The Los Angeles area has among the highest proportion of residents without health insurance in the nation and among the lowest rates of job-based coverage, according to a new UCLA study.
The study of 85 metropolitan areas found that only El Paso and Jersey City, N.J., had greater shares of non-elderly uninsured people.
Los Angeles' rate of 31% dwarfs the national average of 19%. And the area has the second worst coverage rate for workers in the nation, a dubious distinction it shares with New York; the worst being El Paso.
The city's poor standing is partly explained by the huge number of immigrants--mostly Latino--working in industries that don't provide coverage, researchers said.
It "remains shocking that despite the fact that we are doing so well [economically] in Los Angeles and California . . . we have such high rates of uninsurance," said the study's primary author, E. Richard Brown, director of the UCLA Center for Health Policy Research. "The fact is: Employers are not stepping up to the plate and providing benefits to low-wage workers."
That lack of coverage restricts access to care, according to the study, which was financed by the Commonwealth Fund, a New York-based health care foundation. Nationally, low- and moderate-income urban residents without health insurance were two to three times more likely than insured people to lack a physician or other regular provider.
The pattern was more striking in Los Angeles, where the uninsured were nearly eight times more likely to lack a source of regular care.
A separate national study this spring, underscoring the perils of poor access, found that Latinos are more likely to suffer worse health outcomes than whites, largely because of poor insurance coverage.
That study, by the American College of Physicians/American Society of Internal Medicine, found that Latinos develop more severe complications from diabetes and are less likely to get timely care for breast and prostate cancer, hypertension and childhood asthma.
"With all chronic diseases, the sooner you catch them and treat them, the better," said Dr. Vincenza Snow, the organization's senior medical associate for scientific policy. "Most of these people are getting sporadic care, if any at all."
These findings emerged despite Latinos' tendency to remain healthier under adverse conditions--a phenomenon sometimes referred to as "the Latino paradox." Snow said that whatever protection from disease Latino culture and lifestyle offers, it is not enough to override certain ill effects of poor access to care.
Los Angeles and many other cities that fared poorly in the UCLA rankings have large immigrant populations working in low-wage jobs--such as the garment and toy industries or other light manufacturing enterprises--that do not offer health insurance.
Yet citizenship and ethnicity are not the only factors. Rather, Brown said, it is the climate of the labor market and its ability to "get away with" offering less coverage to workers that is key.
Patterns of offering, or not offering, coverage become ingrained as new businesses tend to conform with the market norm, researchers said. The rate of job-based coverage varies widely depending on the city: from a high of 84% in Milwaukee to 49% in El Paso, with an average among the 85 areas of 67%.
"Noncitizens do better in some cities than others," said Cathy Schoen, vice president of research at the Commonwealth Fund. Along with the rest of the labor force, she said, "immigrants fare [better] in markets where the philosophy is that jobs come with benefits."
According to the UCLA study, 35% of low- to moderate-income Latinos and 39% of noncitizen workers were covered through their employer in cities with an overall pattern of high job-based coverage. But in areas like Los Angeles, where job-based coverage is low, just 19% of noncitizens and 25% of Latinos had such insurance.
Brown says low employer coverage puts tremendous pressure on local governments--especially on public hospitals and clinics, known as the health-care "safety net." These facilities are left to treat people who haven't received regular care and whose illnesses consequently have progressed to more serious and costly stages.
Brown and Schoen say the state of California has the ability to step in and fill some gaps in insurance coverage. One way, they say, would be to expand access to the Medi-Cal and Healthy Families insurance programs for low-income families.
States now have the authority to bring adults into programs like Healthy Families, which until recently were reserved for children.
"As a state, we don't do enough to offset this problem," Brown said.
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According to a nationwide study by UCLA, the Los Angeles area has one of the highest percentages of residents who lack health insurance and one of the lowest rates of job-based coverage.
Highest uninsured rates
El Paso: 37%
Jersey City, N.J.: 36%
Los Angeles: 31%
W.Palm Beach, Fla.: 29%
New York: 27%
Fort Lauderdale: 26%
Lowest rates of job-based coverage
El Paso: 49%
Los Angeles: 50%
New York City: 50%
Jersey City, N.J.: 51%
Riverside-San Bernardino: 57%
Tampa, Fla.: 57%
In the Los Angeles area, the uninsured* are nearly eight times as likely to lack regular care as the insured.
* Among people through age 64 who earned less than 250% of the federal poverty level, which was $15,150 for a family of four in 1996.
Sources: 1995-96 National Health Interview Study, The Commonwealth Fund, UCLA Center for
Health Policy Research