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.