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Background: The economic recession that began in 2008, or the “Great Recession,” did not affect all counties in California equally. With differential effects of economic indicators such as job loss, it is possible that differential effects were also seen in health insurance rates by county and demographic group. Objective: To study whether the Great Recession had a differential impact on the uninsured rates among counties in California. Research Design: A four-level “recession index” measured the impact of various economic indicators, between the populations uninsured for all or part of the prior year in 2009 compared to 2007. Methods: Data sources include the 2007 and 2009 California Health Interview Surveys and California Employment Development Department unemployment data. Results: The medium recession impact group (that is, counties with high increases in unemployment and lower household incomes on average) had the highest growth in the uninsured rates, due to a large drop in job-based coverage only partially offset by public coverage. Changes in coverage by demographic groups were similar among recession index categories. Conclusions: We find that the uninsured in 2009 were older, more likely to be U.S.born citizens, had lower household incomes, and were more likely to be unemployed and looking for work, regardless of the impact of the Great Recession at the county level. The growth in the uninsured rates in the medium-impact group highlights the importance of public health insurance programs as a safety net during economic downturns.

The Recession Index: Measuring the Effects of the Great Recession on Health Insurance Rates and Uninsured Populations