Republican lawmakers outnumber Democratic legislators by almost 2-to-1 in the 20 congressional districts with the largest percentage of people who rely on direct purchase health insurance from a company or through a government-sponsored marketplace.
Political Landscape of Direct Purchase Health Insurance
Thirteen of the 20 congressional districts with the greatest percentage of direct purchase health insurance – including policies issued through Obamacare – are represented by Republicans. The GOP has promised overturning the law since its 2010 passage.
A key point of contention currently involves the extension of Biden-era subsidies for Obamacare, which were the cause of the longest government shutdown in U.S. history. Republicans refused to sponsor a vote on extending the subsidiaries while the government was closed. Democrats, meanwhile, have observed that health insurance premiums for Americans will be unaffordable without subsidies. The Urban Institute estimates 4.8 million people could lose health insurance if subsidies aren't restored, increasing the percentage of uninsured Americans by 21 percent.
Direct Purchase Health Insurance and Working-Age Americans
The looming crisis is particularly acute for working Americans between the ages of 35 and 64 who depend on direct purchase health insurance. Adults younger than 26 can be insured through their parents, and poor children are insurable via Medicaid, the federal-state program for low-income and disabled people. People older than 65 generally qualify for Medicare, the federal health insurance program for the elderly.
Geographic Concentration of Direct Purchase Coverage
Eight of the 10 states with the greatest percentage of direct purchase health insurance policies among 35- to 64-year-olds were in Florida, according to the 2019-23 American Community Survey. Five of those eight districts are represented by Republicans, including Rep. Mario Díaz-Balart's district, where 26.6 percent of prime working-age Americans obtain their insurance directly from a company or from a government-sponsored marketplace.
The other two congressional districts are in California. Both are represented by Democrats. Among the 20 congressional districts with the highest percentage of direct purchase health insurance, only one is in neither Florida nor California. An estimated 13.7 percent of working-age adults in a central North Carolina congressional district that includes Asheville buy health insurance directly, ranking 20th in the nation.
Market Size: Direct Purchase vs. Marketplace Plans
The number of Americans who purchase health insurance directly from a business is relatively small compared to the number who buy insurance from an Obamacare marketplace. The Kaiser Family Foundation found about 2.5 million Americans bought direct purchase health insurance from a business in 2024, while about 14.3 million were enrolled in health insurance plans sponsored by the government.
Top 20 Congressional Districts for Direct Purchase Health Insurance
Here are the 20 congressional districts with the highest percentage of 35- to 64-year-olds who purchase health insurance directly:
Explore Direct Purchase Health Insurance Data in Your Community
The geographic concentration of direct purchase health insurance reveals important patterns about healthcare access, economic conditions, and policy impacts across different regions. Understanding these trends in your own congressional district or community can provide valuable insights for healthcare planning, policy advocacy, and business decisions.
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Try Social Explorer's free demo today to create custom maps, generate detailed reports, and uncover insights about direct purchase health insurance and other critical healthcare and economic topics in your community. Start exploring the data that shapes policy decisions and reveals the real story behind healthcare coverage in America.