Transcript Health Insurance in California
The State of Health Insurance in Los Angeles
E. Richard Brown, PhD
Director, UCLA Center for Health Policy Research Professor, UCLA School of Public Health Principal Investigator, California Health Interview Survey
LA Health Collaborative
Los Angeles April 18, 2005 www.healthpolicy.ucla.edu
What I will cover
California’s health insurance
What’s gone up and what’s gone down?
What’s happening with job-based insurance coverage? Why is job-based coverage changing?
Who is most affected by this pattern?
Opportunities for public coverage of the currently uninsured
Past and present as prologue?
Acknowledgements
Thanks to the funders of the work on health insurance coverage that we get to do in the UCLA Center for Health Policy Research
The California Endowment The California Wellness Foundation
Thanks to colleague Shana Alex Lavarreda
2.1 million Los Angeles County residents uninsured all or part of year in 2003
One in four LA residents under age 65 uninsured, compared to about one in five for California as a whole California 6.6 Million Uninsured All or Part Year
21% of Nonelderly
Uninsured All Year Los Angeles 2.1 Million Uninsured All or Part Year
24% of Nonelderly
Larger proportion of uninsured in LA are uninsured all year
12% 9% Uninsured Part Year 15% LA-California difference driven by LA’s proportion with job-based insurance 4% 16% Other Coverage All Year 9% 4% 18% Medi-Cal covers slightly larger proportion of LA residents 5% Medi-Cal or Healthy Families All Year Privately Purchased All Year 5%
Ages 0-64 Source: 2003 California Health Interview Survey
54% Employer Based All Year 49%
California adults and children lost job-based insurance, but children were protected by public programs
A significant drop in job-based insurance for children and adults in California
Down 2.1 percentage points for adults
under age 65 and
down 3.9 percentage points for children statewide
in 2003, compared to 2001 In LA, job-based insurance statistically unchanged
A significant increase in children’s enrollment in Medi-Cal and Healthy Families
Up 5.0 percentage points for children in California points in LA
and
up 4.4 percentage
— but adults’ Medi-Cal enrollment statistically unchanged
A small but significant increase in other coverage for children and adults
Up 1.7 percentage points for all persons under age 65 in California and 1.5 percentage points in LA
Net result: A significant decline in uninsurance for children, but not adults
All-year uninsurance
down 2.5 percentage points for children in California and down 4.7 percentage points in LA
Part-year uninsurance
down 1.2 percentage points for children in California and down 1.5 percentage points in LA In Los Angeles,
291,000 children
0-17 and
1.8 million adults uninsured
for all or some of the year in 2003 18-64 were Source: 2003 California Health Interview Survey
Why did job-based coverage fall?
The rising cost of health insurance made it less affordable for employers and workers, and the labor market hit the skids
Cost of health insurance rose, on average, by a third between 2001 and 2003
But employers increased the average worker share of the premiums
by
65% for single-worker coverage and 79% for family coverage
Employers shifted costs to employee and reduced the number of workers eligible for benefits
Total Cost Single Worker Coverage 2003 Change from 2001 $ 3,101 + 31.6% Family Coverage 2003 Change from 2001 $ 8,504 + 36.1% Worker Cost
$ 418 + 65.2% $ 2,452 + 79.1% Family coverage most affected
— big part of reason children’s job-based coverage fell more than adults’ Source: 2001 and 2003 California Employer Health Benefits Surveys, Kaiser Family Foundation
Why did job-based coverage fall?
California’s unemployment rate
Rose from an annual average of 5.4% in 2001 to 6.8% in 2003 Reducing the number of Californians with access to job-based insurance and workers’ ability to make wage and benefit demands on employers
Even with economic recovery since 2003
Job growth has lagged Most new jobs have been at lower wages and fewer benefits Many workers have dropped out of labor force
California’s pattern of rising health costs and slack labor markets mirrors national pattern, driving down employment-based coverage across the country
Source: California Employment Development Dept.
83% of California uninsured employees do not have access to affordable job-based insurance
Employers not offering health benefits accounts for most of 1.8 million uninsured employees
63% of uninsured California employees work for employer that does not offer health insurance
Bigger problem among small firms and for low-wage workers
Employer’s eligibility rules are also major barrier, especially among larger firms
20% of uninsured employees are not eligible for employer plan Employees not accepting coverage when they’re eligible is smallest problem 17% of uninsured employees don’t accept offered coverage Main reason
given:
“my employer’s plan is unaffordable” Employer Offered Insurance, But Worked for Worker Not Eligible 20% Employer that Did Not Offer Insurance 63% Was Offered and Eligible, But Did Not Accept 17%
Employees Ages 18-64, California Source: 2003 California Health Interview Survey
The uninsured are overwhelmingly workers and their family members
Because so many employees do not have access to affordable job-based insurance, most of the uninsured are
workers and their family members
75% of LA’s uninsured for all or part of year are in families with at least one working adult 59% are full-time employees and their family members Self-employed workers and their family members
Non-working Family 25% At Least One Adult Is Self-Employed 11%
Comprise 11% of uninsured But they are more likely to be uninsured all year
Part-Time Employee Family 5%
Ages 0-64, Los Angeles Source: 2003 California Health Interview Survey
At Least One Adult Works Full-time 59%
And the uninsured are overwhelmingly low-income adults and children
Among LA adults and children who were uninsured all or part year…
67% of have family incomes below 200% of federal poverty level — a very low income
Another 14% are in moderate income families
And 19% are in families with incomes in upper half of state’s income distribution
4 in 10 of these have incomes between 300% and 400% FPL
Below 99% FPL 37% 300%+ FPL 19% 100%-199% FPL 30% 200% - 299% FPL 14%
Ages 0-64, Los Angeles Source: 2003 California Health Interview Survey
2003 Federal Poverty Level was $9,573 for one person, $12,384 for 2-person family, $14,680 for 3-person family, etc.
The uninsured are mainly low-income because few low-income workers have job-based insurance
Medi-Cal protected many poor children, some poor parents, and many poor disabled adults
Few poor and low income LA residents have job-based insurance
California’s job based coverage rates fell at all income levels between 2001 and 2003
But 40% of poor LA residents were uninsured all or part year Other Insurance All Year Medi-Cal or Healthy Families All Year Employer Based Insurance All Year Uninsured All or Part Year 6% 45% 9% 40% 8% 28% 31% 33% 8% 10% 57% 24% 10% 77% 11%
Ages 0-64, Los Angeles Source: 2003 California Health Interview Survey
0-99% of FPL 100-199% of 200-299% of 300% of FPL FPL FPL and Above
2003 Federal Poverty Level was $9,573 for one person, $12,384 for 2-person family, $14,680 for 3-person family, etc.
Many people of color also less likely to have job-based insurance
ALL ethnic groups lost job-based coverage in California in 2003, compared to 2001 Other Insurance All Year 13% 7% Whites have highest rate of job-based insurance & lowest uninsured rate Medi-Cal or Healthy Families All Year Latinos have lowest job based insurance rate and highest uninsured Asian Americans-Pacific Islanders and African Americans in between Employer Based Insurance All Year American Indians statewide also have low job-based insurance rate and high uninsured rate Uninsured All or Part Year 67% 13% White
Ages 0-64, Los Angeles Source: 2003 California Health Interview Survey
5% 27% 33% 35% Latino 11% 13% 56% 20% AAPI 6% 26% 49% 19% African American
Job-based insurance and uninsured rates differ across LA SPAs
Job-based insurance rates vary across LA Service Planning Areas (SPAs) from 30% to 56% of persons under age 65 Uninsured rates vary two-fold from 17% to 34%, driven by job based insurance Medi-Cal and Healthy Families protect many children and some adults who don’t get employment-based insurance Other Insurance All Year 4% 22% Medi-Cal or Healthy Families All Year Employer Based Insurance All Year 55% Uninsured All or Part Year 19% 9% 15% 56% 21% 9% 18% 50% 23% 8% 22% 36% 34% 18% 9% 55% 17% 5% 33% 30% 32% 7% 16% 54% 23%
Ages 0-64, Los Angeles Source: 2003 California Health Interview Survey
An tel Sa op n F e Va ern lle an y do Sa Va n G lle ab y rie l Va lle y Me tro We st So uth Ea st So uth Ba y 8% 17% 53% 21%
We’ve created opportunities for nearly 6 in 10 uninsured children to get public coverage
Of children 0-18 who were uninsured at time of CHIS 2003 interview…
58% in LA County and 55% in California statewide were eligible for Medi-Cal or Healthy Families 429,000 in California 135,000 in LA Another 9,000 in LA and 45,000 statewide were eligible for county programs 34,000 in LA – 157,000 in Calif – were not eligible due to income limits of the programs 57,000 in LA – 148,000 in Calif – were not eligible due to immigration restrictions
Noncitizen Without Green Card, Not Eligible Citizen or Noncitizen w/Green Card, Not Eligible County Program Eligible Healthy Families Eligible Medi-Cal Eligible
Source: 2003 California Health Interview Survey
Los Angeles 235,000 24% 57,000 14% 34,000 4% 9,000 28% 65,000 30% 70,000 California 779,000 19% 148,000 20% 157,000 6% 45,000 29% 225,000 26% 204,000 Children Ages 0-18 Who Were Uninsured at Time of Interview Los Angeles California
Uninsured adults aren’t so fortunate
Of 4.1 million California adults, including 1.4 million LA adults, who were uninsured at time of interview…
85,000 in LA and 244,000 statewide were eligible for Medi-Cal Another 3,000 in California – and none in LA – were eligible for county programs 874,000 in LA and 2.8 million statewide and were citizens or legal immigrants with green card 442,000 in LA and 1.1 million statewide were noncitizens without a green card
Noncitizen Without Green Card, Not Eligible Citizen or Noncitizen with Green Card, Not Eligible County Program Eligible LA = 0% CA = 0.1% Medi-Cal Eligible
Source: 2003 California Health Interview Survey
Los Angeles 1,401,000 32% 442,000 62% 874,000 California 4,119,000 26% 1,080,000 68% 2,792,000 6% 85,000 6% 244,000 Adults Ages 19-64 California
Past and present as prologue?
Employment-based insurance coverage has been on downward slope for over two decades Several factors contribute to this
Voluntary nature of health insurance, including whether employer offers coverage, employer’s eligibility rules, and share worker must pay Economic highs and lows affect employers’ actions and workers’ responses Weak economy accelerates decline, strong economy generates temporary gains Rapidly rising costs of health care push up health insurance costs Underwriting cycles sometimes give false hope of stability Cost increases affect employers’ actions and workers’ responses Globalization has shifted labor market toward service economy, undercutting economic base of generous benefits
Public programs — Medi-Cal, Healthy Families, and a few county programs — enacted and expanded to cover children and some other vulnerable groups
Past and present as prologue?
Patchwork policies and market changes have not altered the trend line
Patchwork programs modestly protect children but fail to address fundamental problems
Managed care expansion slowed health care dollar costs but generated backlash from consumers and health professionals
“Consumer-directed health care” means burdening the sick and the non-affluent
Likely to generate little market enthusiasm and perhaps a lot of backlash
Past and present as prologue?
What direction for good policy and good politics?
Universal coverage for children?
100% Campaign & PICO California proposal, Senate Bill 437 (Escutia) and Assembly Bill 772 (Chan)
Pay-or-play employer mandate?
Daughter of SB 2/Proposition 72?
Individual mandate?
Assemblymembers Keith Richman-Joe Nation proposal
Single-payer?
Senator Sheila Kuehl bill, SB 840 (formerly SB 921)
You can get data that you can use in AskCHIS,
our free, easy-to-use, online data query system Just go to
www.CHIS.ucla.edu