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Health Insurance Coverage and Income Inequality in the United States: Findings from the American Community Survey, 2010 to 2023.

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Title: Health Insurance Coverage and Income Inequality in the United States: Findings from the American Community Survey, 2010 to 2023.
Authors: Molina-Salazar, Raúl Enrique1 (AUTHOR), Carbajal-De-Nova, Carolina1 (AUTHOR) enova@xanum.uam.mx
Source: Inquiry (00469580). 3/13/2026, Vol. 63, p1-15. 15p.
Subject Terms: *Health services accessibility, *Research, *Comparative studies, *Employment, Scale analysis (Psychology), Mathematical variables, Insurance, Income, Public sector, Health insurance, Socioeconomic factors, Scientific observation, Health policy, Medicare, Private sector, Descriptive statistics, Population geography, Surveys, Government programs, Data analysis software, Medicaid, Panel analysis
Geographic Terms: United States
Company/Entity: United States. Dept. of Veterans Affairs
Abstract: Objective: This note seeks to provide crucial insights into disparities in private and public health insurance coverage as determined by income inequality and real income in the United States. Socio-demographic dynamics are complex, as they are shaped by multidimensional factors, including income, socioeconomic status, geography, and educational attainment. Analysis of health insurance coverage disparities across the United States geographical units may reveal inequalities in health care access and, consequently, in health outcomes. Data and Methodology: The data for this analysis are sourced from the American Community Survey, which is conducted by the United Census Bureau. This survey provides detailed information on the Gini index (as a measure of income inequality), real household income, and private and public health insurance coverage. The study utilizes annual data from 2010 to 2023, covering 52 geographical units (50 states, the District of Columbia and Puerto Rico). To explore the relationship between health insurance coverage, income inequality and real income, a panel model incorportating fixed and random effects was employed to explore private and public health insurance coverage as a function of income inequality and real income. Furthermore, 52 geographical units are classified into four groups from the richest to the poorest, where each state income group contains 13 geographical units. This classification reduces the analytical complexity and allows for an easier discernment of effects across different income tiers. Key findings: The results demonstrate that private health insurance coverage is approximately double that of its public counterpart. Divergent effects are observed: increasing income inequality reduces private health insurance coverage (elasticities from −1.08 to −0.67), while simultaneously increasing public health insurance coverage (elasticities from +0.60 to +1.58). In contrast, real income growth positively affects both coverage types showing, nearly unitary elasticities. Disparities across the four income groups suggest an uncoordinated policy response: high income geographical units experience the strongest negative response to inequality, whereas low income geographical units are less affected. Conclusion and policy implications: The findings underscore the structural link between economic conditions and health insurance coverage. They suggest the need for targeted policies that could raise household income, such as job creation and wage growth to ensure equitable health insurance coverage and ultimately improve the health of Americans. Current policies appear to heavily burden the Federal government with subsidies to programs like Medicaid, Medicare, and Veterans Affairs programs. Future research could study the specific responses of each of these programs to income inequality and real income variations. This finer analysis could better guide the distribution of government funds and policies. A further line of inquiry could consider a regional analysis to address geographical dimensions and the issue of ecological fallacy, although this is beyond the scope of this note. [ABSTRACT FROM AUTHOR]
Copyright of Inquiry (00469580) is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Education Research Complete
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  Data: Health Insurance Coverage and Income Inequality in the United States: Findings from the American Community Survey, 2010 to 2023.
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  Data: <searchLink fieldCode="AR" term="%22Molina-Salazar%2C+Raúl+Enrique%22">Molina-Salazar, Raúl Enrique</searchLink><relatesTo>1</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Carbajal-De-Nova%2C+Carolina%22">Carbajal-De-Nova, Carolina</searchLink><relatesTo>1</relatesTo> (AUTHOR)<i> enova@xanum.uam.mx</i>
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  Data: <searchLink fieldCode="JN" term="%22Inquiry+%2800469580%29%22">Inquiry (00469580)</searchLink>. 3/13/2026, Vol. 63, p1-15. 15p.
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  Data: <searchLink fieldCode="DE" term="%22United+States%2E+Dept%2E+of+Veterans+Affairs%22">United States. Dept. of Veterans Affairs</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective: This note seeks to provide crucial insights into disparities in private and public health insurance coverage as determined by income inequality and real income in the United States. Socio-demographic dynamics are complex, as they are shaped by multidimensional factors, including income, socioeconomic status, geography, and educational attainment. Analysis of health insurance coverage disparities across the United States geographical units may reveal inequalities in health care access and, consequently, in health outcomes. Data and Methodology: The data for this analysis are sourced from the American Community Survey, which is conducted by the United Census Bureau. This survey provides detailed information on the Gini index (as a measure of income inequality), real household income, and private and public health insurance coverage. The study utilizes annual data from 2010 to 2023, covering 52 geographical units (50 states, the District of Columbia and Puerto Rico). To explore the relationship between health insurance coverage, income inequality and real income, a panel model incorportating fixed and random effects was employed to explore private and public health insurance coverage as a function of income inequality and real income. Furthermore, 52 geographical units are classified into four groups from the richest to the poorest, where each state income group contains 13 geographical units. This classification reduces the analytical complexity and allows for an easier discernment of effects across different income tiers. Key findings: The results demonstrate that private health insurance coverage is approximately double that of its public counterpart. Divergent effects are observed: increasing income inequality reduces private health insurance coverage (elasticities from −1.08 to −0.67), while simultaneously increasing public health insurance coverage (elasticities from +0.60 to +1.58). In contrast, real income growth positively affects both coverage types showing, nearly unitary elasticities. Disparities across the four income groups suggest an uncoordinated policy response: high income geographical units experience the strongest negative response to inequality, whereas low income geographical units are less affected. Conclusion and policy implications: The findings underscore the structural link between economic conditions and health insurance coverage. They suggest the need for targeted policies that could raise household income, such as job creation and wage growth to ensure equitable health insurance coverage and ultimately improve the health of Americans. Current policies appear to heavily burden the Federal government with subsidies to programs like Medicaid, Medicare, and Veterans Affairs programs. Future research could study the specific responses of each of these programs to income inequality and real income variations. This finer analysis could better guide the distribution of government funds and policies. A further line of inquiry could consider a regional analysis to address geographical dimensions and the issue of ecological fallacy, although this is beyond the scope of this note. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
  Group: Ab
  Data: <i>Copyright of Inquiry (00469580) is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1177/00469580251405999
    Languages:
      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 15
        StartPage: 1
    Subjects:
      – SubjectFull: Health services accessibility
        Type: general
      – SubjectFull: Research
        Type: general
      – SubjectFull: Comparative studies
        Type: general
      – SubjectFull: Employment
        Type: general
      – SubjectFull: Scale analysis (Psychology)
        Type: general
      – SubjectFull: Mathematical variables
        Type: general
      – SubjectFull: Insurance
        Type: general
      – SubjectFull: Income
        Type: general
      – SubjectFull: Public sector
        Type: general
      – SubjectFull: Health insurance
        Type: general
      – SubjectFull: Socioeconomic factors
        Type: general
      – SubjectFull: Scientific observation
        Type: general
      – SubjectFull: Health policy
        Type: general
      – SubjectFull: Medicare
        Type: general
      – SubjectFull: Private sector
        Type: general
      – SubjectFull: Descriptive statistics
        Type: general
      – SubjectFull: Population geography
        Type: general
      – SubjectFull: Surveys
        Type: general
      – SubjectFull: Government programs
        Type: general
      – SubjectFull: Data analysis software
        Type: general
      – SubjectFull: Medicaid
        Type: general
      – SubjectFull: Panel analysis
        Type: general
      – SubjectFull: United States
        Type: general
      – SubjectFull: United States. Dept. of Veterans Affairs
        Type: general
    Titles:
      – TitleFull: Health Insurance Coverage and Income Inequality in the United States: Findings from the American Community Survey, 2010 to 2023.
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              Text: 3/13/2026
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              Y: 2026
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