|Detroit Health Insurance Coverage Status|
|Written by Tom Jankowski|
|Wednesday, 05 January 2011 12:51|
We recently received an inquiry from a Seniors Count! community partner, asking:
I am interested in a particular population in the City of Detroit: The near-elderly without health insurance. How many people age 55-64 are there in the city without health insurance? How many of them have pre-existing conditions that may prevent them from purchasing private health insurance?
The definitive health insurance coverage estimates are produced by the Census' American Community Survey. Those data are available for the individual years 2008 and 2009, which means that we can get estimates for the entire city, but not by subdivisions within the city, such as census tracts. The basic table on health insurance coverage status in the City of Detroit in 2009 can be found at the Census Bureau website. However, it obscures the condition of our sub-population of interest because it lumps them in with everyone between the ages of 18 and 64.
As the table shows, senior citizens and children are fairly well covered compared to adults in the middle part of life. (Note that the margin of error associated with the estimate of the propotion of uninsured elders is relatively large, and therefore somewhat unreliable.) Those between the ages of 18 and 64 are much more likely to be uninsured, at a fairly reliable rate of 26.5%. The question is, what about the near-elders, those age 55 through 64? How do they fare in health insurance coverage status? Below is a portion of Table B27001 from the 2009 ACS:
As the second table shows, those between the ages of 55 and 64 are more likely to lack health insurance coverage than their elder peers. However, they do seem to fare better than their younger compatriots in the mid-life group, with an overall uninsured rate of about 15% compared to 26.5% for the entire 18 to 64 group.
Now, what about pre-existing conditions? That is data the ACS instruments do not collect. The closest we can come to capturing pre-existing conditions is with the ACS disability measures. And, unfortunately, those numbers are not broken down in the standard tables by the smaller age group in which we are interested but only in the larger 18-64 age group shown below, from Table B18135:
Since it is impossible to go further using the standard ACS tables, we took a closer look at the data using IPUMS, the Integrated Public Use Microdata Series, produced by the Minnesota Population Center at the University of Minnesota. We cross-tabulated disability status by health insurance coverage status in the ACS 2009 1-year sample, filtering for Detroiters between the ages of 55 and 64. Since the estimation methods vary from those used to produce the standard census tables, the overall number of people in that age group is estimated to be slightly higher than that shown in the second table above (101,677 vs. 100,473), and the uninsured rate is estimated to be slightly higher (16.6% vs. 15%) as well. Furthermore, IPUMS does not provide the margins of error for raw estimates, but only for computed percentages. Finally, it should be recognized that the IPUMS results are merely estimates based on a total sample size of only 640 cases overall, and since the margins of error are not provided, the estimated numbers should be reported and interpreted very carefully. Keeping those caveats in mind, here are the IPUMS results:
Now, what does all this data tell us? It tells us that lack of health insurance appears to be a problem for Detroit residents, but disproportionately affects those in mid-life. Within that group, those people with one or more disabilities are estimated to be about half as likely to be uninsured than those with no disabilities. Using the public use microdata to separate out our population of interest, those age 55 to 64, yields similar estimates, that those with a disability are around half as likely to be without health insurance than those with no disabilities. However, the older subgroup has a higher rate of insurance coverage overall compared to the broader 18-to-64 group--our best estimates indicate that more than 1 of every 10 people age 55 to 64 with a disability in Detroit have no health insurance. Once again, our correspondent asked about pre-existing conditions, but the only health measures available in the 2009 ACS are disability measures, and once again, the estimates produced here from IPUMS data, such as the estimate that 3,778 near-elder Detroiters with a disability have no health insurance, should be used with great caution.
Please feel free to post in comments if you have any questions, concerns, or suggestions.