Many Suburban Americans Lack Health Insurance

With the creation of the Affordable Care Act (ACA), obtaining health insurance has never been easier, especially for those in between jobs or whose employers do not offer coverage. Despite the uninsured rate hitting a record low recently, millions of Americans are still without insurance.

A new study published by Health Affairs suggests that 1 in 7 Americans living in the suburbs is uninsured. The authors found that nearly 40% of the uninsured population lives in the suburbs, an area that is generally thought to be more affluent than other regions.

These results suggest that lower income individuals living in suburban areas are facing similar barriers to healthcare as those living in urban and rural areas.

“We rarely think about suburbs when we think about vulnerable populations,” said lead author Alina Schnake-Mahl. “Increasing rates of suburban poverty haven’t gotten much attention from the public health sector, and policymakers really haven’t started to consider what these shifts in the geography of poverty mean for healthcare access and for health disparities.”

The authors said that suburban poverty has increased due to the 2008 recession, millennials and older adults moving to cities, more affordable housing options in the suburbs, and immigration to these areas, according to the study.

Included in the study were data from 2.7 million adults who participated in the CDC’s Behavior Risk Factor Surveillance System. This was the first national study to compare healthcare coverage and access in suburban, urban, and rural areas.

The authors found the suburbs are home to 38% of the uninsured population, with an uninsured rate of 15%, according to the study.

The authors discovered that the likelihood of not having a usual source of care was 19% in the suburbs, with 34% of the population foregoing an annual physician’s visit.

Low income adults were 8 times more likely to be uninsured and 1.7 times more likely to not have received a recent checkup compared with higher-income individuals, regardless of their geographic location, according to the study.

The authors note that insurance gains in the suburbs have been limited compared with urban and rural areas, even under the ACA. By 2015, the uninsured rates for the suburbs was similar to urban areas.

The investigators speculate that several factors play a role in barriers to healthcare, including a lack of community health centers and free clinics, safety net hospitals far from suburban areas with limited transportation options, providers who may not be willing to treat uninsured patients, and limited mental health services and substance abuse treatment, according to the study.

“In most studies, suburban areas are grouped with urban areas. But suburbs are unique geographies with specific challenges for healthcare access,” Schnake-Mahl said. “Providing services and care to the suburban poor population may require different policies than those typically relied on in urban or rural areas.”