Geography Helps Determine Insurance
Affluent versus poor. Rural versus urban. Minorities versus whites.
These are the fault lines most likely to determine whether Californians have health insurance and regular access to medical care, according to new data from the UCLA Center for Health Policy Research.
The latest iteration of UCLA's California Health Interview Survey (CHIS), a voluminous documentation of the state's insurance status and related indicators, has made it clear where you live and who you are represent clear indicators of health status. If you reside in a rural or an impoverished urban area with a disproportionately minority population, you're much more likely to be uninsured or consider yourself in poor health.
Statewide, 26.6% of Californians were uninsured for all or part of 2011 or 2012, and 50.6% have job-based health insurance. A total of 16.2% say they're in only fair or poor health.
In South Los Angeles County, which is 67.3% Latino and 27.6% African-American, the uninsured rate was 40.1%. A total of 31.9% say they're in fair or poor health, and only 31.8% have employment-based coverage.
“Thirty-two percent is rock bottom,” said Shana Alex Lavarreda, who heads the UCLA Center's health insurance studies. She added that South Los Angeles has lagged in economic development, as well as the jobs that provide health insurance coverage.
But Southern Los Angeles County is not the only island of uninsured and poor health in California.
According to CHIS data, the San Joaquin Valley's uninsured rate was 30.5% during 2011-12, and 41.5% of the population had job-based coverage. A total of 23.7% said they were in fair or poor health. In the sparsely-populated Central California counties bordering Nevada, the uninsured rate was 32.7%, and 45% had job-based coverage, although those in fair and poor health was better than the statewide average. In the three counties in the Redding area, only 36.4% of residents had job-based coverage.
By contrast, California's more affluent and less diverse counties have much higher rates of insurance. In Marin County, one of the wealthiest in the United States, only 14.2% of residents lacked coverage, 58.4% had job-based coverage and only 5.5% said they were in fair or poor health. Nearly three-quarters of its residents are white. In San Mateo County, part of the Silicon Valley, only 11.2% of residents were uninsured, 67.5% had job-based coverage and 12.1% said they were in fair or poor health.
Lavarreda said the gap between health and health insurance haves and have-nots has been widened by the Great Recession. Also, CHIS interviewers took great pains to try and contact more individuals who only own cell phones, a practice more widespread among those in lower-income brackets. About a third of the current CHIS interviews were with cellphone-only individuals, compared to about 15% in the prior survey.
Although Lavarreda believes the Affordable Care Act, which is expected to provide public and private health insurance to millions of Californians, will improve the CHIS numbers in the future, she beliebes it will take several years to help address the disparities.
