Ranks of Uninsured in State Expand

Despite a thriving economy, the number of Californians without health insurance continues to grow by 23,000 per month, a clip that far exceeds the national rate and one that shows no signs of slowing, according to a new report.

The state’s ranks of the uninsured swelled to 7.3 million in 1998, accounting for nearly one in four residents, according to the report, a joint project of researchers at UC Berkeley and UCLA.

In Los Angeles County, the rate is nearly one in three, while nationally it is 17%, or about one in six.

“California’s insurance problems are bad and getting worse,” said the study’s principal author, Helen Schauffler, who is director of UC Berkeley’s Center for Health and Public Policy Studies.

At least one public official said the findings cry out for legislative changes.

“These numbers are staggering and unacceptable,” said Assembly Speaker Antonio Villaraigosa (D-Los Angeles). “We need to enact new policies and expand on existing ones.”

The steady rise in the state’s uninsured is driven primarily by a decline in coverage through Medi-Cal, California’s version of the federal Medicaid insurance program for the poor, the report concludes. In addition, although the economy is booming, employer-based coverage has remained flat in California, failing to compensate for the Medi-Cal dip.

From 1995 to 1998, Medi-Cal coverage slipped from 14% to 11% of the population. The study’s authors attribute that largely to welfare reform and changed eligibility requirements.

A 1996 law tightened eligibility rules for immigrant noncitizens and separated eligibility for Medi-Cal from cash assistance programs for families. Many families were confused about or unaware of their eligibility, or fearful of the stigma attached to welfare programs.

At the same time, California’s rate of employer-based coverage has leveled off at about 58% of the population, the lowest in the country. The national rate of employer-based coverage is holding steady at 69%.

Experts say relying on employers to fill insurance gaps isn’t realistic.

“It would be irresponsible to turn our backs on the employer-based system, but all these findings suggest that we cannot expect the employer-based system to grow,” said Larry Levitt, a director at the Kaiser Family Foundation, a nonprofit health care organization that this week released its own analysis of the state’s employer coverage.

“It’s hard to figure what would make more employers offer more coverage, if not this [booming] economy,” Levitt said.

Health care officials are alarmed at the growing ranks of the uninsured because it means decreased access to medical care and, ultimately, poorer health. But insurance experts are hard pressed to explain California’s dismal performance relative to other states.

“We’re not really sure why it compares so badly,” Schauffler said.

The conventional wisdom is that the California work force is concentrated in smaller firms and in industries less likely to offer coverage. But, as the Kaiser Family Foundation reports, California businesses are only slightly smaller than the national average and the state’s industries are not inclined to be stingier with coverage.

California’s low rate of coverage might be explained in part by the state’s high concentration of new businesses and its large number of noncitizen workers who often do not expect to receive health benefits, experts said. Half of noncitizens in the state had no private or public insurance in 1998, up from 44% in 1995, according to the UC report.

The lack of coverage in California is particularly pronounced, as well, among young adults, Latinos, older women and children, the UC report found.

More than 2 million children were without private or public health insurance in 1998, an increase of 150,000--or 7.5%--since 1997. This rise came despite the launching of the state’s Healthy Families program in July 1998, aimed directly at the children of the working poor. As of November 1999, nearly 1.5 million children were eligible for Medi-Cal or Healthy Families but were not enrolled, the UC report said.

Although only 15% of California’s whites were uninsured in 1998, 40% of the state’s Latinos were--a disparity Levitt described as a “horrific situation.”

“It makes you wonder how bad it has to get before we figure out a way . . . to fix it,” he said.

Other studies have suggested that the rate of insurance is so low among Latinos largely because of their concentration in low-wage service or manufacturing jobs that don’t offer coverage.

The UC report suggests that the insurance problem is becoming intractable. The study found that nearly half of those without coverage in California have been without insurance for more than five years or have never had health insurance.

Politicians and public policy experts fear a widening insurance gap, similar to the growing disparity among rich and poor.

Those who do have insurance tend to fare quite well in California. According to the Kaiser study, employees who receive coverage through their jobs in California tend to pay less for coverage and have wider choices than their counterparts in other states.

“It’s definitely a case of the haves and have-nots right now in California,” Levitt said. “There are almost two completely different labor markets. If you’re in a high-skilled job, chances are you are going to get health insurance too. If [not], you don’t.”

The UC report offers several recommendations to narrow this growing insurance gap:

* Improve, expand and streamline public coverage through Medi-Cal and Healthy Families.

* Expand the high-risk insurance pool.

* Expand coverage for the self-employed.

* Provide subsidies to poor people to help them buy private insurance, participate in the high-risk pool or participate in public programs.

*

* INSURANCE PLAN

Clinton proposes expanding federal health coverage to 5 million poor Americans. A16