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U.S. Health Care Debate The Demographics of Health and Wealth
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U.S. Health Care Debate The Demographics of Health and Wealth

Recent discussions of a new U.S. health care plan have focused as much on wealth as they have on health.  To help pay for expanded coverage to the estimated 40-50 million uninsured Americans, proposals in the House of Representatives have centered on a “wealth surcharge” for high income households. The surcharges include one focused on those with combined incomes over $350,000 annually, and another on those with incomes over $1,000,000.

Looking at 210 Designated Market Areas (DMAs) across the U.S., Nielsen Claritas demographic data shows that just over 800,000 households (roughly 0.7%) earn more than $500,000. Those that make $250,000-500,000 account for an additional 1.6% for a total of 2.3% of homes that could be considered “affluent.”

Where The Wealthy Are

The top 10 most affluent markets (San Francisco, New York, W. Palm Beach, Fl., Washington D.C., Palm Springs, CA, Ft. Myers/Naples, Fl., Boston, Santa Barbara, CA, Los Angeles, and San Diego) identified in the dark green [see full graphic] account for 42.6% of all households in the U.S. earning more than $500,000. These affluent households are twice as concentrated in these markets than the USA overall. In these markets, about 1.5% have incomes $500,000+ and 2.8% have incomes $250,000-$500,000 annually.

… And Where The Uninsured Are

Not surprisingly, many of the same markets that have a large majority of high-income households also tend to be the most insured as identified by the light blue [see full graphic]. San Francisco (with 85% estimated insured) leads the way, whereas Greenville, MS (66%) registers as the least insured metropolitan area.

Markets with the most insured households tend towards the major metro areas of the coasts and the Great Lakes, whereas markets with a higher incidence of uninsured households tend toward the secondary metropolitan areas, small towns and rural markets of the South and interior heartland.

This analysis has been based on a likelihood or a rate for being insured and uninsured rather than an absolute number of households without insurance. So while San Francisco has the lowest rate of uninsured, they will certainly have more uninsured households than Greenville, MS. However, even taking market size into account, Nielsen estimates there are roughly 8.3 million uninsured households in the top 27 high income markets (where 60% of all affluent households are) versus 15.4 million uninsured households in the lesser affluent markets. The gap becomes more apparent when you look at the top 50 high-income DMAs – those top 50 markets contain 81% of households with incomes of $500,000+, but only 34% of the uninsured.

Were a “high income” surtax employed to fund universal coverage, there would likely be a “wealth transfer” from the large, metro markets of the East and West to the smaller, second-tier markets of the deep South, the Mississippi valley, and central plains. [See graphic for side by side comparison].