ACS 5-year data, about 10.6 percent of the civilian, non-institutionalized residents of the Kansas City metropolitan area were uninsured. Two counties have uninsurance rates substantially greater than the metropolitan average – Wyandotte at 21 percent and Jackson at 13.3 percent. Two counties have proportions of residents without health insurance that are roughly equal to the metro average — Allen at 10.3 percent and Lafayette at 9.9 percent. Somewhat lower than the regional average are Clay (9.1 percent), Ray (9.1 percent) and Cass (8.4 percent). The remaining counties all have proportions of residents who are uninsured that are substantially lower than the overall metropolitan area, from 7.5 percent in Platte County to a low of 6.5 percent in Leavenworth County.

When examining the number of uninsured by county, a somewhat different picture emerges. As might be expected, the largest counties contain the largest number of uninsured residents. Jackson County is home to nearly 90,000 uninsured residents, or 42 percent of the metro total.

About 38,000 residents of Johnson County and 34,000 residents of Wyandotte are uninsured, accounting for 17 percent and 16 percent, respectively, of the region’s uninsured. About 21,000 Clay county residents are uninsured, or 10 percent of the total. No other county accounts for more than 4 percent of the region’s uninsured population.

Unlike the general population, the majority of the uninsured are adults between the ages of 18 and 54.

Compared to the general population, the uninsured are disproportionately young adults. About 16 percent of the uninsured are between the ages of 18 and 24, twice the 8 percent of the general population that are in this age group. Similarly, 25 percent of those without health insurance are 25 to 34 years of age, compared to 14 percent of the general population. Conversely, the uninsured are disproportionately underrepresented in both older and younger age groups. This due to the availability of public insurance programs for these age groups — Medicare for the elderly and the Children’s Health Insurance Program.

Whites are underrepresented among the uninsured, while minorities are overrepresented.

Hispanics are the most likely race or ethnic group to be uninsured, as 28 percent don’t have any health insurance. Blacks and Asians are uninsured at rates that are significantly lower than Hispanics, 16 percent and 14 percent, respectively. Still, these rates are significantly higher than that of whites, with an uninsurance rate of only 7.5 percent.

Nonetheless, because whites are the largest racial and ethnic group in the region, about half of all those who are uninsured are white. Hispanics comprise nearly a quarter of the uninsured, while blacks comprise nearly a fifth.

Nearly 50 percent of non-citizens don’t have health insurance.

Only 9 percent of those born in the U.S. don’t have health insurance, compared to 35 percent of those who are foreign-born. Of those that are foreign-born, those who are naturalized citizens are uninsured at rates only about 5 percent higher than native-born citizens. People who aren’t citizens, however, have among the highest uninsurance rates of any demographic group, and nearly 50 percent don’t have any health insurance.

Nonetheless, because foreign born residents are relatively small in number, they comprise only 21 percent of residents without insurance, while nearly 80 percent of Kansas City area residents without health insurance are native born.

The uninsured tend to have less education, leading to employment in occupations where part-time work is the norm and an unemployment rate three times the regional average.

Lower levels of education are strongly associated with a higher likelihood of being uninsured. About 31 percent of residents without a high school degree don’t have health insurance, making them at twice as likely to be uninsured as residents who have graduated high school, and nearly 10 times as likely as those with a bachelor’s degree or higher.

Yet, those without a high school diploma comprise only 8 percent of the region’s adult population at least 25 years old, while those with a high school degree comprise 26 percent and those with a bachelor’s degree or higher comprise 35 percent. As a result, the educational attainment of the uninsured is more evenly distributed across educational levels than the above figures would seem to indicate. Residents who don’t have a high school degree account for less than a quarter of the uninsured. High school graduates, due to their larger numbers, account for slightly more than one-third of the uninsured, while those with an associate degree account for slightly less than one-third. Meanwhile, residents with a bachelor’s degree or higher only account for 11 percent of the uninsured.

The uninsured have half the wages, half the household income and twice the poverty rate of the general population in the Kansas City region.

The story for income is much the same as it is for educational attainment, as lower levels of income are also strongly associated with a higher likelihood of being uninsured. About 23 percent of residents in households making less than $25,000 per year don’t have health insurance, compared to 17 percent of those in households making between $25,000 and $50,000, 11 percent of those making $50,000 to $75,000 and only 3 percent of those with household incomes of at least $100,000.

Despite their much higher likelihood of not having health insurance, those earning below $25,000 a year comprise a slightly smaller fraction of the uninsured than those earning $25,000 to $50,000. This is because residents in the former group comprise a significantly smaller share of the overall population than the latter, 14 percent vs. 20 percent. Still, these people in these two income groups are disproportionately represented in the ranks of the uninsured as, when combined, those earning less than $50,000 per year comprise 63 percent of the uninsured but only 34 percent of the population. Conversely, those earning $75,000 or more comprise only 19 percent of the uninsured but 47 percent of the population.

The Affordable Care Act (ACA) allowed states to expand Medicaid benefits to those living in households with incomes below 138 percent of the federal poverty level, which is calculated based on both income and the number of people in the household. In part because both Kansas and Missouri did not expand Medicaid, metro area residents living in households with incomes below 138 percent of the poverty level still are much more likely to be uninsured than other income groups, as roughly one-quarter of them don’t have health insurance. This compares to about one-fifth of those with incomes between 138 percent and 200 percent. The likelihood of being uninsured drops to under one in ten for those with incomes between 200 and 300 percent of poverty, and to one in 40 for those with household incomes of at least 400 percent of poverty.

As a result, those with incomes near the federal poverty level are disproportionately uninsured. Often 200 percent of poverty is used as a definition of low-income households to allow for the fact that when the official poverty level was initially developed, health care and childcare costs were not considered. Those who are uninsured disproportionately reside in such households at rates that are two to three times that of the general population. Overall, about 28 percent of the population lives in households with incomes below 200 percent of poverty compared to 62 percent of the uninsured. Conversely, 55 percent of residents live in households with incomes above 300 percent of poverty, compared to only 19 percent of those who are uninsured.