The Patient Protection and Affordable Care Act Meets the "Persistently Uninsured'

Under the Patient Protection and Affordable Care Act (commonly known as Obamacare'), the national uninsured rate has fallen from 17.3 per cent in 2013 to 11.7 per cent in the first half of 2015. While this is a substantial drop, even accounting for the states that did not expand Medicaid, the remaining double-digit national rate, as well as higher rates in some states, indicates that a significant minority of Americans are not buying insurance. Researchers have identified a segment of the population with weak or uncertain preferences for health insurance. This article explores how such individuals are unevenly distributed across states and whether cultural preferences relating to time preference and risk aversion underlie the geographic distribution of the persistently uninsured'. It concludes by reviewing the policy implications presented by the presence of numerous health insurance sceptics in certain jurisdictions.