April 30, 1999
UCLA NEWS SERVICE
California's robust economy has not helped the state's minority residents increase their access to affordable health insurance, according to a series of reports by the UCLA Center for Health Policy Research.
Even as some minority groups have benefited from higher employment levels, the number of non-elderly minority people who lack health insurance has remained high or even increased, according to the analysis.
"More people are working, but they are not getting health insurance as a part of their reward," said Rebecka Levan, a researcher at the UCLA Center for Health Policy Research and a primary author of the reports. "When it comes to health insurance, many minority workers are, in effect, penalized because they don't receive all the benefits of working."
Latinos, African Americans and Asian Americans are much more likely to be uninsured than whites. Among those under the age of 65, about 36 percent of Latinos, 21 percent of African Americans and 24 percent of Asian Americans and Pacific Islanders have no health insurance, compared with 15 percent of non-elderly whites, according to the report.
"An equitable health care system should provide everyone with the same access to health insurance and health care," said E. Richard Brown, director of the UCLA Center for Health Policy Research and one author of the reports. "We're finding that this is just not the case. Our findings are an indictment of the system as inequitable."
Not having health insurance in the workplace appears to be the largest contributor to minority groups not having health insurance, particularly among Latinos. While 69 percent of non-elderly whites have job-based health insurance, just 41 percent of Latinos, 55 percent of African Americans and 56 percent of Asian Americans and Pacific Islanders have job-based coverage.
The proportion of African Americans with job-based insurance has risen from 49 percent in 1994-'95 to 55 percent in 1996-'97. But those gains among African Americans have been offset by a decrease in government-sponsored Medi-Cal coverage, which dropped from 24 to 18 percent over the same period.
The number of uninsured Asian Americans has increased, due largely to a significant drop in those covered by Medi-Cal. The proportion of uninsured non-elderly Asian Americans and Pacific Islanders increased from 21 percent in 1994-'95 to 24 percent in 1996-'97, a period when Medi-Cal coverage dropped by one-third -- from 16 percent to 11 percent.
Certain Asian-American and Pacific Islander groups are more likely to be uninsured -- primarily Southeast Asians, Koreans, Chinese and Filipinos, though the reasons for their lack of coverage vary, according to researchers.
Latinos, Asian Americans and Pacific Islanders more often work in small firms that are less likely to offer their workers health insurance, and they tend to be employed in lower-paying jobs.
Differences in insurance coverage between whites and minority groups remain even when workplace differences are adjusted. For example, blacks who work at large companies -- employers who are most likely to offer their workers health insurance -- have health insurance less often than their white peers.
The cost of health insurance offered by employers deters many low-wage workers. California's employers ask workers to contribute an average of $1,700 per year for coverage in a health maintenance organization -- a price that may cause some low-income workers to reject coverage, researchers say.
"Affordability remains the fundamental problem all these people face," said Brown. "Given their incomes, they are not likely to be able to address these problems on their own."
Brown and his colleagues suggest that the state should expand government-sponsored programs to provide health insurance for more of the state's uninsured. For example, the state is eligible for $1.5 billion in federal matching funds for health insurance programs that it has no plans to use.
"We should be using that money, which requires relatively modest amounts of state matching funds, to provide affordable health care to those who need it," Brown said. "If we aren't doing this now, when are we going to be making improvements in our system? There are no reasonable excuses for inaction now, given the state's robust economy."
The reports are based on an analysis of the National Health Interview Survey from 1993 and 1994, and the Current Population Survey from 1997 and 1998. Other authors of the studies are William Cunningham, Marjorie Kagawa-Singer, Robert Wyn and Nancy Hays. The research was supported by the Henry J. Kaiser Family Foundation.
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