20% of Californians Lack Health Insurance : Most Are Working People and Their Children, Study Finds; Figures Worst in L.A., San Diego

Californians are less likely than other Americans to have health insurance of any kind, and adults living in Los Angeles and San Diego are the least likely of all to have this protection, according to a new study prepared for the Legislature.

More than one in five Californians under the age of 65--about 5.2 million people--had no private health insurance, no Medicare and no Medi-Cal coverage during 1985, according to the report by the UCLA School of Public Health.

The study, entitled Californians Without Health Insurance, breaks new ground in documenting the number of uninsured people statewide as well as providing a breakdown of their age, race, sex, income and type of employment.

Not Confined to Poor

In describing the ranks of the uninsured, the study pointed out that the problem is not confined to poor people and ethnic minorities.

More than three-quarters of the uninsured population is made up of working people and their children. The rest are mainly homemakers, students and disabled or retired persons. About 2% are unemployed.

Nearly half the uninsured are living near the poverty line--defined as $10,989 in annual income for a family of four. But a large number are not poor. One-fourth have family incomes at least three times the poverty level.

People of all races lack health insurance, but Latinos face a “substantially higher risk,” the report stated.

Statewide, about 21.6% of the non-elderly population has no health insurance whatsoever, the report said, compared to the national average of 17.6%.

“Among the 20 largest metropolitan areas in the United States, the Los Angeles-Long Beach area and San Diego have the largest percentages of uninsured adults,” the report pointed out. It cited “disproportionately large” rates of more than 26% in each of those areas but did not pinpoint the reasons why. About 30% of the children in Los Angeles are uninsured.

Public policy makers have shown a growing concern for this gap in health care, but the lack of statistical data for California has hindered attempts to solve the dilemma.

Assemblyman Burt Margolin (D-Los Angeles), who this year introduced legislation aimed at the problem of uninsured workers, said the UCLA report “will add tremendous momentum to the debate on how to restructure the health care system.”

“The report confirms that a crisis is building, a crisis that we must deal with in a collaborative effort by insurance carriers, major employers and state government,” Margolin continued. “It is indefensible to have a system that leaves millions of persons unprotected and subject to financial ruin.”

Previous studies have found that uninsured people are less likely to see a physician if they have serious symptoms, get their children immunized, receive prenatal care during the first trimester of pregnancy or have their blood pressure checked.

E. Richard Brown, associate professor of public health at UCLA who directed the new study, said that people who lack insurance face “substantial risk of being unable to obtain necessary health care. When they do get health care, they are likely to add to the fiscal burdens of county and state programs for the medically indigent and community health providers.”

In the 1984-85 fiscal year, California’s hospitals reported $1.1 billion in bad debts and charity care to people without insurance. Of that, $550 million was reported by California’s public hospitals.

In Los Angeles County, medically uninsured patients are turning to the public hospitals for help, putting a new strain on the system, said Irv Cohen at the County Department of Health Services. “The impact is substantial,” he said. “It just exasperates the problems of the public hospital system.”

The UCLA report explained that “one of the main reasons” why so many working people have no health insurance is that a substantial number of employers do not offer health insurance as a subsidized fringe benefit. Relatively large percentages of employees do not get health insurance in retail businesses, personal services firms, agriculture, forestry and fishing, compared to basic manufacturing industries, which are heavily unionized and tend to provide more fringe benefits.

“This lack of coverage through the workplace is as problematic throughout the country as it is in California,” the report stated. “Public policies that encourage or require employers to provide health insurance to their full-time, full-year employees could reduce substantially the number of uninsured people in California.”

Latino workers are more than twice as likely to be uninsured as workers of other races, the report pointed out. “The most obvious reason is that Latino workers are far less likely to receive health insurance as a subsidized fringe benefit.”

It is not only Latino workers, but also their children and their elderly who are “at greater risk of being uninsured” than people of other races, according to the report.

Latinos make up 40% of the uninsured population in California, which is 1 1/2 times as large as their share of the total non-elderly population.

The report does not say how much of this may be attributed to the immigration status of large numbers of Latinos, to the industries in which they are employed or to their being denied benefits that other workers and residents receive.

“The high percentage of uninsured Latinos . . . partially explains California’s overall higher percentage of uninsured,” the report stated. Yet it also points out that California has a higher percentage of uninsured non-Latino white adults, “suggesting that understanding other factors besides ethnicity is essential to addressing the problems of the uninsured.”

Of all people, only blacks in California fared better than the national average, the report stated without explanation.

In an interview, Brown said the report raises a number of questions that need further study. He said he has no explanation why the Los Angeles area and San Diego have such a high percentage of uninsured residents. In the Los Angeles-Long Beach area the number of uninsured totals 1,417,000, the report found. In San Diego, 343,000 are uninsured.

In other metropolitan areas in California, the percentage of uninsured people was 24% in Bakersfield, 23% in Fresno, 22% in Oxnard-Ventura, 21% in Anaheim-Santa Ana, 18% in San Francisco, 17% in Oakland, 16% in Sacramento, 16% in Riverside-San Bernardino and 14% in San Jose.

Among the study’s other findings:

- Younger people are more likely to be uninsured than older ones. Individuals 18 to 29 were most likely to be uninsured, followed by those under 18. California’s children under 18 were at greater risk of being uninsured than were children in the country as a whole.

- Women between the ages of 45 and 64 are at greater risk of being uninsured than men of the same age. They are almost 50% more likely to be uninsured than their counterparts across the country.

- About 15% of all uninsured workers are self-employed. People who work part time (or full time for only part of the year) have a greater risk of being uninsured than full-time employees. Excluding the self-employed, part-time employees were nearly three times as likely to be uninsured as full-time employees.