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Falling Through the Cracks
Seven Million Californians Are Medically Uninsured, UC Researchers Report

By Janet Gilmore, Public Affairs
Posted January 20, 1999

Photo: Health Insurance Report

Report on the status of health insurance coverage in California.

Despite a booming economy, the number of Californians without health insurance coverage grew at a rate of 50,000 per month in 1997, leaving more than seven million Californians without medical insurance, according to a report released Jan. 15 by UC researchers.

This trend occurred in an era when many Californians are dropping from the Medi-Cal rolls and the cost of purchasing coverage outside of an employer-paid plan is rising.

Such findings are included in "The State of Health Insurance in California, 1998," an annual overview and analysis of the industry issued by the Health Insurance Policy Program, a joint project of campus's Center for Health and Public Policy Studies and the UCLA Center for Health Policy Research.

"For many people there's nowhere to turn," said Helen Schauffler, director of the Berkeley program and a principal author of the report. "Their employer does not offer benefits, they do not qualify for a government program and they cannot afford to purchase private health insurance. California's new governor and legislature should act immediately to address this critical public health challenge," she said.

Examining many aspects of health care coverage for Californians under age 65, the report reveals that Medi-Cal coverage for the poor dropped from 42 percent in 1996 to 32 percent in 1997. This occurred while the proportion of the state's population living in poverty increased nearly five percent.

The drop in insurance coverage for the poor is likely linked to welfare reform measures that discouraged legal immigrants from applying for Medi-Cal and moved many residents off the welfare rolls, according to the report's authors.

At the same time, researchers suspect that many residents were left uninsured because they took jobs with small firms that could not afford to provide health insurance coverage for employees.

Without employer-sponsored plans, relatively few Californians can afford to purchase their own individual policies. In fact, only 4.8 percent of the state's residents did so in 1997.

"California's health insurance coverage continues to erode, with troubling consequences for the financial well being, access to health services and health status of the state's residents," said E. Richard Brown, director of the UCLA program and a principal author of the report.

The uninsured have the least access to health promotion programs and to preventive care services that have proven to be effective and cost-effective in reducing disease and preventing premature death. For example, only 34 percent of uninsured women over age 50 received mammograms in the last two years and only 39 percent received a clinical breast exam in the past year.

In addition, nearly one-third of uninsured adults did not seek medical services when they needed it -- compared to only seven percent among insured residents.

"These findings are very troubling," said Schauffler, "because delaying treatment for health problems can produce much more serious and expensive health problems later, or even death."

California's Medi-Cal and Healthy Families programs have the potential to cover more than one million of the state's 1.85 million uninsured children. But serious deficiencies within the programs' policies and structure are limiting enrollment, according to Brown.

"Tens of thousands of currently eligible children are being kept out of Medi-Cal and Healthy Families by an overly complex and burdensome application and inadequate outreach efforts," said Brown. "In addition, many immigrant parents fear that their current immigration status and future opportunities for citizenship will be put at risk if their eligible children -- even U.S. citizen children -- use these programs."

The report also found that:

  • Health Maintenance Organizations or HMOs are increasingly dropping their health promotion programs addressing substance abuse, HIV/AIDS prevention and sexually transmitted diseases.
  • Roughly half -- 49 percent -- of noncitizens were uninsured in 1997, compared to 44 percent in 1995.
  • Among Californians below the poverty level, 43 percent were uninsured, compared to 38 percent a year earlier.
"We've divided our population," commented Schauffler. "We've decided that some groups are deserving and some groups are not, based on something that has nothing to do with their need. It doesn't make sense.

"As a society we have to decide if we want to keep picking off 'deserving groups' or if we want to design a comprehensive solution to cover all people," she said. "These are hard-working people and we're treating them like second-class citizens."

The report is available on the web at


January 20 - 26, 1999 (Volume 27, Number 19)
Copyright 1999, The Regents of the University of California.
Produced and maintained by the Office of Public Affairs at UC Berkeley.
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