Summary: More than ever, U.S. consumers are being asked to manage their diseases and make significant health care decisions on their own. Recent changes in health care policy related to flexible spending accounts (FSAs) and over the counter (OTC) reimbursement could bring about real shifts in how consumers view their health and wellness options. Understanding the impact on consumer choice will be critical for retailers and manufacturers as they assess the potential risks and opportunities.

Background: History of Flexible Spending Accounts for OTC Medications
In September 2003, OTC medicines were made eligible for reimbursement in health care flexible spending accounts. These FSAs are voluntary programs many employers use to allow their employees to set aside money every year through payroll withholdings to pay for certain medical expenses not covered by insurance; this money does not get taxed.

However, the Patient Protection and Affordable Act of 2010, removed OTC medicine eligibility from FSAs, HSAs (health savings accounts), and other similar accounts unless the medicine is prescribed by a physician. These changes went into effect on January 1, 2011.

To better understand the impact of these changes on OTC purchase behavior, Nielsen surveyed the primary shopper from more than 27,000 households in December 2010.

Flexible Spending Account Enrollment Awareness and Usage
Approximately 19 million or 16 percent of U.S. households are aware of enrollment in a Flexible Spending Account through an employer.

Of the enrollees, just over half covered the costs of their OTC medications with FSA funds in the past 12 months ending in December 2010, equating to about 9.8 million households. Other uses of FSA coverage included prescription medications, dental or vision care, co-payments and office visits to a healthcare professional. Elective medical procedures were the least commonly reported as uses for the FSA dollars amongst reported households.

Alternatives to OTC Reimbursement for FSA Consumers
When faced with losing the ability to use FSA funds to cover OTC medication expenses, consumers are likely to be resilient in fulfilling their self medication needs. In fact, 21 percent indicated they would do nothing differently. However 21 percent of consumers responded that they would drastically reduce or discontinue purchasing of OTC medications.

The physician will likely play a key role under the new rules as consumers search for ways to continue using FSA funds. For example, 46 percent of consumers who used FSA to pay for OTC medications indicated they would request prescriptions for their OTC medications. Physicians will also likely be asked if a prescription product is available to replace OTC medications.

Finally, a large percentage of consumers will seek lower cost OTC options including bigger product sizes, store brands, deals and/or changing stores for better pricing as an alternative.

OTC Category Purchasing
When looking at OTC category purchasing, households that used FSA funds to pay for OTC medications in 2010 spent significantly more on cough & cold remedies and first aid categories than the general population. However, those consumers who will engage a doctor to ask for an Rx for their OTC medication and/or request an Rx replacement spent significantly more across a number of categories including cough & cold, first aid, antacids and laxatives.

OTC Channel Preferences
Consumers who used FSA funds for OTC medications in 2010 spent significantly more OTC dollars in the drug channel than the general population. Households who will look for lower cost OTC options also spent significantly more in the drug channel, while those who would consider changing stores for better OTC prices also spend significantly more in drug and mass merchandisers. Households that may discontinue or drastically reduce OTC use spent significantly more OTC dollars in the drug and club channels.

Moving Forward into 2011
The new health care law will impact many of the 10 million households who used FSA funds to pay for OTC medications in 2010. While a small number of consumers will reduce or discontinue use of OTCs, it is clear that most will be resilient and shift their healthcare utilization patterns to overcome the policy change. Doctors will likely play a key role in this shift as these consumers seek to make their medication costs FSA eligible by asking for a prescription for their OTC and/or requesting a prescription product as a replacement. In addition, retailers and manufacturers must pay particular attention to those consumers who may seek lower cost options (size, store brand, deal etc…) and/or change their store preference for lower cost OTC medications. Recognition of these shifts along with changing health care utilization patterns should drive marketing strategies (professional promotion, assortment strategies, pricing tactics) to meet these consumers’ needs.

Robert Buckeldee, Managing Director, OTC/Pharmacy Services, Nielsen Europe

SUMMARY: The over-the-counter (OTC) medicines category remains highly attractive with significant growth potential from both developing markets and established European and North American markets. However, the economic downturn has affected usage in several ways, which is troubling for both governmental agencies and manufacturers of the OTC products.

The global market for over-the-counter (OTC) non-prescription medicines remains buoyant, with growth in value sales in 2009 estimated at 4.7%, bringing the value of the category to over $95 bn (source: Nicholas Hall Company).  Much of this growth has been driven by developing markets, with double-digit growth recorded in Brazil, Russia, India and China (BRIC).  Many established mature markets for OTC medicines recorded very modest levels of growth.

As wealth and economic prosperity filters down through the layers in the BRIC markets and consumers find they have more disposable income, categories like OTC medicines will benefit from consumers helping themselves to treat minor ailments and prevent illness.

But as economic woes continue to circle around North America and Western Europe, and governments need to tighten the belt of public spending to help manage record debt levels, spending on healthcare within these developed economies will also come under intense scrutiny.  Only recently, the government in Greece has withdrawn state reimbursement from non-prescription medicines and they will not be the last to make radical changes to their healthcare financing.

The market for OTC medicines in developed Western Europe markets should start to see significant growth over time as consumers are encouraged to take proactive involvement in managing minor ailments and make less reliance on the state for help.

Hands-On Health Care
Against this backdrop, it is important to gauge consumer sentiment towards OTC medicines since the height of global economic uncertainty.  One year ago in March 2009, Nielsen asked consumers around the world whether the global economic crisis would impact their usage of the OTC medicines category.  Close to 50% of consumers globally indicated behavior would change, with one-quarter stating they would use the products less frequently and one-fifth saying they were more likely to use natural and traditional remedies.

Move the clock forward one year after the global economic crisis has affected day-to-day life and the same questions elicit key changes.  Most notably, only one-third (34%) of consumers now indicate the global economic crisis will affect their usage of non-prescription medicines in the year ahead.  A year of experience of the “new world order” has made more consumers realize that self-care is too important to put at risk.

Of those who indicate they will change OTC usage, there are subtle shifts in intentions compared to last year.  The 2010 results show a greater percentage of consumers now plan to visit the doctor more, buy cheaper products, and stop buying the products completely.

Protecting Equity
There are some key regional variations behind these changes.  The notion of visiting the doctor more frequently, and by extension being prescribed medicine rather than buying OTC products, is troubling for governments who need to manage healthcare budgets.

A recent study published by the PAGB in the U.K. —the trade association for manufacturers of over-the-counter medicines and food supplements—estimated that 57 million general practice consultations take place each year to treat minor ailments at a cost of £2bn to the National Health Service (NHS).  Governments need to take positive action to ensure consumers to visit the pharmacy as the first point of care for minor ailments and encourage them to buy OTC medicines.

Of concern to manufacturers of OTC products is the increase of consumers intending to purchase cheaper products or to stop buying them altogether.  Buying cheaper products feeds into an established trend and the growth of store brands and generic products within OTC medicines is proof that consumers increasingly understand the power of the active ingredient, as opposed to the brand.  The issue of dropping out of the category was relatively strong in the U.S., India and South Africa.  Market trends later in the year will determine if this intention is followed-up by action.

Within OTC medicines, supply feeds demand for store brands and generics, not the opposite.  So it is no surprise that the intention to buy cheaper products manifests itself in countries where chains are prevalent or where generics already have a strong foothold.  While market shares for store brand or generic products are generally lower than more mainstream branded grocery categories, the trend is rising and manufacturers need to invest in brand equity to protect sales.

Divergent Growth Strategies for East & West
The OTC medicines category remains highly attractive with significant growth potential from both developing markets and established European and North American markets.  Consumers understand that they can use OTC medicines without breaking the bank of their personal finances.

In developing markets, it is up to manufacturers to sell the benefits of their products to new consumers.  In Europe and North America, strategies will need to involve a more complex partnership with government agencies, healthcare professionals, pharmacists and retailers to encourage consumers to treat minor ailments without resorting to aid from state infrastructure and public finances.

SUMMARY: No matter where consumers live, healthcare is important. But where they live often determines how minor ailments are treated. While Europeans put their trust in the neighborhood pharmacist, North Americans rely more on the advice of doctors. In countries where healthcare infrastructures and economies are evolving, opportunities exist to lessen the considerable burden consumers currently put on doctors and help governments reduce their healthcare expenditure.

The sore throat and cough that accompany the onset of a cold usually sends the typical American to his local drug store to purchase a preferred over-the-counter remedy, chosen because of past experience with the product. Rarely—if ever—is the pharmacist consulted, and almost never is a doctor called for such a common malady. But in Europe, consumers have been taught that pharmacists are an important source of health care information and they are likely to be consulted almost as frequently as a doctor, according to a new global study by The Nielsen Company.

Surveying more than 27,000 consumers in 54 countries, Nielsen has benchmarked the incidence of 17 common minor ailments—all of which can be treated with non-prescription medicines—as well as how consumers typically deal with them. Globally, respondents suffered from an average of almost four (3.9) such ailments in the last 12 months. The most common ailments: headaches, endured by 44% of respondents, followed by cold (38%) and cough (34%). A hearty 13% suffered from none of the 17 conditions listed.

Latin Americans are most prone to suffering from minor ailments (4.73 out of 17) while consumers in Asia Pacific are least prone (3.48 suffered). On a country basis, the Dutch suffered least from these ailments, with an average of 2.47 followed by the Japanese and the Chinese. At the other end of the spectrum, consumers in South Africa have the highest levels of incidence at 5.47 followed by Philippines and New Zealand.

Consult the Doctor or Pharmacist?
Having established the level of incidence by country for each of the 17 ailments, Nielsen’s study explored whether the consumer would seek advice from either a doctor or a pharmacist in helping them with their ailment. Respondents were presented with four options:

1. Every time I suffer
2. Only when I experience symptoms I have not had before
3. Only when the symptoms are more severe than normal
4. Never

Consumer responses varied significantly across the ailments, and between doctor and pharmacist. Analysis of those who said they would never seek the advice of a doctor or pharmacist highlights the gap that still exists with consumers with respect to seeing the pharmacist as a point of care, rather than a retailer of products. For all the ailments (except hangover), a higher proportion of consumers said they would never seek advice from a pharmacist relative to the proportion who would never seek advice from a doctor. This gap, however, is generally lower in Europe, where the pharmacist has been promoted as a key part of the primary healthcare system in a number of countries, and generally higher in Latin America where the doctor remains embedded in the mindset of consumers as the place to go for advice.

Across the categories, a high percentage of flu sufferers will always seek advice from doctor and pharmacist, but generally speaking, consumers mostly seek advice for these minor ailments from a doctor and/or a pharmacist only when symptoms are more severe than they would normally experience. This finding indicates that for the vast majority of consumers suffering from these minor ailments, there is a willingness to work through the ailment without professional advice, either through routine self-medication with non-prescription medicines or other traditional remedies, or by letting the body self-correct. This finding further reinforces the need for manufacturers to drive brand equity within the self-medication sector, and build loyalty with their suffering consumers.

A more detailed analysis of two most common ailments shows strong regional differences. The headache ailment is the most commonly suffered globally, and it follows that the analgesics category is the largest in sales globally with over $9.5 billion of sales in 2008, according to OTC industry expert Nicholas Hall & Company. The cough ailment is the third most commonly suffered, but consumers are much more likely to engage with either a doctor or pharmacist for this ailment than with a headache.

On the global level, 34% of headache sufferers will never seek advice from a doctor about the ailment, compared to 44% who will never seek advice from a pharmacist—a 10 point gap in favor of the doctor. Similarly for coughers, there is a 13 point gap in favor of the doctor. When these gaps are viewed regionally, the gap narrows considerably in Europe to only 2% and 4% respectively. And the gap broadens significantly in Latin America to 24% and 26% respectively.

The many campaigns run by European governments and healthcare providers to position the pharmacist as a point of primary care are paying off, and consumers are more engaged with the pharmacist than in other parts of the world.

Interestingly, North America is similar to Latin America in terms of the doctor/pharmacist gap, but this can be attributed to the wide availability of non-prescription medicines that can be purchased without any pharmacist intervention. The role of the pharmacist in relation to minor ailments has been lessened through this process.

The Take-Away
Pharmacists in North America tend to be viewed as retailers, while in Europe they are viewed as a go-to for minor ailments. These views are fairly solid in consumers’ mindsets in their respective regions. But the real opportunity lies in Latin America, where evolving healthcare infrastructures and economies provide a chance to educate consumers to use the pharmacist as a point of primary care and advice. This will lessen the considerable burden consumers currently put on doctors in the region for advice about minor ailments and by extension help governments reduce their healthcare expenditure.

Consumers tend to want to treat minor ailments on their own, and the pharmacist can play an important role in helping consumers do that by helping them understand which medication might be best for what ails them. Additionally, manufacturers of OTC products need to understand the dynamics in each region and tailor marketing efforts to fully capitalize on growth opportunities. In the U.S., that may mean marketing direct to consumers; in Europe, marketing towards pharmacists may be more effective.

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.

Panel confidence before and after speech

During the speech, the panel also indicated their positive and negative reactions using dial meters, which showed the health care debate is still sharply divided among party lines.

Discussing the impact of the bailouts and stimulus, the President noted efforts earlier in the year had “pulled the economy back from the brink,” driving Democratic support high, and sending the Independent and Republican meters downward. Similarly, when the President brought up the costs of the Bush administration tax cuts and the cost of the Iraq war, Democrats responded enthusiastically as Independents and Republicans headed in the other direction.

Online Reaction

Outside the focus group, internet chatter related to the President’s two speeches this week, the address, and a speech to school children the day before, online sentiment for the speech was generally positive according to Nielsen Buzzmetrics. However, the school speech drew much more attention based on controversy surrounding parental and school concerns about the scope and potential partisan nature of the President speaking to school children to promote his agenda.

Viewership to last night’s address was down 38.6% from President Obama’s first address to a joint session of Congress on February 24, which aired from approximately 9:00PM to 10:30PM.

In July, President Obama held a press conference focused on health care that drew nearly 25 million viewers.

When Sen. Edward Kennedy died late on Tuesday Aug. 25, a year after his 2008 appearance at the Democratic National Convention in Denver, news coverage and online discussion began in earnest as soon as the Kennedy family made the announcement.

By the end of Wednesday (Aug. 26) Kennedy attracted nearly 1% of all blog buzz, according to Nielsen’s BlogPulse search engine, and by Thursday morning (Aug. 27), he was the most-discussed person in the blogosphere. His New York Times obituary was also the most-cited news story among bloggers and the phrase “Ted Kennedy dies” was the phrase used most by bloggers Aug. 26-27.

Consumers posted comments about Kennedy, not only on political and news blogs, but on celebrity blogs as well. Key political blogs where discussion took place included liberal-leaning sites the Huffington Post and Crooks & Liars as well as conservative-leaning sites Michelle Malkin and Hot Air, and differences in opinion were obvious. Comments on liberal-leaning blogs recounted Kennedy’s accomplishments as a champion for labor, the poor and for universal health care, which he called the “cause of my life.” Comments on conservative blogs were much harsher and critical of Kennedy, not only for his politics but also for his personal life.

The month prior to his death, the Senator was increasingly mentioned in conversations surrounding the passage of a health care bill as was his wish to have a successor named quickly upon his passing.

Health Insurance

Given the proposal of a public health plan, consumers were asked if they would prefer a less-expensive yet less-comprehensive public health plan subsidized by the government to a privatized insurance plan that offered more benefits and flexibility. It appears that although the private plan was the plan of choice, many of the respondents (40%) could not commit to an answer without further information about what the details of the plan would include. It is imperative that health insurance carriers start to increase their brand awareness, value proposition and targeting efforts so that consumers make the most informed decisions once a public plan becomes available.

When we drill down into the penetration of different medical insurance types, the study notes that overall medical insurance is down slightly, but dental and vision insurance are higher — an interesting finding is that for both vision and dental, it’s the employer-based coverage that is down, but individual coverage is up-so when consumers lose their coverage from work, they fill that gap on their own. Heath Savings Accounts and Flexible Spending Accounts are also both up but not from individual plan purchases. In this case, employers are increasing benefits and stepping up these offerings. The same scenario is also true for critical illness coverage.

Property and Casualty Insurance

With regard to shopping and switching coverage, some consumers kept their options open to new offers, with 46% of the respondents saying they have shopped for auto insurance in the past three years. However, only one quarter of those respondents reported actually switching carriers during that time. In addition, only 16% of residential insurance customers changed carriers in the past three years.

Most respondents stated that they would be willing to pay a little more for auto insurance if it means they get better coverage; with 52% of the participants either strongly agreeing (15%) or agreeing somewhat (37%). Interestingly, 45% of the respondents said they actually did have their auto & home insurance policies with the same insurance company.

And good news for carriers who offer both auto and residential coverage to their customers: 62% of respondents would prefer to have their auto and residential insurance at the same carrier. The majority of respondents surveyed (73% selected 8-10 on a 10-point scale where 10 is extremely likely to recommend) said they would be extremely likely to recommend their primary auto and residential insurance carrier to friends and family. Insurance companies with a referral program will likely benefit from this feeling of satisfaction and goodwill.

Life Insurance

Despite the aging population, the percentage of households with life insurance policies has decreased steadily from 2005. Individual life policies have also experienced declines (i.e., whole, universal life and variable life) but individual term policies remained constant between 2007 and 2009 at 23%. Reasons for this could be that fewer employers are offering life insurance as part of their benefit packages or due to rising unemployment.

Agent recommendations and covering final/funeral expenses topped the list of reasons why individual life insurance policies were purchased. However, future channel preference for both types of policies moved away from the agent. More consumers want to purchase life insurance through direct channels and their employer compared to 2007.

Insurance companies will have to increase relationships with employers, offer alternative direct channel options and provide clear educational materials to make up for the lack of the personal relationship with the agent-particularly when trying to influence the decision to purchase these policies for the first time. With penetration rates for life insurance policies declining, insurance carriers will need to deal with multiple issues to grow this business, including a challenging economy, lack of importance as part of retirement and investment planning.

Looking at 210 Designated Market Areas (DMAs) across the U.S., Nielsen Claritas demographic data shows that just over 800,000 households (roughly 0.7%) earn more than $500,000. Those that make $250,000-500,000 account for an additional 1.6% for a total of 2.3% of homes that could be considered “affluent.”

Where The Wealthy Are

The top 10 most affluent markets (San Francisco, New York, W. Palm Beach, Fl., Washington D.C., Palm Springs, CA, Ft. Myers/Naples, Fl., Boston, Santa Barbara, CA, Los Angeles, and San Diego) identified in the dark green [see full graphic] account for 42.6% of all households in the U.S. earning more than $500,000. These affluent households are twice as concentrated in these markets than the USA overall. In these markets, about 1.5% have incomes $500,000+ and 2.8% have incomes $250,000-$500,000 annually.

… And Where The Uninsured Are

Not surprisingly, many of the same markets that have a large majority of high-income households also tend to be the most insured as identified by the light blue [see full graphic]. San Francisco (with 85% estimated insured) leads the way, whereas Greenville, MS (66%) registers as the least insured metropolitan area.

Markets with the most insured households tend towards the major metro areas of the coasts and the Great Lakes, whereas markets with a higher incidence of uninsured households tend toward the secondary metropolitan areas, small towns and rural markets of the South and interior heartland.

This analysis has been based on a likelihood or a rate for being insured and uninsured rather than an absolute number of households without insurance. So while San Francisco has the lowest rate of uninsured, they will certainly have more uninsured households than Greenville, MS. However, even taking market size into account, Nielsen estimates there are roughly 8.3 million uninsured households in the top 27 high income markets (where 60% of all affluent households are) versus 15.4 million uninsured households in the lesser affluent markets. The gap becomes more apparent when you look at the top 50 high-income DMAs – those top 50 markets contain 81% of households with incomes of $500,000+, but only 34% of the uninsured.

Were a “high income” surtax employed to fund universal coverage, there would likely be a “wealth transfer” from the large, metro markets of the East and West to the smaller, second-tier markets of the deep South, the Mississippi valley, and central plains. [See graphic for side by side comparison].

Learn more about Nielsen Claritas.

In a continued push for congressional support of health care reform President Obama held his fourth prime time press conference on Wednesday July 22, 2009. The conference was carried live from 8:00PM to approximately 9:00PM on 11 networks. The sum of average audience for those networks was 24,682,519 viewers and had a combined household rating of 16.3. The networks carrying the press conference were ABC, CBS, NBC, Univision*, Telemundo*, BBC-A, BET, CNBC, CNN, FOX News Channel, and MSNBC.

Viewing to last night’s press conference was down 14% from his April 29 press conference and down 50% from his first primetime conference on February 9.