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Economy booms but health insurance lags: More Californians lack coverage, new UC report finds
19 Jan 2000

By Kathleen Scalise, Public Affairs

BERKELEY-- Despite booming economic conditions in the state, the number of Californians without health insurance continues to grow at an alarming rate, according to a new report issued today (Wednesday, Jan. 19) by the Health Insurance Policy Program, a joint project of the University of California, Berkeley, Center for Health and Public Policy Studies, and the UCLA Center for Health Policy Research.

An additional 23,000 Californians fell off the health insurance rolls each month from 1997 to 1998, according to the 124-page report, which compares the most recent data available from 1999 and earlier. About 7.3 million Californians, or one in four of the state's non-elderly residents, have no health insurance. Of those, nearly half have been uninsured for more than five years or have never been insured.

"California's health insurance problems are bad and getting worse," said Helen Schauffler, a UC Berkeley professor of health policy and director of UC Berkeley's Center for Health and Public Policy Studies, who co-authored the report with E. Richard Brown, a UCLA professor of public health and director of the UCLA Center for Health Policy Research.

"Not having health insurance has serious long-term consequences for the health of Californians," Schauffler said.

The annual report is the fourth in a series that began in 1996, covering the status of health insurance coverage in California. This latest report will be presented to state legislators and reporters at a Sacramento briefing on Thursday, Jan. 20, at 11 a.m. in the State Capitol Governor's Conference Room. The report includes an overview and analysis of employer-sponsored, public and private health insurance coverage; purchasing groups; the integration of public health into California's health care system; and comparisons to prior data and national data.

Among the findings, California's uninsured population increased by 276,000 newly uninsured persons during 1998 and accounted for one in every three of the nation's newly uninsured. This is three times its share of the nation's uninsured population.

The drop in coverage is largely driven by a decline in Medi-Cal enrollment, the researchers found. Since 1995, the percentage of non-elderly Californians who relied on Medi-Cal fell from 14 percent to 11 percent. Meanwhile, rates of employer-based or privately purchased health coverage remained flat.

"California's increasing uninsured rate is a direct result of public policies that have decreased Medi-Cal coverage," said Brown. "The governor and legislature should act this year to expand eligibility in Medi-Cal and the Healthy Families Program to cover more children and their parents, and they should simplify and streamline these programs."

The researchers found that California continues to lead the nation in the number of residents without health insurance. One in six uninsured Americans lives in California. The state has a significantly higher uninsured rate - 24 percent - than the 17 percent national average. Additionally, only 58 percent of California workers have job-based insurance versus 69 percent in the rest of the United States.

"California ranks dead last among the 50 states and the District of Columbia in the proportion of non-elderly residents who have job-based insurance," Brown said.

"Without health insurance, people delay or fail to seek care when they need it and lack access to important preventive care and health promotion services," Schauffler said. "This can lead to much more serious medical problems and results in poorer health. The state should set a policy goal of achieving universal, affordable, high-quality health coverage to improve the health of all Californians."

The "chronically uninsured" - the nearly half of Californians without health insurance for at least five years or who have never had coverage - are most likely to be male, Latino and poor.

"This study makes clear that it is people of color, children, the working poor and those unable to work who are bearing the brunt of California's health insurance crisis," said Gary Yates, president and CEO of The California Wellness Foundation, which funded the report as part of its Work and Health Initiative. "This is a public health problem with significant implications for the health of the state's residents and the vitality of its workforce and economy. This issue needs the immediate and focused attention of policy makers in California."

The report also found that:

· Because of cost, one in three uninsured Californians did not seek health care when they needed it in 1999. Twenty-one percent of uninsured adults reported their health as fair or poor, as compared to 10 percent of those with health insurance.

· The uninsured have higher rates of preventable risk factors such as smoking and obesity, and lower participation rates in health promotion programs.

· More than 2 million California children were without health insurance in 1998, an increase of 150,000 from 1997. California's children had a higher uninsured rate (21 percent) than did children in the rest of the United States (15 percent), and received less coverage from job-based insurance (54 percent vs. 66 percent).

· California's uninsured rate for children grew from 17 percent to 21 percent between 1995 and 1998. Medi-Cal coverage of children declined dramatically, from 25 percent in 1995 to 20 percent in 1998.

· Virtually all population subgroups in California with the exception of non-Latino whites saw an increase in the uninsured rate. Most affected was California's burgeoning Latino population, with an uninsured rate of 40 percent in 1998. Only 40 percent of Latinos have job-based insurance, and Medi-Cal coverage of Latinos dropped from 22 percent in 1995 to 17 percent in 1998.

The new report also offers health policy recommendations for the 2000 California legislative session. These include:

· Improving and expanding Medi-Cal and the Healthy Families Program by streamlining the application process and integrating them into a single, seamless, restructured program, removed from the welfare system.

· Expanding the state's high-risk pool to accommodate all eligible Californians and to guarantee that all individuals who want health insurance can purchase it.

· Expanding prior small group market reforms to include firms with only one employee.

· Providing subsidies to individuals whose incomes fall below 250 percent of the federal poverty level to enable them to purchase private insurance, participate in the high risk pool and buy into expanded public programs.


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