ASPE has developed estimates of the number of uninsured who are likely to qualify for coverage for 2016 through Qualified Health Plans (QHPs) in the Health Insurance Marketplace (“QHP-eligible uninsured”) for select designated market areas (DMA) in the United States. A DMA is a geographic area that represents a specific television market defined by the Nielsen Company. Some DMAs span multiple states.
We define QHP-eligible uninsured individuals as those who are uninsured and have incomes at or above the level that determines eligibility for Marketplace insurance affordability programs (generally greater than 100% or 138% of the federal poverty level (FPL), depending on state Medicaid expansion status).
In order to support local outreach efforts, ASPE has developed two sets of data. The first list consists of the top 60 DMAs based on the largest number of QHP-eligible uninsured, and the second list consists of the top 20 DMAs by the number of QHP-eligible uninsured as a percent of the DMA’s total nonelderly population. Because some of these estimates apply to small geographic areas, they are subject to potentially significant sampling errors. Particularly for smaller areas, these estimates should be treated as approximate. Due to this sampling error, the true ranking of DMAs by the number of QHP-eligible uninsured could differ from that implied by these estimates. Our estimates are less precise at the DMA than at the national level and thus should be used with caution for uses that require precise estimates.
The estimates presented here are of the QHP-eligible uninsured population in the entirety of each DMA, regardless of whether portions of the DMA are in states using the HealthCare.gov eligibility and enrollment platform or in a State-based Marketplace (SBM) operating its own platform.
To estimate the current number of QHP-eligible uninsured, we calculated the number of QHP-eligible uninsured individuals prior to the first open enrollment period based on the 2013 American Community Survey (ACS). We then adjusted that estimate to reflect the reduction in uninsured that occurred between 2013 and the second quarter of 2015, according to the Gallup-Healthways Well-Being Index. This analysis suggests there are currently 10.5 million QHP-eligible uninsured in the United States. To produce DMA-level estimates, we then distribute the national QHP-eligible population based on the geographic distribution of the uninsured in the most recent American Community Survey, the 1-year Public Use Microdata Sample (2013) and 5-year summary file (2009-2013). The estimates of the nonelderly population are based on the ACS 5-year summary file (2009-2013).
The approximations presented here may not line up with other available estimates of the remaining uninsured due to differences in data sources and methodology. Complete state and sub-state level 2015 estimates of the uninsured are not yet available from federal surveys, the gold standard for estimates of the uninsured.