What is the uninsured medical travel opportunity in the USA?


The Affordable Care Act 2010 (ACA) increased the number of Americans with health insurance to over 91%, a national record.

The Trump administration’s attacks on healthcare and ACA are, however, likely to bring the figures down. The 2018 midterm elections also showed Democratic and Republican candidates offering vastly different solutions to combat the increasing costs of insurance and prescription drugs.

There are however many reasons, unconnected with national politics, for why millions of Americans do not have any health insurance.

8.7% US uninsured average

According to the recently published 2017 US Census Bureau data, the national average of uninsured Americans in all 50 states currently stands at 8.7%, with notable state variations dependent on regions and socio-political factors.

The state of Texas for example has the largest percent of uninsured residents at 17.3%, followed by Oklahoma with 14.2% and Alaska at 13.7%. The lowest uninsured rates are Massachusetts at 2.8%, Hawaii at 3.8% and Colombia at 3.8%.

In 2017, 8.8% of people, or 28.5 million, did not have health insurance at any point during the year. The uninsured rate and number of uninsured in 2017 were not statistically different from 2016 (8.8% or 28.1 million). Between 2016 and 2017, the percentage of people without health insurance cover decreased in three states and increased in 14 states.

Private health insurance coverage

In 2017, private health insurance coverage continued to be more prevalent than government coverage, at 67.2% and 37.7% respectively. Of the subtypes of health insurance coverage, employer-based insurance was the most common, covering 56% of the population, followed by Medicaid (19.3%), Medicare (17.2%), direct-purchase cover (16%) and military cover (4.8%).

In 2017, non-Hispanic Whites had the lowest uninsured rate at 6.3%. The uninsured rates for Blacks and Asians were 10.6 % and 7.3%, respectively. Hispanics had the highest uninsured rate at 16.1%.

So, who are the uninsured?

They tend to be 19 to 64 years old, male, have less than a high school education and/or have lower incomes. This profile is different from the profile of the overall US population. Specifically:

  • Working-age adults made up a much larger share of the uninsured population than any other age group. Most uninsured people (84.6 %) were 19 to 64 year olds. The two largest groups in that age range are 26 to 34 year olds and 35 to 44 year olds. About 1 in 4 uninsured people were 26 to 34 years old, and about 1 in 5 people were aged 34 to 44.
  • Over half of all people without health insurance coverage were male (54.6%), even though the US population has more women than men.
  • 4 in 10 uninsured people were non-Hispanic white, while nearly 6 in 10 people in the US were non-Hispanic white. Other races and ethnic groups made up most of the uninsured population but less than half (39.3%) of the total population.
  • The uninsured were disproportionately concentrated in the South.

The latest data also shows that 14% of those without health insurance are under 19 years old. That number may seem a little high, but it is relatively low, considering that children represented almost one-quarter of the US population last year. By contrast, only a small fraction of the uninsured, just 1.4 %, were age 65 and over.

Most people without health insurance coverage had a high school education or less. People who did not complete high school made up a much larger part of the uninsured population (26.9%) than the overall population (11.8%). The uninsured population was also disproportionately more likely to live in poverty. About 1 in 3 uninsured workers were in service occupations, compared with about 1 in 5 workers in the US overall.

The Census Bureau collects health insurance data using three national surveys: the Current Population Survey's Annual Social and Economic Supplement (CPS ASEC), American Community Survey (ACS), and Survey of Income and Program Participation (SIPP).

Some states have a more anti-establishment attitude to compulsory insurance. According to the Insurance Information Institute, 12.6% of American drivers had no insurance in 2012. The worst states were Oklahoma at 25.9%, and Florida at 23.8%.

Learn more about US insurance and why so few US health insurance companies offer international medical travel benefits.



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