This paper argues that large communities of military dependents and retirees — combined with their exclusive access to free or low-cost Department of Defense health care and insurance — alter local socioeconomic and labor market characteristics in ways that contribute to the need for health care safety-net services. Multivariate regression analyses indicate that areas with relatively large military communities have higher civilian medical uninsurance rates and lower rates of employer-offered health benefits, both of which contribute to pressures on providers of care to needy populations. Uninsurance rates grew more slowly in areas with relative declines in military populations, net of overall population change, but the presence or closure of military medical facilities was not a significant predictor of uninsurance rates or employer-offered benefits. These findings suggest that some of the larger systemic disadvantages of high uninsurance rates in some areas are attributable to political and strategic decisions about where military personnel serve and how they are compensated with health care benefits.
This study was conducted during a research fellowship with the Robert Wood Johnson Foundation’s Scholars in Health Policy Research Program, University of California, Berkeley/UC San Francisco and was performed under the auspices of RAND Labor and Population.
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