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Health Coverage Declines, U.S. Says

While a state program helps fill gap, California is fourth worst in the nation, census finds.

August 27, 2004|Scott Martelle | Times Staff Writer

The percentage of Californians with health insurance declined slightly last year as increased enrollment in government healthcare programs helped offset cuts in private health insurance, according to census figures released Thursday.

The number of Californians with no health coverage increased 200,000 from 2000 to 2003 and stands at 6.5 million, or 18.4%.

California continued to have the fourth-worst percentage of its residents without health insurance, surpassed only by Oklahoma, New Mexico and Texas, which has the highest percentage of uninsured in the nation. Nationwide, 15.6% of Americans had no coverage in 2003, compared with 15.2% a year earlier.

The number of Californians with private insurance declined by 300,000 as companies continued to drop coverage for their workers.

"Unfortunately, it's not a surprise," said E. Richard Brown, director of UCLA's Center for Health Policy Research. "What we've seen is a decline in job-based coverage due to the kinds of jobs that are being created during this very limited economic recovery, and rapid and uncontrolled rising costs of healthcare, which has put a tremendous burden on employers and employees."

As an example, Brown cited the Southern California supermarket strike and lockout, which ended in March with a new contract that installed a two-tier system in which new hires will pay more for fewer benefits than existing workers.

"We've seen a real change in eligibility [for workers], and that's part of the employer response to rising costs," Brown said. "And we've also seen growth in these kinds of [low-benefit] jobs, as better-paying jobs with better benefits have been disappearing."

Those declines were partially made up by increases in government health programs, which now cover 9.3 million residents, more than a quarter of the state's population. Those programs have been a major factor in pushing up the state's budget deficit.

Much of the increase in enrollment came from the state's Healthy Families program, which offers lower-cost insurance coverage for children of the working poor whose families earn too much to be eligible for Medi-Cal. Enrollment in that program jumped from 392,000 in March 2001 to 634,000 in March 2003.

Healthy Families has been threatened by the state's budget crisis. In this year's budget, Gov. Arnold Schwarzenegger initially called for capping enrollment in the program to save money, but eventually relented.

Peter Warren, spokesman for the California Medical Assn., said the census report reflected a persistent reality that contributed to the announced shutdowns of six emergency rooms in Los Angeles County in the last 14 months.

"The reason we have hospital closings and emergency rooms closing is because so many uninsured are using those services and then can't pay for it," Warren said, adding that the problem is exacerbated by the lack of preventive healthcare for the uninsured. "They show up sicker and needing more extensive treatment than they would otherwise need if they had regular care."

Warren said the association estimates that California emergency rooms and physicians performed $635 million in treatments in 2001-02 for which no payments were made.

The census report, which looked at numbers statewide and at cities and counties with more than 250,000 residents, also identified deep pockets of poverty in the Central Valley. It ranked Fresno fourth in poverty nationwide, with 28.4% of residents below the federal poverty line in 2003. Fresno ranked just above Miami and just below Detroit. The poverty rate for the city marked a large increase from 20.2% the year before.

Nearby Tulare County ranked among the nation's poorest counties with populations of more than 250,000. Among its residents, 22.9% were living in poverty in 2003, a decrease from 25% the year before.

Statewide, the percentage of Californians living in poverty held steady at 13.1% or roughly 4.6 million residents, including 1.8 million children.

The state's median household income also remained close to steady and stands at $48,912. Nationally, median household income remained unchanged, but more people fell into poverty, with the rate rising from 12.1% in 2002 to 12.5% last year.

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