Few issues have roused the American public in recent years as much as the debate over health insurance reform. While the Obama administration calls for mandatory coverage for all Americans, about 8 in 10 Americans already have insurance, and have shared their mixed views about the proposed legislation. While some support the plan, a vocal number worry about the possibility of higher premium costs. Others cite concern over a government-run health care program — the so-called public option intended to ensure affordable coverage and drive costs down by injecting competition into the industry. Still more voice a general opposition to any changes that might impact their coverage.

Who are these insured Americans who so vocally lodged their complaints at recent town hall meetings and rallies on Capitol Hill? And what’s behind the resistance? How does their perspective differ from that of people who currently lack health insurance but may be required to obtain it?

The Haves
According to new research by Nielsen Claritas, 78 percent of Americans own health insurance, and they represent a wide-ranging group of people. As defined by Nielsen PRIZM, the segmentation system that classifies Americans into 66 lifestyle types, the insureds tend to be upscale and educated suburbanites. A disproportionate number include elderly, middle-class couples in small-town and rural communities. And high rates of health insurance owners are found among well-off Boomer couples and families in exurban towns.

People who buy health insurance have other preferences that reflect their lifestyles and concerns.

Americans With Health Insurance
What’s Hot		What’s Not
Golf	Sport	Horse racing
Gardening	Leisure	Bingo
Treadmill	Exercise	Roller skating
Classical	Music	Rap
Opera	Culture	Karaoke
Collectables	Hobbies	Needlepoint
Books on tape	Purchase	Videos by mail
Home & Garden TV	TV	Univision
All news	Radio	Hispanic
Consumer Reports	Print	Soap Opera Weekly
Computer software	Gadgets	Portable DVD player
Land’s End	Retail	Wal-Mart
Tracking investments	Internet	Job search
Domestic red wine	Drink	cognac
Common stock	Financial	No-interest checking account
Source: The Nielsen Company

Geographically, the concentration of health insurance owners reflects the broad demographic disparity between America’s coasts and interior. The insured tend disproportionately to have six-figure incomes, college degrees and white-collar jobs, and are receptive to health-related products and concerns. Cosmopolitan in their outlook, these Americans already follow doctors’ orders, pursuing physical activity and avoiding fat- and sugar-filled foods. They’re more likely than the general population to get exercise by biking, skiing, playing golf and using treadmills. They have high rates for buying vitamins, eating high-fiber food and getting regular checkups from an internist and dermatologist. And such self-care appears to be effective: they have low rates for buying pain relievers, over-the-counter stimulants and cough syrup. Ironically, research shows that those with health insurance may be less likely to need it than those who lack coverage.

The Have Nots
The uninsured are more likely to live in small towns and rural communities where access to good health care can be a challenge. Young and underemployed, they reside in small city PRIZM clusters. These consumers tend disproportionately to have modest educations, work at blue-collar jobs, earn below $25,000 a year and live in low-rise apartments. They’re somewhat old fashioned in their leisure pursuits, enjoying roller skating, bingo, needlepoint, horse racing and gospel music. There’s an undeniable ethnic factor to the health insurance gap: nearly 25 percent of those who lack coverage are African-American or Hispanic.

Top 20 and bottom 20 insured Designated Market Areas

Top Cities With Insurance		Top Cities Without Insurance
Rank	City	Rank	City
1	Juneau, AK	190	Paducah et al, KY-MO-IL
2	Honolulu, HI	191	Myrtle Beach et al, SC
3	San Francisco et al, CA	192	Lafayette, IN
4	Washington et al, DC-MD	193	Alexandria, LA
5	Fairbanks, AK	194	Gainesville, FL
6	Boston et al, MA-NH	195	Jonesboro, AR
7	Monterey-Salinas, CA	196	Laredo, TX
8	Anchorage, AK	197	Monroe-El Dorado, LA-AR
9	Hartford & New Haven, CT	198	Joplin-Pittsburg, MO-KS
10	Baltimore, MD	199	Tri-Cities, TN-VA
11	Philadelphia, PA	200	Bluefield et al, WV
12	Santa Barbara et al, CA	201	Lexington, KY
13	Seattle-Tacoma, WA	202	Clarksburg-Weston, WV
14	Minneapolis-St. Paul, MN	203	Albany, GA
15	Chicago, IL	204	Charleston et al, WV
16	Ft. Myers-Naples, FL	205	Hattiesburg-Laurel, MS
17	San Diego, CA	206	Columbus et al, MS
18	New York, NY	207	Meridian, MS
19	Detroit, MI	208	Harlingen et al, TX
20	Sacramento et al, CA	209	Greenwood-Greenville, MS
Source: The Nielsen Company

The Deeper Difference
Psychographic surveys provide another explanation for the impassioned opinions of the insured. Studies show that they are skeptical consumers who check the ingredients of food before they buy. They dislike most advertisements, believing them to be more manipulative than informative. And they are willing to pay more for a brand that they trust (especially American-made products), avoiding those new and improved products without a long history. They can be open-minded, declaring that they’re early adopters when it comes to technology. But overhauling health insurance isn’t the same as buying an iPod, and they require a sound, rational explanation before they will be convinced of the need.

What truly distinguishes the health insurance haves from the have-nots may be that they’re group-oriented. They’re more likely than the general population to belong to civic clubs, country clubs and unions. The Obama administration is wise to pay attention to labor unions that have demanded changes in the bill throughout the negotiations between the White House and Congress. Americans with health insurance recognize that they’re a majority in this country, and that there’s power in numbers.

A Targeted New Prescription for Insurers
Of course, consumers aren’t the only ones who will be affected by new legislation. Health insurers recognize they may soon have to alter their benefits packages and marketing strategies to reach a potential new audience of low-income households.

Because the insured and uninsured populations vary significantly from state to state and market to market, insurance companies will have to develop even more targeted initiatives—especially in states that may have the ability to opt out of any government-run health insurance plan and design their own exchanges and coverage options. Health insurers will need to reexamine their current members’ ongoing medical and wellness needs and at the same time determine the basic and emerging needs of the uninsured. Marketing managers will have to analyze their service territories on a more localized basis to determine the best product strategy and outreach effort to connect with different population segments. While the goal of the reform initiative is a healthier citizenry, there’s no magic pill that will get the nation there easily.

The number of persons age 2+ in Hispanic TV homes will also grow with estimates showing a 2.4% increase to a total of 44.3 million. The number of persons 2+ in African American TV homes will increase by 1.3% to 37.5 million, and persons 2+ in Asian TV homes will remain at 14.5 million.

Download the full list of Ethnic DMA rankings and universe estimates.

Local TV Market Universe Estimates

The Top 10 local markets, known in the industry as Designated Market Areas or DMAs, will remain the same this season, with a few rank changes in the Top 20. Moving up are Seattle, from 14 to 13, and Denver from 18 to 16. Tampa, Miami and Cleveland are each down one rank.

There were no new markets to enter the Top 50 or the Top 100, although there were several multi-rank increases and decreases. Notable changes in the Top 100 markets include:

• Four Florida markets are down (Tampa, Miami, Ft. Myers, Tallahassee), partially due to declines in domestic migration
• New Orleans has the largest percentage increase among all markets, up 5.2% from last year, and moves up 2 ranks from 53 to 51 as former residents return to the city and Census Bureau estimates are adjusted
• New York adds the most homes of any market (+59,710) while Waco shows the largest change in ranks, moving from 94 to 89
• Other multi-rank increases in the Sun Belt region include Tucson (+2), Shreveport (+2), and Charleston, SC (+2)
• The Midwest sees multi-rank decreases in Columbus, OH (-2), Grand Rapids (-2), Flint (-2) and South Bend (-2)

For complete details, download the full list of DMA rankings and universe estimates.

“This data begs the question: is the constant negative news feed on the industry warranted when newspapers are actually being read by three-fourths of the adult population? When you look at audience data, it seems irrational that advertisers are leaving newspapers because the numbers speak for themselves,” said Gary Meo, senior vice president, print and digital media, Scarborough Research.