Profile of Those Without Health Insurance in Bexar County, Texas

Juanita M. Firestone, Ph.D.
Richard J. Harris, Ph.D.
MRPI Faculty Associates

ISSUE: Analyses over the issue of health insurance too often focus only on identifying the proportion of the general population without health insurance based on indicators such as sex, race, ethnicity, employment status and household type. While useful, these examinations only tell part of the story. This brief provides a detailed profile of the uninsured in Bexar County by examining those who are uninsured and identifying their demographic characteristics. In other words, are there important demographic characteristics of the uninsured in Bexar County? And, how can these patterns inform public policy alternatives to this issue?

DATA AND METHODS: Data from the March Annual Demographic Files of the Current Population Surveys conducted by the U.S. Bureau of Labor Statistics and the Bureau of the Census are used here to develop a demographic profile of those uninsured in Bexar County, Texas.

FINDINGS: Figures 1 - 7 display the characteristics of individuals without insurance in Bexar County.

In terms of age, two age categories stand out as having large proportions of individuals with no health insurance (see Figure 1). Close to thirty percent of individuals without insurance in Bexar County are between 40 and 64 years of age. The next largest age category of uninsured individuals, twenty-seven percent (26.5), are those seventeen or younger. Over sixteen percent of uninsured individuals who reported no heath insurance are between the ages of 18 -24. The uninsured are least likely to be found in the sixty-five and over age group (0.2%) because this cohort is typically covered by Medicare and/or Medicaid.

Of individuals who reported having no health insurance in Bexar County, sixty-nine percent (69%) are Hispanics, one-fourth (25%) are White, non-Hispanics, about three percent (3.4%) are African Americans, two percent (2.4%) are Asians and, less than one percent (0.2%) are Native Americans (see Figure 2).

Figure 3, demonstrates that the uninsured are nearly equally distributed in terms of gender; close to forty-nine percent (48.7%) are female and fifty-one percent (51.3%) are male.

Figure 4 reveals that over sixty percent (63.4%) of the respondents who declared they had no health insurance were from households where both the husband and wife were present. Of the uninsured, over a quarter (27.5%) were female household families, while about nine percent (9.2%) of the uninsured were male-headed households.

Among the uninsured, almost forty-seven percent (46.6) have never been married, and over one third (34.7%) are married individuals living with their spouse.

Importantly, almost thirty-five percent (34.7) of individuals who indicated that they did not have health insurance are employed full time. This figure compares to about twenty-two percent (21.7%) of the uninsured who indicated that they were not in the labor force and seventeen percent (17.2) who indicated that they were employed part time (see Figure 6).

The impact of education on chances of not having health insurance is also dramatic. Over one third (36.4%) of individuals, who reported that they had no health insurance, had not completed a high school degree. In addition, nearly an additional one-third (31.1%) have only a high school education. Over one fourth (25.5%) of the uninsured, have some college, about six percent (6.1%) have a Bachelor's degree, less than one percent (.7%) have either Master's degree and less than one half percent (.2%) have advanced degrees (Ph.D. or Professional degree such as Law or Medicine).

DISCUSSION: Results indicate that the "typical" uninsured person in San Antonio is most likely to be Hispanic, male, married living with his spouse and children, employed full time, between the ages of 40 and 64, and have not completed high school. It is important to note that, while unemployment is associated with higher percentages without health insurance, even full time employment does not guarantee adequate insurance coverage. By focusing on the characteristics of individuals who are uninsured, we see that those without health insurance in Bexar County are similar to the "working poor." This profile is very different from the stereotypes that individuals who have no health insurance are "unemployed, on welfare or otherwise indigent."

Uninsured individuals are likely to be substantially worse off than are those with insurance on measures of health access and health status. Individuals who lack insurance are very likely faced with unmet medical needs when sick and an inability to pay medical bills. An important challenge for the San Antonio metropolitan area will be to continue to find strategies that will improve access to affordable health insurance coverage. Moreover, since a large proportion of the uninsured are employed, the challenge will be to find solutions that fit the reality of the San Antonio workforce.

RECOMMENDATIONS: To effectively confront the issue of the lack of health insurance in the San Antonio metropolitan area, civic leaders must commit to:

1. Examining the changing workforce and economy and its substantive implications for available, affordable and accessible health insurance;
2. Improving the continuity, quality, and affordability of health insurance for working families; and
3. Taking a proactive stand on finding creative ways to expand health insurance coverage to those who fall out of the current safety net.